Campbell's Operative Orthopaedics

Cover
List of Techniques
Campbell’s Operative Orthopaedics
Copyright
Dedication
Contributors
Preface
Part I: General Principles
Chapter 1: Surgical Techniques
Surgical Techniques
Tourniquets
Radiographs in the Operating Room
Preventing Mistakes
Positioning of the Patient
Local Preparation of the Patient
Wound Irrigating Solutions
Draping
Draping the Edges of the Incision
Prevention of Human Immunodeficiency Virus and Hepatitis Virus Transmission
Reversing Prophylactic Anticoagulation Prior to Surgery
Blood Loss Control During Surgery
Venous Thromboembolism Prophylaxis
Postoperative Pain Control
Special Operative Techniques
Methods of Tendon-to-Bone Fixation
Suture Anchors
Suture Buttons
Bone Grafting
Structure of Bone Grafts
Sources of Bone Grafts
Autogenous Grafts
Allogenic Grafts
Bone Bank
Cancellous Bone Graft Substitutes
Indications for Various Bone Graft Techniques
Onlay Cortical Grafts
Inlay Grafts
Multiple Cancellous Chip Grafts
Hemicylindrical Grafts
Whole-Bone Transplant
Conditions Favorable for Bone Grafting
Preparation of Bone Grafts
Cancellous Iliac Crest Bone Grafts
Surgical Approaches
Toes
Approaches to the Metatarsophalangeal Joint of the Great Toe
Calcaneus
Tarsus and Ankle
Anterior Approaches
Lateral Approaches to the Tarsus and Ankle
Medial Approaches
Tibia
Tibial Plateau Approaches
Fibula
Knee
Anteromedial and Anterolateral Approaches
Posterolateral and Posteromedial Approaches to the Knee
Medial Approaches to the Knee and Supporting Structures
Lateral Approaches to the Knee and Supporting Structures
Direct Posterior, Posteromedial, and Posterolateral Approaches to the Knee
Femur
Hip
Anterior Approaches to the Hip
Lateral Approaches to the Hip
Posterior Approaches to the Hip
Medial Approach to the Hip
Acetabulum and Pelvis
Anterior Approaches to the Acetabulum
Posterior Approaches to the Acetabulum
Extensile Acetabular Approaches
Ilium
Symphysis Pubis
Sacroiliac Joint
Spine
Sternoclavicular Joint
Acromioclavicular Joint and Coracoid Process
Shoulder
Anteromedial Approaches to the Shoulder
Anterior Axillary Approach to the Shoulder
Anterolateral Approaches to the Shoulder
Posterior Approaches to the Shoulder
Humerus
Approaches to the Distal Humeral Shaft
Elbow
Posterior Approaches to the Elbow
Lateral Approaches
Radius
Ulna
Wrist
Hand
References
Supplemental References
Chapter 2: Advanced Imaging in Orthopaedics
Magnetic Resonance Imaging
MRI Technology and Technique
Contraindications
Contrast Agents in MRI
Foot and Ankle
Tendon Injuries
Ligament Injuries
Osseous Injuries
Other Disorders of Foot and Ankle
Knee
Pathologic Conditions of Menisci
Cruciate Ligament Injury
Other Knee Problems
Hip
Osteonecrosis
Transient Osteoporosis
Trauma
Spine
Intervertebral Disc Disease
Postoperative Back Pain
Spinal Tumors
Spinal Trauma
Shoulder
Pathologic Conditions of the Rotator Cuff
Impingement Syndromes
Pathologic Conditions of Labrum
Other Causes of Shoulder Pain
Wrist and Elbow
Carpal Ligament Disruptions
Other Pathologic Conditions of Hand and Wrist
Elbow
Tumor Imaging
Computed Tomography
CT Technology and Technique
Trauma
Developmental Skeletal Pathology
Arthropathy
Tumor Evaluation
Conclusion
References
Supplemental References
Part II: Reconstructive Procedures of the Hip in Adults
Chapter 3: Arthroplasty of the Hip
Applied Biomechanics
Forces acting on the hip
Stress transfer to bone
Design and Selection of Total Hip Components
Femoral components
Cemented femoral components
Cementless femoral components
Specialized and custom-made femoral components
Acetabular components
Cemented acetabular components
Cementless acetabular components
Alternative bearings
Highly crosslinked polyethylene
Ceramic-On-Ceramic Bearings
Indications and Contraindications for Total Hip Arthroplasty
Preoperative Patient Evaluation and Optimization
Preoperative Radiographs
The Hip-Spine Relationship
Preparation and Draping
Surgical Approaches and Techniques
Total hip arthroplasty through posterolateral approach
Component implantation
Total hip arthroplasty through the direct anterior approach
Minimally invasive techniques
Computer-assisted surgery
Trochanteric osteotomy
Surgical Problems Relative to Specific Hip Disorders
Arthritic disorders
Osteoarthritis (primary or secondary hypertrophic arthritis or degenerative arthritis)
Inflammatory arthritis
Osteonecrosis
Protrusio acetabuli
Developmental dysplasia
Legg-Calvé-Perthes disease
Slipped capital femoral epiphysis
Dwarfism
Traumatic and posttraumatic disorders
Acute femoral neck fractures
Failed hip fracture surgery
Acetabular fractures
Failed reconstructive procedures
Proximal femoral osteotomy and deformity
Acetabular osteotomy
Arthrodesis and ankylosis
Metabolic disorders
Paget disease
Gaucher disease
Sickle cell anemia
Chronic renal failure
Hemophilia
Infectious disorders
Pyogenic arthritis
Tuberculosis
Tumors
Neuromuscular disorders
Complications
Mortality
Hematoma formation
Heterotopic ossification
Thromboembolism
Neurologic injuries
Vascular injuries
Limb-length discrepancy
Dislocation
Fractures
Trochanteric nonunion
Infection
Antibiotic prophylaxis
Classification
Diagnosis
Management
Early Postoperative Infection
Late Chronic Infection
Acute Hematogenous Infection
Reconstruction after infection
Loosening
Femoral loosening
Cemented femoral components
Cementless Femoral Components
Acetabular loosening
Cemented Acetabular Components
Cementless Acetabular Components
Diagnosis
Osteolysis
Adverse local tissue reaction
Revision of Total Hip Arthroplasty
Indications and Contraindications
Preoperative planning
Surgical approach
Removal of the femoral component
Removal of femoral cement
Removal of the acetabular component
Cemented Acetabular Component
Reconstruction of acetabular deficiencies
Classification
Management
Segmental deficits
Combined deficits
Pelvic discontinuity
Reconstruction of femoral deficiencies
Classification
Management
Segmental deficits
Cavitary deficits
Massive deficits
Femoral deformity
Postoperative Management of Total Hip Arthroplasty
References
Supplemental References
Chapter 4: Surface Replacement Hip Arthroplasty
Results
Indications and Patient Selection
Preoperative Radiographic Evaluation and Templating
Postoperative Management
Revision of Surface Replacement Arthroplasty Components
References
Supplemental References
Chapter 5: Arthrodesis of the Hip
Indications and Results
Techniques
Arthrodesis of the Proximal Femur to the Ischium
Total Hip Arthroplasty After Hip Arthrodesis
References
Supplemental References
Chapter 6: Hip Pain in the Young Adult and Hip Preservation Surgery
Evaluation and History
Patient History
Physical Examination
Radiographic Assessment
Femoroacetabular Impingement
Surgical Indications
Surgical Dislocation of the Hip
Results
Combined Hip Arthroscopy and Limited Open Osteochondroplasty
Results
Periacetabular Osteotomy
Surgical Technique
Results
Hip Arthroscopy
Extraarticular Hip Impingement
Hip Dysplasia
Periacetabular Osteotomy
Surgical Indications
Surgical Technique
Results
Complications Following Periacetabular Osteotomy
Hip Arthroscopy With Borderline Hip Dysplasia
Total Hip Replacement Following Periacetabular Osteotomy
Extraarticular Sources of Hip Pain
Greater Trochanteric Pain Syndrome
Gluteus Medius and Minimus Tears
Endoscopic Repair of the Hip Abductors
External Snapping Hip (External Coxa Saltans)
Internal Snapping Hip
Osteitis Pubis
Sports Hernia (Athletic Pubalgia)
Osteonecrosis of the Femoral Head
Diagnosis
Treatment
Nonoperative Treatment
Core Decompression
Bone Grafting
Vascularized Fibular Grafting
Proximal Femoral Osteotomy
Arthroplasty
Idiopathic Transient Osteoporosis
Protrusio Acetabuli
Adult-Onset Rheumatoid Arthritis
Juvenile Idiopathic Arthritis
Osteoarthritis
Neuropathic Arthropathy (Charcot Joint)
References
Supplemental References
Part III: Reconstructive Procedures of the Knee in Adults
Chapter 7: Arthroplasty of the Knee
Modern Prosthesis Evolution and Design
Varus-valgus constrained prostheses
Mobile-bearing prostheses
Unicompartmental prostheses
Hinged implants
Knee replacement systems
Knee and Implant Biomechanics
Functional anatomy and kinematics
Role of the posterior cruciate ligament in total knee arthroplasty
Axial and rotational alignment of the knee
Patellofemoral joint biomechanics and functional anatomy
Polyethylene and bearing choices
Component fixation
Indications and Contraindications
Total knee arthroplasty
Unicondylar knee arthroplasty
Patellofemoral arthroplasty
Indications and considerations for patellar resurfacing in primary total knee arthroplasty
Indications and considerations for simultaneous bilateral total knee arthroplasty
Considerations for outpatient knee joint arthroplasty
Results of Primary Total Knee Arthroplasty
Functional and radiographic outcome measures
Prosthesis survival
Preoperative evaluation
Ambulatory and short-stay considerations
Anesthetic options
Pain management strategies after partial and total knee arthroplasty
Blood preservation management in partial and total knee arthroplasty
Surgical Technique for Primary Total Knee Arthroplasty
Intramedullary and extramedullary alignment instrumentation
Computer-assisted alignment technique
Robotic-assisted surgery considerations
Custom cutting blocks
Soft-tissue balancing
Soft-tissue balancing techniques (pie-crusting or standard release)
Management of bone deficiency
Patellofemoral tracking
Wound closure
Arthroplasty Techniques (Unicondylar and Patellofemoral Knee Arthroplasties)
Postoperative management
Surgical Problems Relative to Specific Disorders
Previous high tibial osteotomy
Previous patellectomy
Neuropathic arthropathy
Other medical conditions
Complications
Thromboembolism
Infection
Patellofemoral complications
Neurovascular complications
Periprosthetic fractures
Revision Total Knee Arthroplasty
Aseptic failure of primary total knee arthroplasty
Surgical exposures
Component removal
Knee revision and reconstruction principles
Results
References
Supplemental References
Chapter 8: Arthrodesis of the Knee
Indications and Results
Techniques
Compression Arthrodesis With External Fixation
Arthrodesis With Intramedullary Rod Fixation
Arthrodesis With Plate Fixation
References
Supplemental References
Chapter 9: Soft-Tissue Procedures and Osteotomies About the Knee
Muscle Contractures
Quadriceps Contracture of Infancy and Childhood
Flexion, Extension, and Combined Contractures
Snapping Syndromes
Painful Paraarticular Calcifications
Tendinitis and Bursitis
Prepatellar Bursitis
Tibial Collateral Ligament Fibrositis and Bursitis
Fibular Collateral Ligament Bursitis
Infrapatellar Bursitis
Popliteal Cyst (Baker Cyst)
Medial Gastrocnemius Bursitis
Semimembranosus Bursitis
Semimembranosus Tendinitis
Chronic Synovitis
Synovectomy of the Knee
Rheumatoid Arthritis of the Knee
Adult-Onset Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis
Surgical Procedures
Arthroscopic Synovectomy
Proximal Tibial Osteotomy
Arthrodesis
Arthroplasty or Reconstruction
Osteoarthritis of the Knee
Surgical Procedures
Debridement
Osteochondral and Autologous Chondrocyte Transplantation
Proximal Tibial Osteotomy
Lateral Closing Wedge Osteotomy
Medial Opening Wedge Osteotomy
Opening Wedge Hemicallotasis
General Complications of High Tibial Osteotomy
Total Knee Arthroplasty after Proximal Tibial Osteotomy
Distal Femoral Osteotomy
References
Supplemental References
Part IV: Reconstructive Procedures of the Ankle in Adults
Chapter 10: Total Ankle Arthroplasty
Development of Total Ankle Arthroplasty Systems
Design Rationale
Fixed-Bearing Versus Mobile-Bearing Designs
Alignment
Ingrowth Versus Cement Fixation
Metaphyseal Fixation
Talar Component Design
Polyethylene Wear
Preoperative Evaluation
Indications
Total Ankle Arthroplasty or Ankle Arthrodesis for Ankle Arthritis
Outpatient Total Ankle Arthroplasty
Considerations for Adjunctive Procedures
Deformity Correction
Ligament Considerations
Special Circumstances
Inflammatory Arthritis
Obesity
Diabetes
Osteonecrosis of the Talus
Pantalar Disease; Concomitant Hindfoot Arthrodesis
Takedown of Ankle Arthrodesis and Conversion to Ankle Arthroplasty
Gout
Bilateral Total Ankle Arthroplasty
Outcomes
Sports Participation
Role of Experience and Numbers of Cases
Range of Motion
By Diagnosis
Complications
In-Hospital Complications
Wound Healing Complications
Osteolysis, Loosening, and Subsidence
Malalignment
Polyethylene Failure
Fracture
Infection
Deep Venous Thrombosis
Heterotopic Ossification
Medial Malleolar Pain
Progression of Arthritis in Adjacent Joints
Osteophyte Formation/Impingement
Revision Ankle Arthroplasty
References
Supplemental References
Chapter 11: Ankle Arthrodesis
Alternatives to Ankle Arthrodesis
Nonoperative treatment
Operative treatment
Joint debridement
Periarticular osteotomies
Distraction arthroplasty
Total ankle arthroplasty
Indications for Ankle Arthrodesis
Patient Evaluation
Clinical evaluation
Radiographic evaluation
Techniques of Ankle Arthrodesis
Arthroscopic arthrodesis
Arthrodesis with external fixation
Special Considerations
Osteonecrosis of the talus
Failed total ankle arthroplasty
Infection/osteomyelitis
Charcot neuroarthropathy
Bone graft/supplementation
Complications
Nonunion
Treatment
Adjacent joint pain and arthritis
References
Supplemental References
Part V: Reconstructive Procedures of the Shoulder and Elbow in Adults
Chapter 12: Shoulder and Elbow Arthroplasty
Reconstructive Procedures of the Shoulder
History
Anatomy and Biomechanics
Prosthesis Design
Clinical Presentation and Radiographic Evaluation
Preoperative Planning
Hemiarthroplasty
Indications
Surgical Technique
Outcomes
Modified Hemiarthroplasty: Interposition Arthroplasty and Glenoidplasty (Ream and Run)
Resurfacing Hemiarthroplasty
Total Shoulder Arthroplasty
Indications
Surgical Technique
Outcomes
Osteoarthritis
Inflammatory Arthritis
Posttraumatic Arthritis and Posttraumatic Sequelae
Osteonecrosis
Capsulorrhaphy Arthropathy and Arthropathy of Recurrent Instability
Reverse Total Shoulder Arthroplasty
Indications
Surgical Technique
Outcomes
Cuff Tear Arthropathy
Rotator Cuff Dysfunction Without Arthritis
Proximal Humeral Fractures
Rheumatoid Arthritis with Rotator Cuff Tear
Salvage Procedures
Glenoid Bone Loss
Activities After Shoulder Arthroplasty
Complications of Shoulder Arthroplasty
Intraoperative Complications
Postoperative Complications
Glenoid Loosening
Humeral Loosening
Instability
Periprosthetic Fracture
Rotator Cuff Failure
Infection
Deltoid Muscle Dysfunction
Heterotopic Ossification
Stiffness
Complications of Reverse Total Shoulder Arthroplasty
Revision Shoulder Arthroplasty
Indications
Outcomes
Other Surgical Options for Failed Shoulder Arthroplasty
Hemiarthroplasty
Resection Arthroplasty
Glenohumeral Arthrodesis
Rehabilitation After Shoulder Arthroplasty
Reconstructive Procedures of the Elbow
Anatomy and Biomechanics
Types of Arthroplasty
Debridement Arthroplasty
Interposition (Fascial) Arthroplasty
Resection and Implant Arthroplasty of the Radial Head
Radial Head Arthroplasty
Total Elbow Arthroplasty
Indications
Surgical Technique
Semiconstrained (Linked) Total Elbow Arthroplasty
Outcomes
Unconstrained Total Elbow Arthroplasty
Semiconstrained Total Elbow Arthroplasty
Complications
Salvage
Revision Elbow Arthroplasty
Resection Arthroplasty
References
Supplemental References
Chapter 13: Salvage Operations for the Shoulder and Elbow
Shoulder Arthrodesis
Indications
Position
Surgical Techniques
Complications
Outcomes
Elbow Arthrodesis
Indications
Surgical Techniques
Complications
Outcomes
Tendon Transfers for Irreparable Rotator Cuff Tears
Indications
Surgical Techniques
Latissimus Dorsi Tendon Transfer for Irreparable Posterior Superior Rotator Cuff Tears
Outcomes
Lower Trapezius Tendon Transfer for Irreparable Posterior Superior Rotator Cuff Tears
Outcomes
Pectoralis Major Tendon Transfer for Irreparable Subscapularis Tears
Outcomes
Latissimus Dorsi Tendon Transfer for Irreparable Subscapularis Tears
Outcomes
Complications
References
Supplemental References
Part VI: Amputations
Chapter 14: General Principles of Amputations
Incidence and Indications
Peripheral Vascular Disease
Trauma
Burns
Frostbite
Infection
Tumors
Surgical Principles of Amputations
Determination of Amputation Level
Technical Aspects
Skin and Muscle Flaps
Hemostasis
Nerves
Bone
Open Amputations
Postoperative Care
Complications
Hematoma
Infection
Wound Necrosis
Contractures
Pain
Dermatologic Problems
Amputations in Children
References
Supplemental References
Chapter 15: Amputations of the Foot
Toe Amputations
Midfoot Amputations
Hindfoot and Ankle Amputations
References
Supplemental References
Chapter 16: Amputations of the Lower Extremity
Foot and Ankle Amputations
Transtibial (Below-Knee) Amputations
Nonischemic Limbs
Rehabilitation in Nonischemic Limbs
Ischemic Limbs
Rehabilitation in Ischemic Limbs
Disarticulation of the Knee
Transfemoral (Above-Knee) Amputations
Rehabilitation after Transfemoral Amputation
References
Supplemental References
Chapter 17: Amputations of the Hip and Pelvis
Disarticulation of the Hip
External Hemipelvectomy (Hindquarter Amputation)
References
Supplemental References
Chapter 18: Major Amputations of the Upper Extremity
Hand Amputations
Wrist Amputations
Forearm Amputations (Transradial)
Elbow Disarticulation
Arm Amputations (Transhumeral)
Shoulder Amputations
Forequarter Amputations
Targeted Muscle Reinnervation (TMR) After Shoulder or Transhumeral Amputation
References
Supplemental References
Chapter 19: Amputations of the Hand
Considerations for Amputation
Principles of Finger Amputations
Fingertip Amputations
Free Skin Graft
Flaps for Fingertip Coverage
Amputations of Single Fingers
Index Finger
Middle or Ring Finger Ray Amputations
Ring Avulsion Injuries
Little Finger Amputations
Thumb Amputations
Amputations of Multiple Digits
Painful Amputation Stump
Reconstructions After Amputation
Reconstruction After Amputation of the Hand
Reconstruction After Amputation of Multiple Digits
Reconstruction of the Thumb
Pollicization
References
Supplemental References
Part VII: Infections
Chapter 20: General Principles of Infection
Etiology
Patient-Dependent Factors
Nutritional Status
Glucose
Rheumatoid Arthritis
Immunologic status
Surgeon-Dependent Factors
Skin preparation
Operating room environment
Prophylactic antibiotic therapy
Methicillin-Resistant Staphylococcus Aureus
Diagnosis
Laboratory studies
Imaging studies
Culture studies
Treatment
Human Immunodeficiency Virus and Hepatitis B and C
Diagnostic tests
Confirmatory tests
Musculoskeletal syndromes in human immunodeficiency virus–infected patients
Risks and prevention
References
Supplemental References
Chapter 21: Osteomyelitis
Classification
Acute Hematogenous Osteomyelitis
Diagnosis
Treatment
Subacute Hematogenous Osteomyelitis
Brodie abscess
Chronic Osteomyelitis
Classification
Diagnosis
Treatment
Management of defects
Polymethylmethacrylate antibiotic bead chains
Biodegradable antibiotic delivery systems
Closed suction drains
Soft-tissue transfer
External fixation
Adjunctive therapies
Sclerosing Osteomyelitis of Garré
Residual Stage of Osteomyelitis
Chronic Recurrent Multifocal Osteomyelitis
Anaerobic Osteomyelitis
Incision and Drainage for Osteomyelitis of Specific Regions
Calcaneus
Pelvic regions
Ilium
Ischium and pubis
Spine
Resection or Excision for Osteomyelitis
Resection of the tarsals
Amputation for Osteomyelitis
References
Supplemental References
Chapter 22: Infectious Arthritis
Clinical Presentation
Synovial Fluid Studies
Imaging Studies
Pathogenesis
Microbiology
Treatment
Tarsal Joints
Ankle
Aspiration
Drainage
Ankle Arthroscopy
Knee
Aspiration
Drainage
Arthroscopic Drainage of the Knee
Hip
Aspiration
Drainage
Arthroscopic Drainage
Complications of Acute Septic Arthritis of the Hip
Pathologic Dislocation
Osteomyelitis
Pelvic Abscess
Persistent Infection
Sacroiliac Joint
Spine
Sternoclavicular and Acromioclavicular Joints
Shoulder
Aspiration
Drainage
Arthroscopic Drainage of the Shoulder
Elbow
Aspiration
Drainage
Arthroscopy of the Elbow
Wrist
Aspiration
Drainage
Arthroscopy of the Wrist
Operations to Correct Deformities After Septic Arthritis
Ankle
Knee
Intraarticular Osteotomy
Hip
Arthroplasty
Operations to Stabilize the Hip
Operations to Correct Deformity
Operations to Equalize Leg Lengths
References
Supplemental References
Chapter 23: Tuberculosis and other Unusual Infections
Tuberculosis
North American demographics
Musculoskeletal Involvement
Laboratory Findings
Imaging
Nonoperative Treatment of Appendicular Tuberculous Infections
Operative Treatment
Foot
Excision of Bones
Ankle
Knee
Hip
Arthrodesis
Evacuation of Abscesses
Sacroiliac Joint
Pubis
Clavicle
Shoulder
Elbow
Arthrodesis
Wrist and Hand
Tuberculosis of Long Bones
Amputation
Other Unusual Infections
Nontuberculous Mycobacterial Infections
Brucellosis
Typhoid Fever
Syphilis
Anaerobic Infections
Viral Osteitis and Arthritis
Actinomycosis
Lyme Disease
Fungal Infection
Coccidioidomycosis
Blastomycosis
Histoplasmosis
Cryptococcosis
Sporotrichosis
Echinococcosis
References
Supplemental References
Part VIII: Tumors
Chapter 24: General Principles of Tumors
Diagnostic Evaluation
General approach to musculoskeletal neoplasms
Physical examination
Radiographic examination
Other imaging examinations
Laboratory tests
Metastases of unknown origin
Staging
Biopsy
Adjuvant Treatment
Radiation therapy
Chemotherapy
Principles of Surgery
Amputation versus limb salvage
Margins
Curettage
Resection and reconstruction
Considerations for pediatric patients
Surgical Techniques
Upper extremity
Resection of the shoulder girdle
Resection of the clavicle
Resection of the scapula
Resection of the distal ulna
Resection of the hand
Pelvis
Lower extremity
Resection of the distal femur
Resection-arthrodesis of the ankle
Resection of the talus
Rotationplasty
References
Supplemental References
Chapter 25: Benign Bone Tumors and Nonneoplastic Conditions Simulating Bone Tumors
Bone-Forming Tumors
Osteoid osteoma
Bone island
Cartilage Lesions
Chondroma
Osteochondroma
Fibrous Lesions
Nonossifying fibroma
Cortical desmoid
Benign fibrous histiocytoma
Fibrous dysplasia
Osteofibrous dysplasia
Desmoplastic fibroma
Cystic Lesions
Unicameral bone cyst
Aneurysmal bone cyst
Intraosseous ganglion cyst
Epidermoid cyst
Fatty Tumors
Lipoma
Vascular Tumors
Hemangioma
Other Nonneoplastic Lesions
Paget disease
“Brown tumor” of hyperparathyroidism
Bone infarct
Osteomyelitis
Stress fracture
Posttraumatic osteolysis
References
Supplemental References
Chapter 26: Benign/Aggressive Tumors of Bone
Giant Cell Tumor
Chondroblastoma
Chondromyxoid Fibroma
Osteoblastoma
Langerhans Cell Histiocytosis
References
Supplemental References
Chapter 27: Malignant Tumors of Bone
Osteosarcoma
Chondrosarcoma
Ewing Sarcoma
Chordoma
Adamantinoma
Malignant Vascular Tumors
Malignant Fibrous Histiocytoma and Fibrosarcoma
Multiple Myeloma and Plasmacytoma
Lymphoma
Metastatic Carcinoma
References
Supplemental References
Chapter 28: Soft-Tissue Tumors
Benign Tumors and Tumor-Like Lesions
Fatty Tumors
Nerve Sheath Tumors
Synovial Lesions
Vascular Lesions
Fibrous Lesions
Malignant Tumors
Malignant Fibrous Histiocytoma/Undifferentiated Pleomorphic Sarcoma
Liposarcoma
Synovial Sarcoma (Malignant Synovioma)
Fibrosarcoma
Epithelioid Sarcoma
Dermatofibrosarcoma Protuberans
Rhabdomyosarcoma
Malignant Peripheral Nerve Sheath Tumor
Extraskeletal Osteosarcoma
Extraskeletal Ewing Sarcoma
Extraskeletal Chondrosarcoma
References
Supplemental References
Part IX: Congenital and Developmental Disorders
Chapter 29: Congenital Anomalies of the Lower Extremity
Anomalies of the Toes
Polydactyly
Syndactyly
Macrodactyly
Cleft foot (partial adactyly)
Contracture or angulation of the toes
Congenital hallux varus
Congenital metatarsus adductus
Treatment
Anomalies of the Foot
Congenital clubfoot (talipes equinovarus)
Radiographic evaluation
Classification
Nonoperative treatment
Ponseti Casting Technique for Correction of Clubfoot Deformity
Management of Recurrence
Operative treatment
Recalcitrant clubfeet
Triple Arthrodesis and Talectomy for Uncorrected Clubfoot
Calcaneovalgus foot
Congenital vertical talus
Clinical and radiographic findings
Treatment
Triple Arthrodesis
Anomalies of the Leg
Congenital angular deformities of the leg
Posteromedial bowing of the tibia
Congenital pseudarthrosis of the fibula and tibia
Fibula
Tibia
Classification
Treatment
Intramedullary Fixation
Vascularized Graft
Ilizarov Technique
Bone Morphogenetic Protein
Complications
Stiffness of the Ankle and Hindfoot
Refracture
Valgus Ankle Deformity
Tibial Shortening
Constrictions of the Leg
Congenital Hyperextension and Dislocation of the Knee
Congenital dislocation of the patella
Congenital deficiencies of the long bones
Tibial hemimelia
Classification
Treatment
Fibular hemimelia
Classification
Treatment
Proximal femoral focal deficiency
Classification
Treatment
Limb-length discrepancy
Clinical assessment
Radiographic assessment
Techniques for predicting growth remaining
Treatment
Operative Treatment
Epiphysiodesis
Limb Shortening
Limb Lengthening
References
Supplemental References
Chapter 30: Congenital and Developmental Abnormalities of the Hip and Pelvis
Developmental Dysplasia of the Hip
Diagnosis and Clinical Presentation
Screening
Imaging
Treatment
Newborn (Birth to 6 Months)
Infant (6 to 18 Months)
Preoperative Traction
Adductor Tenotomy
Arthrography and Closed Reduction
Three-Dimensional Imaging After Closed Reduction
Open Reduction
Concomitant Osteotomy
Teratologic Dislocations
Osteonecrosis
Toddler (18 to 36 Months)
Femoral Osteotomy in Dysplasia of the hip
Child (3 to 8 Years)
Primary Femoral Shortening
Pelvic Osteotomy
Salter Innominate Osteotomy
Pemberton Acetabuloplasty
Steel Osteotomy
Dega Osteotomy
Ganz (Bernese) Periacetabular Osteotomy
Shelf Operations
Innominate Osteotomy With Medial Displacement of the Acetabulum (Chiari)
Adolescent and Young Adult (>8 Years)
Congenital and Developmental Coxa Vara
Exstrophy of the Bladder
Anterior Iliac Osteotomies and Approximation of the Symphysis Pubis
References
Supplemental References
Chapter 31: Congenital Anomalies of the Trunk and Upper Extremity
Congenital Elevation of the Scapula (Sprengel Deformity)
Congenital Muscular Torticollis
Congenital Pseudarthrosis of the Clavicle
Congenital Dislocation of the Radial Head
Congenital Pseudarthrosis of the Radius
Congenital Pseudarthrosis of the Ulna
Congenital Radioulnar Synostosis
References
Supplemental References
Chapter 32: Osteochondrosis or Epiphysitis and Other Miscellaneous Affections
Legg-Calvé-Perthes Disease
Diagnosis
Classification
Bilateral involvement
Imaging Evaluation
Treatment
Innominate osteotomy
Lateral shelf procedure
Varus derotational osteotomy
Lateral opening wedge osteotomy
Arthrodiastasis
Reconstructive surgery
Osteochondroplasty (Cheilectomy)
Valgus extension osteotomy
Valgus flexion internal rotation osteotomy
Shelf procedure
Chiari osteotomy
Trochanteric overgrowth
Osteochondrosis or Epiphysitis
Traction epiphysitis of the fifth metatarsal base (Iselin Disease)
Osteochondrosis of the metatarsal head (Freiberg Infraction)
Osteochondrosis of the navicular (Köhler Disease)
Osteochondritis of the ankle
Apophysitis of the tibial tuberosity (Osgood-Schlatter Disease)
Osteochondritis dissecans of the knee
Osteochondritis dissecans of the patella
Osteochondritis dissecans of the hip
Osteochondrosis of the capitellum (Osteochondritis Dissecans)
Tibia Vara (Blount Disease)
Osteotomies
Neurovascular complications of high tibial osteotomy
Rickets, Osteomalacia, and Renal Osteodystrophy
Hemophilia
Total joint arthroplasty
Synovectomy
Arthroscopic synovectomy
Open ankle synovectomy
Arthrodesis
Osteotomy
Complications of hemophilia
Congenital Affections
Osteogenesis imperfecta
Multiple osteotomies, realignment, and medullary nail fixation
Fassier-duval telescoping rod (Pega Medical, inc., Laval, Quebec, Canada)
Osteotomy and medullary nailing with locked nail
Dwarfism (Short Stature)
Traumatic physeal arrest from bridge of bone
References
Supplemental References
Part X: Nervous System Disorders in Children
Chapter 33: Cerebral Palsy
Etiology
Classification
Geographic Classification
Monoplegia
Hemiplegia
Diplegia
Quadriplegia
Total Body
Other Types
Physiologic Classification
Spastic
Athetoid
Choreiform
Rigid
Ataxic
Hypotonic
Mixed
Functional Classification
Diagnosis
Prognostic Factors
Gait Analysis
Associated Conditions
Treatment
Nonoperative Treatment
Operative Treatment
Neurosurgical Intervention
Hip
Flexion Deformities
Adduction Deformities
Subluxation and Dislocation
Varus Derotational Osteotomy
Redirectional Osteotomy
Knee
Hip and Knee Relationships
Flexion Deformity
Combined Hamstring Lengthening, Posterior Capsular Release
Distal Transfer of Rectus Femoris
Recurvatum of the Knee
Knee Valgus
Patella Alta
Rotational Abnormalities
Foot and Ankle
Equinus Deformity
Surgical Correction of Equinus Deformity
Lengthening of the Gastrocnemius-Soleus Muscle Complex
Varus or Valgus Deformity
Equinovarus Deformity
Lengthening of the Posterior Tibial Tendon
Split Tendon Transfers
Osteotomy of the Calcaneus
Lateral Displacement Calcaneal Osteotomy
Planovalgus Deformity
Calcaneus Deformity
Cavus Deformity
Forefoot Adduction Deformity
Correction of Flexible Forefoot Adductus
Hallux Valgus Deformity
Claw Toes
Spine-Pelvic Obliquity and Scoliosis
Upper Extremity
Shoulder
Elbow
Forearm, Wrist, and Hand
Adults With Cerebral Palsy
Adult Stroke Patients
Lower Extremity
Hip
Knee
Foot
Talipes Equinus
Talipes Equinovarus
Varus Foot
Planovalgus
Toe Flexion
Upper Extremity
Shoulder
Elbow
Phenol Nerve Block
Functional Electrical Nerve Stimulation
References
Supplemental References
Chapter 34: Paralytic Disorders
Poliomyelitis
Pathologic findings
Clinical course and treatment
Acute stage
Convalescent stage
Chronic stage
Tendon transfers
Arthrodesis
Foot and ankle
Tendon transfers
Paralysis of Specific Muscles
Anterior Tibial Muscle
Anterior and Posterior Tibial Muscles
Posterior Tibial Muscle
Anterior Tibial, Toe Extensor, and Peroneal Muscles
Peroneal Muscles
Peroneal and Long Toe Extensor Muscles
Gastrocnemius-Soleus Muscles
Flail Foot
Dorsal Bunion
Bony procedures (Osteotomy and Arthrodesis)
Calcaneal Osteotomy
Dillwyn Evans Osteotomy
Subtalar Arthrodesis
Triple Arthrodesis
Complications of Triple Arthrodesis
Talectomy
Ankle Arthrodesis
Pantalar Arthrodesis
Tendon transfer techniques
Talipes Equinovarus
Split Transfer of the Posterior Tibial Tendon
Talipes Cavovarus
Talipes Equinovalgus
Talipes Calcaneus
Knee
Flexion contracture of the knee
Quadriceps paralysis
Genu recurvatum
Soft-Tissue Operations for Genu Recurvatum
Flail knee
Tibia and femur
Hip
Flexion and abduction contractures of the hip
Paralysis of the gluteus maximus and medius muscles
Paralytic dislocation Of the hip
Leg-length discrepancy
Total joint arthroplasty
Trunk
Pelvic obliquity
Treatment
Serratus Anterior Paralysis
Trapezius and Levator Scapulae Paralysis
Paralytic Scoliosis
Shoulder
Tendon and muscle transfers for paralysis of the deltoid
Tendon and muscle transfers for paralysis of the subscapularis, suprascapularis, supraspinatus, or infraspinatus
Arthrodesis
Elbow
Muscle and tendon transfers to restore elbow flexion
Muscle transfers for paralysis of the triceps
Posterior Deltoid Transfer (Moberg Procedure)
Forearm
Pronation contracture
Wrist and hand
Myelomeningocele
Epidemiology
Associated Conditions
Hydrocephalus
Hydrosyringomyelia
Arnold-chiari malformation
Tethered spinal cord
Other spinal abnormalities
Urologic dysfunction
Bowel dysfunction
Latex hypersensitivity
Miscellaneous medical issues
Classification
Orthopaedic evaluation
Gait evaluation
Principles of orthopaedic management
Nonoperative management
Operative management
Foot
Equinus deformity
Clubfoot
Varus Deformity
Cavovarus deformity
Supination deoformity
Calcaneal deformity
Hindfoot valgus
Vertical talus
Pes cavus deformity
Toe deformities
Ankle
Hemiepiphysiodesis of the distal tibial epiphysis
Knee
Flexion contracture
Extension contracture
Varus or valgus deformity
Hip
Flexion contracture
Flexion-abduction–external rotation contracture
External rotation contracture
Abduction contracture
Adduction Contracture
Hip subluxation and dislocation
Pelvic obliquity
Spine
Scoliosis
Kyphosis
Kyphectomy
Arthrogryposis Multiplex Congenita
Treatment
Lower extremity
Scoliosis
Brachial Plexus Palsy
Clinical features
Treatment
References
Supplemental References
Chapter 35: Neuromuscular Disorders
Treatment Considerations
Bone Health—Osteoporosis and Fracture Management
Orthoses
Seating Systems
Differentiation of Muscle Disease From Nerve Disease
Hematologic Studies
Electromyographic Studies
Muscle Tissue Biopsy
Muscular Dystrophy
Duchenne Muscular Dystrophy
Physical Examination
Medical Treatment
Orthopaedic Treatment
Rideau Technique
Other Variants of Muscular Dystrophy
Becker Muscular Dystrophy
Emery-Dreifuss Muscular Dystrophy
Limb-Girdle Dystrophy
Facioscapulohumeral Muscular Dystrophy
Infantile Facioscapulohumeral Muscular Dystrophy
Congenital Dystrophies
Myotonic Dystrophy
Hereditary Motor and Sensory Neuropathies
Charcot-Marie-Tooth Disease (Peroneal Muscular Atrophy)
Cavovarus Foot Deformity
Clinical and Radiographic Evaluation
Orthopaedic Treatment
Hip Dysplasia
Spinal Deformities
Friedreich Ataxia
Spinal Muscular Atrophy
References
Supplemental References
Part XI: Fractures and Dislocations in Children
Chapter 36: Fractures and Dislocations in Children
General Principles
Growth Plate Injuries
Open Fractures
Birth Fractures
Nonaccidental Trauma
Clavicle
Sternoclavicular Fractures and Dislocations
Lateral (Distal) Clavicular Fractures
Acromioclavicular Dislocations
Shoulder Dislocations
Proximal Humeral Fractures
Closed Treatment
Operative Treatment
Humeral Shaft Fractures
Supracondylar Humeral Fractures
Lateral Condylar Fractures
Complications After Lateral Condylar Fracture
Medial Condylar Fractures
Complications After Medial Condylar Fracture
Medial Epicondylar Fractures
Complications After Medial Epicondylar Fracture
Chronic Medial Epicondyle Apophysitis (Little League Elbow)
Distal Humeral Fractures
Treatment
Capitellar Fractures
Olecranon Fractures
Radial Head and Neck Fractures
Complications After Radial Neck Fracture
Coronoid Fractures
Elbow Dislocations
Complications After Elbow Dislocation
Radial Head Dislocations (Monteggia Fracture-Dislocations)
Galeazzi Fractures
Nursemaid’s Elbow
Forearm Fractures
Proximal Third Forearm Fractures
Middle Third Forearm Fractures
Plastic Deformation and Greenstick Fractures
Distal Third Forearm Fractures
Wrist Dislocations
Scaphoid and Carpal Fractures
Metacarpal Fractures
Thumb Metacarpal Fractures
Phalangeal Fractures
Distal Phalangeal Fracture
Complications of Phalangeal Fractures
Pediatric Spine Fractures and Dislocations
Cervical Spine
Atlantooccipital Fractures and Instability
Upper Cervical Spine (C1–C2) Injuries
Rotatory Subluxation
Lower Cervical Spine (C3–C7) Injuries
Thoracolumbar Spine
Pelvic Fractures
Avulsion Fractures
Acetabular Fractures
Hip Fractures
Type I, Transepiphyseal Separations
Type II, Transcervical Fractures
Type III, Cervicotrochanteric Fractures
Type IV, Intertrochanteric Fractures
Complications
Traumatic Hip Dislocations
Slipped Capital Femoral Epiphysis
Treatment
In Situ Pin or Screw Fixation
Contralateral Slips
Open Techniques
Complications
Osteonecrosis
Chondrolysis
Femoral Neck Fracture
Continued Slipping
Femoroacetabular Impingement
Femoral Fractures
Femoral Shaft Fractures (Diaphyseal Femoral Fractures)
Spica Casting
External Fixation
Intramedullary Nailing
Plating
Complications
Fractures of the Distal Femoral Physis
Complications
Knee Fractures and Dislocations
Patellar Dislocations
Patellar Fractures
Fractures of the Intercondylar Eminence of the Tibia
Tibial Tuberosity Fractures
Osteochondral Fractures
Floating Knee Injuries
Tibial and Fibular Fractures
Proximal Tibial Physeal Fractures
Proximal Tibial Metaphyseal Fractures
Middle and Distal Tibial Shaft Fractures
Distal Tibial and Fibular Epiphyseal Fractures
Triplane Fractures
Tillaux Fractures
Foot Fractures
Talar Fractures
Talar Neck Fractures
Fractures of the Dome and Lateral Process of the Talus
Osteochondral Fractures of the Talus
Calcaneal Fractures
Tarsal Fractures
Metatarsal and Phalangeal Fractures
References
Supplemental References
Part XII: The Spine
Chapter 37: Anatomic Approaches to the Spine
Anatomy of Vertebral Column
Anatomy of Spinal Joints
Anatomy of Spinal Cord and Nerves
Anatomy of Cervical, Thoracic, and Lumbar Pedicles
Circulation of Spinal Cord
Surgical Approaches
Anterior approaches
Anterior approach, occiput to C3
Extended maxillotomy and subtotal maxillectomy
Anterior approach, C3 to C7
Anterolateral approach, C2 to C7
Anterior approach to cervicothoracic junction, C7 to T1
Anterior approach to the thoracic spine
Video-assisted thoracic surgery
Anterior approach to the thoracolumbar junction
Anterior retroperitoneal approach, L1 to L5
Percutaneous lateral approach to lumbar spine, L1 to L4-5 (Dlif Or Xlif)
Anterior transperitoneal approach to the lumbosacral junction, L5 to S1
Video-assisted lumbar surgery
Posterior approaches
Minimally Invasive Approaches to the Posterior Spine
References
Supplemental References
Chapter 38: Degenerative Disorders of the Cervical Spine
Overview of Disc Degeneration and Herniation in the Cervical Spine
Disc and Spine Anatomy
Neural Elements
Natural History of Disc Disease
Diagnostic Studies
Radiography
Myelography
Computed Tomography
Magnetic Resonance Imaging
Other Diagnostic Tests
Injection Studies
Epidural Steroid Injections
Cervical Epidural Injection
Zygapophyseal (Facet) Joint Injections
Cervical Discography
Cervical Disc Disease
Signs and Symptoms
Differential Diagnosis
Confirmatory Imaging
Nonoperative Treatment
Operative Treatment
Minimally Invasive Posterior Approaches to the Cervical Spine
Results
Anterior Cervical Arthrodesis
General Complications
Postoperative Complications
Posterior Cervical Arthrodesis
Cervical Disc Arthroplasty
Rheumatoid Arthritis of the Spine
Clinical Evaluation
Diagnostic Imaging
Radiography
Computed Tomographic Myelography and Magnetic Resonance Imaging
Cervical Instability
Nonoperative Treatment
Operative Treatment
Ankylosing Spondylitis of the Cervical Spine
Diagnosis
Treatment
Osteotomy of the Cervical Spine
References
Supplemental References
Chapter 39: Degenerative Disorders of the Thoracic and Lumbar Spine
Overview of Lumbar and Thoracic Disc Degeneration and Herniation
Disc and Spine Anatomy
Neural elements
Natural History of Disc Disease
Axial lumbar pain
Diagnostic Studies
Radiography
Myelography
Computed tomography
Magnetic resonance imaging
Other diagnostic tests
Injection studies
Epidural cortisone injections
Thoracic epidural injection
Lumbar epidural injection
Zygapophyseal (Facet) joint injections
Lumbar Facet Joint
Sacroiliac Joint
Discography
Thoracic Disc Disease
Signs and symptoms
Confirmatory imaging
Treatment results
Operative treatment
Costotransversectomy
Thoracic disc excision
Thoracoscopic disc excision
Thoracic endoscopic disc excision
Lumbar Disc Disease
Signs and symptoms
Differential diagnosis
Confirmatory imaging
Nonoperative treatment
Operative treatment
Microdiscectomy
Microscopic Lumbar Disc Excision
Tubular Techniques
Endoscopic techniques
Transforaminal and Interlaminar Endoscopic Lumbar Discectomy
Additional exposure techniques
Lumbar root anomalies
Results of surgery for disc herniation
Complications of disc excision
Free fat grafting
Repeat lumbar disc surgery
Disc excision and fusion
Thoracic and Lumbar Spine Arthrodesis
Anterior arthrodesis
Anterior disc excision and interbody fusion of the lumbar spine
Minimally invasive anterior fusion of the lumbar spine
Posterior arthrodesis
Posterolateral or intertransverse fusions
Internal fixation in lumbar spinal fusion
Treatment after posterior arthrodesis
Pseudarthrosis after spinal fusion
Degenerative Disc Disease and Internal Disc Derangement
Patient selection process
Differential spinal anesthetic
Psychogenic pain
Sympathetic pain
Somatic pain
Central pain
Modified technique
Interpretation
Thoracic/Lumbar Disc Arthroplasty (Total Disc Replacement)
Failed spine surgery
Stenosis of the Thoracic and Lumbar Spine
Anatomy
Natural history
Clinical evaluation
Diagnostic imaging
Radiography
Magnetic resonance imaging
Computed tomographic myelography
Other diagnostic studies
Nonoperative treatment
Epidural steroid injection
Operative treatment
Principles of spinal stenosis surgery
Adjacent segment degeneration
Decompression
Less-Invasive Decompression
Decompression with fusion
Interspinous distraction
Ankylosing Spondylitis
Osteotomy of the lumbar spine
Smith-petersen osteotomy
Pedicle subtraction osteotomy
Eggshell osteotomy
Adult Spinal Deformity
Incidence and progression of deformity
Classification
Sagittal and coronal balance
Spinopelvic alignment
Clinical evaluation
Anatomy and biomechanics
Diagnostic imaging
Radiography
Computed tomographic myelography and magnetic resonance imaging
Nonoperative treatment
Operative treatment
Decompression in degenerative scoliosis
Posterior Instrumentation and Fusion
Idiopathic Scoliosis
Degenerative Scoliosis
Anterior spinal instrumentation and fusion
Postoperative management
Combined anterior and posterior fusions
Other techniques
Iliac fixation
Coccygeal Pain
References
Supplemental References
Chapter 40: Spondylolisthesis
General Information
Diagnosis
Etiology
Classification
Wiltse Classification of Spondylolisthesis
Type 1 Dysplastic
Type 2 Isthmic
Type 3 Degenerative
Type 4 Traumatic
Type 5 Pathologic
Type 6 Iatrogenic
Marchetti-Bartolozzi Classification of Spondylolisthesis
Developmental Spondylolisthesis
Acquired Spondylolisthesis
Acquired Traumatic Spondylolisthesis
Acquired Postsurgical Spondylolisthesis
Acquired Pathologic Spondylolisthesis
Acquired Degenerative Spondylolisthesis
Radiographic Pelvic Parameters and Spinopelvic Alignment
Natural History
Lumbosacral Dysplasia
Spondylolysis
Patient Presentation
Diagnostic Evaluation
Evaluation for Operative Treatment
Operative Treatment
Adult Isthmic Spondylolisthesis
Pathophysiology
Nonoperative Treatment
Operative Treatment
Surgical Options
Evaluation for Operative Treatment
Outcomes of Operative Treatment
Operative Planning
Degenerative Spondylolisthesis
Pathophysiology
Nonoperative Treatment
Operative Treatment and Outcomes
Operative Planning
Perioperative Management and Complications
Preoperative Management
Intraoperative Management
Pseudarthrosis
Neurologic Deficits
Vascular Complications
Infection
References
Supplemental References
Chapter 41: Fractures, Dislocations, and Fracture-Dislocations of the Spine
Initial Management of Spinal Injury
Initial Spine Assessment
Spine Precautions
Diagnostic Imaging
Additional Imaging
Neurologic Assessment
Spinal Cord Injury
Neurogenic And Spinal Shock
Immediate Cervical Spinal Reduction
Spinal Cord Injury Treatment
Spinal Cord Syndromes
Cervical Spine Injuries
Radiographic Evaluation Protocol
Halo Vest Immobilization and Cervical Orthoses
Occipitocervical Dissociation Injury Patterns
Occipital Condyle Fractures
Transverse Atlantal Ligament Rupture
Atlas Fractures
Treatment of “Stable” C1 Fractures
Treatment of “Unstable” C1 Fractures
Axis Fractures
Odontoid Fractures
Treatment
Posterior C1-C2 Fusion Techniques
Traumatic Spondylolisthesis of the Axis (Hangman Fracture)
Treatment
Subaxial Cervical Spine Injury (C3-T1)
Classification
Treatment
Extension Injuries
Burst Fractures
Facet Dislocations
Facet Fracture With Subluxation
Fracture-Dislocations
Ankylosing Spondylitis
Vertebral Artery Injuries
Thoracic and Lumbar Injuries
Classification
Treatment
Compression Fractures
Burst Fractures
Distraction Injuries
Extension Injuries
Fracture-Dislocations
Decompression
Posterior Stabilization
Anterior Stabilization
Sacral Fractures and Spinopelvic Dissociation Injuries
Classification
Treatment
References
Supplemental References
Chapter 42: Infections and Tumors of the Spine
Infections of the Spine
Spinal Anatomy
Pyogenic Vertebral Osteomyelitis and Discitis
Clinical Presentation
Laboratory Studies
Imaging Techniques
Radiography
Computed Tomography
Magnetic Resonance Imaging
Radionuclide Scanning
Diagnostic Biopsy
Differential Diagnosis
Nonoperative Treatment
Prognosis
Operative Treatment
Specific Infections
Infections in Children
Spinal Epidural Abscess (SEA)
Surgical Site Infections
Brucellosis
Fungal Infections
Tuberculosis
Treatment of Thoracic and Lumbar Tubercular Spinal Infection
Treatment of Cervical Tubercular Spinal Infections
Atypical Tubercular Infections
Abscess Drainage By Anatomic Level
Cervical Spine
Dorsal Spine
Lumbar Spine
Pelvis
Psoas Abscess
Tumors of the Spine
Benign Tumors
Stability
Classification and Adjuvant Treatments
Posterior Element Tumors
Osteoid Osteoma
Osteoblastoma
Osteochondroma
Aneurysmal Bone Cyst
Vertebral Body Tumors
Hemangioma
Eosinophilic Granuloma
Giant Cell Tumor
Primary Malignant Tumors
Classification
Osteosarcoma
Ewing Sarcoma
Chordoma
Multiple Myeloma
Metastatic Tumors
Classification
Operative Treatment
References
Supplemental References
Chapter 43: Pediatric Cervical Spine
Normal Embryology and Growth and Development
Anomalies of the Odontoid
Diagnosis
Radiographic findings
Treatment
Posterior cervical approaches
Anterior cervical approaches
Halo vest immobilization
Basilar Impression
Radiographic findings
Treatment
Atlantooccipital Fusion
Radiographic findings
Treatment
Idiopathic Atlantooccipital Instability
Klippel-Feil Syndrome
Associated conditions
Scoliosis
Renal anomalies
Cardiovascular anomalies
Deafness
Synkinesis
Respiratory anomalies
Sprengel deformity
Cervical ribs
Clinical findings
Radiographic findings
Treatment
Atlantoaxial Rotatory Subluxation
Radiographic findings
Treatment
Cervical Instability in Down Syndrome
Neurologic findings
Radiographic findings
Treatment
Familial Cervical Dysplasia
Congenital Anomalies of the Atlas
Larsen Syndrome
Intervertebral Disc Calcification
References
Supplemental References
Chapter 44: Scoliosis and Kyphosis
Scoliosis
Infantile Idiopathic Scoliosis
Treatment
Casting
Operative treatment
Juvenile Idiopathic Scoliosis
Treatment
Growing rod instrumentation
Guided growth and physeal stapling
Instrumentation with fusion
Adolescent Idiopathic Scoliosis
Etiology
Natural history
Patient evaluation
Radiographic evaluation
Measurement of curves
Vertebral rotation
Sagittal balance
Curve patterns
Lenke Classification
Nonoperative treatment
Observation
Orthotic treatment
Operative treatment
Preoperative preparation
Intraoperative considerations
Surgical goals
Posterior arthrodesis
Bone grafting
Complications of bone grafting
Posterior spinal instrumentation
Correction maneuvers
Segmental instrumentation: pedicle screws
Pedicle fixation
Insertion of lumbar pedicle screws
Insertion of thoracic pedicle screws
Fusion levels and screw placement
Hook site preparation and placement
Sublaminar Cables/Bands
Complications and pitfalls in segmental instrumentation systems
Management of rigid curves
Complications of posterior scoliosis surgery
Early complications
Neurologic Injury
Infection
Ileus
Superior Mesenteric Artery Syndrome
Atelectasis
Pneumothorax
Dural Tear
Wrong Levels
Urinary Complications
Vision Loss
Late complications
Pseudarthrosis
Crankshaft Phenomenon
Posterior thoracoplasty
Concave rib osteotomies
Anterior instrumentation for idiopathic scoliosis
Complications and pitfalls of anterior instrumentation
Video-assisted thoracoscopy
Pitfalls and complications
Endoscopic anterior instrumentation of idiopathic scoliosis
Neuromuscular Scoliosis
Nonoperative treatment
Observation
Orthotic treatment
Operative treatment
Preoperative considerations
Operative considerations
Postoperative considerations
Luque rod instrumentation with sublaminar wiring
Sacropelvic fixation
S2 iliac lumbopelvic screw placement
Cerebral palsy
Classification
Nonoperative treatment
Operative treatment
Complications
Friedreich ataxia
Charcot-Marie-Tooth disease
Syringomyelia
Spinal cord injury
Orthotic treatment
Operative treatment
Poliomyelitis
Spinal muscular atrophy
Orthotic treatment
Operative treatment
Familial dysautonomia
Arthrogryposis multiplex congenita
Duchenne muscular dystrophy
Variants of muscular dystrophy other than Duchenne type
Congenital Scoliosis
Classification
Patient evaluation
Natural history
Nonoperative treatment
Operative treatment
Posterior fusion without instrumentation
Posterior fusion with instrumentation
Combined anterior and posterior fusions
Combined anterior and posterior convex hemiepiphysiodesis (growth arrest)
Hemivertebra excision
Thoracic insufficiency syndrome
Kyphosis
Scheuermann Disease
Classification
Etiology
Clinical findings
Radiographic findings
Natural history
Associated conditions
Differential diagnosis
Treatment
Nonoperative treatment
Observation
Orthotic Treatment
Operative treatment
Complications
Congenital Kyphosis
Clinical and radiographic evaluation
Operative treatment
Treatment of type I deformity
Treatment of type Ii deformity
Complications of operative treatment
Progressive Anterior Vertebral Fusion
Infantile Lumbar Hypoplasia
Spondylolysis and Spondylolisthesis
Classification
Etiology and natural history
Clinical findings
Radiographic findings
Treatment of acquired spondylolysis
Repair of spondylolytic defect
Posterolateral fusion
Treatment of developmental spondylolisthesis
Nonoperative treatment
Operative treatment
Treatment of severe (high dysplastic) spondylolisthesis
Treatment of spondyloptosis
Kyphoscoliosis
Myelomeningocele
Incidence and natural history
Clinical evaluation
Radiographic findings
Scoliosis and lordosis in myelomeningocele
Orthotic Treatment
Operative Treatment
Combined anterior and posterior fusion
Kyphosis in myelomeningocele
Incidence and Natural History
Operative Treatment
Sacral agenesis
Treatment
Unusual Causes of Scoliosis
Neurofibromatosis
Management of nondystrophic curves
Management of dystrophic scoliosis
Scoliosis without kyphosis
Kyphoscoliosis
Kyphoscoliosis with spinal cord compression
Postoperative management
Complications of surgery
Marfan syndrome
Diagnosis
Nonoperative treatment
Observation
Orthotic Treatment
Operative treatment
Vertebral column tumors
Clinical findings
Radiographic evaluation and treatment
Biopsy
Benign tumors of the vertebral column
Osteoid Osteoma
Osteoblastoma
Aneurysmal Bone Cysts
Eosinophilic Granuloma
Hemangioma
Primary malignant tumors of the vertebral column
Ewing Sarcoma
Osteogenic Sarcoma
Postirradiation spinal deformity
Incidence
Radiographic findings
Treatment
Complications and pitfalls
Osteochondrodystrophy
Diastrophic dwarfism
Spondyloepiphyseal dysplasia
Osteogenesis imperfecta
Anesthesia problems
Orthotic treatment
Operative treatment
Unusual Causes of Kyphosis
Postlaminectomy spinal deformity
Treatment
Skeletal dysplasias
Achondroplasia
Mucopolysaccharidoses
References
Supplemental References
Part XIII: Sports Medicine
Chapter 45: Knee Injuries
Anatomy
Osseous Structures
Extraarticular Tendinous Structures
Extraarticular Ligamentous Structures
Medial Side Anatomy
Medial Collateral Ligament
Midmedial Capsule
Posteromedial Corner
Lateral Collateral Ligament
Iliotibial Band
Popliteal Tendon
Lateral Side Anatomy
Anterolateral Ligament
Popliteus Muscle and Ligament
Intraarticular Structures
Mechanics
Menisci
Function and Anatomy
Meniscal Healing and Repair
Mechanism of Tear
Classification of Meniscal Tears
Diagnosis
Diagnostic Tests
Imaging Studies
Radiography
Arthrography
Other Diagnostic Studies
Arthroscopy
Nonoperative Management
Operative Management
Late Changes After Meniscectomy
Surgical Repair of Torn Menisci
Meniscal Autografts and Allografts
Other Conditions of Menisci
Cysts of Menisci
Discoid Meniscus
Treatment
Acute Traumatic Lesions of Ligaments
General Considerations
Etiology
Mechanism
Ligament Healing
Classification
Diagnosis
History and Physical Examination
Standard Stress Tests
Rotary Tests
Radiographic Examination
Classification of Knee Instability
One-Plane Instability
Rotary Instability
Combined Instabilities
Treatment Considerations
Nonoperative Treatment
Operative Treatment
Medial Compartment (Collateral) Disruptions
Repair
Reconstruction
Reconstruction With Allograft Tendons
Lateral Compartment (Collateral) Disruptions
Reconstruction of Lateral Compartment
Posterolateral Rotary Instability
Posterolateral Instability With Varus Knee
Anterolateral Rotary Instability
Anterior Cruciate Ligament Injuries
Incidence
Anatomy
Biomechanics
History and Physical Examination
Natural History
Treatment
Reconstruction for Anterior Cruciate Ligament Insufficiency
Intraarticular Reconstruction
Reconstruction With Hamstring Tendons
Combined Anterior Cruciate Ligament Instabilities
Synthetic Materials for Ligament Reconstruction
Allograft Ligament Replacement
Rehabilitation After Anterior Cruciate Ligament Reconstruction
Results of Anterior Cruciate Ligament Reconstruction
Complications of Anterior Cruciate Ligament Surgery
Revision Anterior Cruciate Ligament Surgery
Graft Selection
Technical Considerations
Posterior Cruciate Ligament
Anatomy
Biomechanics
Physical Examination
Natural History
Treatment
Nonoperative Treatment
Operative Treatment
Reconstruction of Posterior Cruciate Ligament
Reconstruction of Posterior Cruciate Ligament With Bone–Patellar Tendon–Bone or Achilles Tendon–Bone Grafts
Arthroscopically Aided Posterior Cruciate Ligament Reconstruction
Complications of Posterior Cruciate Ligament Reconstruction
Traumatic Dislocations
Classification
Examination and Radiographic Evaluation
Vascular and Nerve Injuries
Vascular Injuries
Nerve Damage
Other Associated Injuries
Treatment
Outcome of Operative Treatment of Knee Dislocations
Synovial Plicae
Articular Cartilage Injuries
Treatment
Arthroscopic Debridement
Abrasion Chondroplasty, Microfracture
Osteochondral Autograft Transplant, Osteochondral Allografting, Autologous Chondrocyte Implantation
Autologous Chondrocyte Implantation
Emerging Technologies
Osteochondritis Dissecans
Etiology
Clinical and Radiographic Findings
Treatment
Excision of Loose Bodies
Fixation of Fragments
Drilling of the Lesion
Outcomes of Treatment of Osteochondritis Dissecans of the Knee
Complications
Disorders of the Patella
Osteochondritis Dissecans of the Patella
Dorsal Defect of the Patella
Bipartite Patella
Chondromalacia of the Patella
Classification and Etiology
Clinical Findings
Treatment
Extraarticular Ankylosis of the Knee
Extraarticular Ankylosis in Extension
Extraarticular Ankylosis in Flexion
Open Wounds of the Knee Joint
References
Supplemental References
Chapter 46: Shoulder and Elbow Injuries
Shoulder Injuries
Anatomy and Biomechanics
Clinical Presentation and Physical Examination
Neer Impingement Sign and Impingement Test
Hawkins-Kennedy Test
Jobe Test
Internal Rotation Resistance Stress Test
Active Compression Test
Dynamic Labral Shear Test
Kim Test for Posteroinferior Labral Tear
Jerk Test for Posterior Labral Lesions
Biceps Load II Test for Isolated Slap Lesions
Gerber Subcoracoid Impingement Test
Jobe Apprehension-Relocation Test
Speed Test
Yergason Sign
Lift-Off Test
Belly Press Test
Bear-Hug Test for Subscapularis Tear
External Rotation Stress Test
External Rotation Lag Sign
Patte (Hornblower) Sign
Drop Sign
Internal Rotation Lag Sign
Imaging
Impingement Syndrome
Subcoracoid Impingement
Internal Impingement
Primary (External) Impingement
Complications
Rotator Cuff Tear
Partial-Thickness and Full-Thickness Tears
Massive and Irreparable Tears
Complications
Cuff Tear Arthropathy
Adhesive Capsulitis
Primary Frozen Shoulder
Treatment
Complications
Calcific Tendinitis
Chronologic Progression
Percutaneous and Surgical Treatment
Quadrilateral Space Syndrome
Suprascapular Nerve Entrapment
Elbow Injuries
Elbow Tenopathies
Lateral Epicondylitis (Tennis Elbow)
Treatment
Medial Epicondylitis
Elbow Contractures
Heterotopic Ossification
References
Supplemental References
Chapter 47: Recurrent Dislocations
Patella
Clinical Features
Radiographic Features
Conservative Treatment
Acute Patellar Dislocation or Subluxation
Surgical Treatment of Patellar Instability
Iatrogenic Medial Patellar Instability
Hip
Sternoclavicular Joint
Shoulder
Normal Functional Anatomy
Pathologic Anatomy
Classification
History
Physical Examination
Radiographic Evaluation
Examination Using Anesthetic and Arthroscopy
Anterior Instability of the Shoulder
Surgical Treatment
Unsuccessful Surgical Repairs for Anterior Instability
Multidirectional Instability of the Shoulder
Capsular Shift With Incision Adjacent to the Glenoid
Hill-Sachs Lesions
Posterior Instability of the Shoulder
Conservative Treatment
Surgical Treatment
Surgical Failures
Arthroscopic Surgery
Elbow
Anatomy
Pathophysiology
Physical Examination
Nonoperative Treatment
Arthroscopy
Surgical Treatment
References
Supplemental References
Chapter 48: Traumatic Disorders
Compartment Syndrome
Anatomy and Pathophysiology
Acute Compartment Syndrome
Clinical Evaluation
Treatment
Acute Compartment Syndrome of Thigh
Acute Compartment Syndrome of Lower Leg
Chronic Exertional Compartment Syndrome
Clinical Evaluation
Treatment
Nonoperative Treatment
Operative Treatment
Rupture of Muscles and Tendons
Rupture of Achilles Tendon
Anatomy and Pathophysiology
Clinical Evaluation
Treatment
Acute Rupture
Open Repair Techniques For Achilles Tendon Rupture
Chronic Rupture
Complications
Rupture of Gastrocnemius Muscle
Tendinosis of Extensor Mechanism of Knee (Jumper’s Knee)
Chronic Patellar Tendinosis
Stress Fracture Through The Patella
Rupture of Extensor Mechanism of Knee
Anatomy and Pathophysiology
Clinical Evaluation
Treatment of Acute Rupture of Patellar Tendon
Treatment of Chronic Rupture of Patellar Tendon
Rupture of Tendon of Quadriceps Femoris Muscle
Acute Rupture
Chronic Rupture
Complications
Rupture of Adductor Longus Muscle
Rupture of Gluteus Medius and Minimus Tendons
Hamstring Tendon Injuries
Treatment
Nonoperative Treatment
Operative Treatment
Complications
Rupture of Biceps Brachii Tendons
Proximal Biceps Tendon Rupture
Distal Biceps Tendon Rupture
Rupture of Pectoralis Major Muscle
Rupture or Avulsion of Triceps Tendon
Displacement of Tendons
Peroneal Tendons
Classification
Clinical and Radiographic Evaluation
Treatment
Complications
Biceps Brachii Tendon
Clinical Evaluation
Treatment
References
Supplemental References
Part XIV: Arthroscopy
Chapter 49: General Principles of Arthroscopy
Instruments and Equipment
Arthroscope
Television Cameras
Accessory Instruments
Probe
Scissors
Basket Forceps
Grasping Forceps
Knife Blades
Motorized Shaving Systems
Electrosurgical, Laser, and Radiofrequency Instruments
Implants
Miscellaneous Equipment
Care and Sterilization of Instruments
Irrigation Systems
Tourniquet
Leg Holders
Anesthesia
Documentation
Advantages
Disadvantages
Indications and Contraindications
Basic Arthroscopic Techniques
Triangulation Technique
Complications
Damage to Intraarticular Structures
Damage to Menisci and Fat Pad
Damage to Cruciate Ligaments
Damage to Extraarticular Structures
Blood Vessels
Compartment Syndromes
Nerves
Ligaments and Tendons
Hemarthrosis
Thrombophlebitis
Infection
Tourniquet Paresis
Synovial Herniation and Fistulas
Instrument Breakage
Implant Complications
References
Supplemental References
Chapter 50: Arthroscopy of the Foot and Ankle
Ankle Arthroscopy
Complications
Ankle Impingement Syndromes
Anterior Ankle Impingement
Outcomes
Posterior Ankle Impingement
Outcomes
Anterior and Posterior Impingement
Osteochondral Lesions of the Talus
Ankle Fractures
Tillaux Fractures
Calcaneal Fractures
Ankle Arthrodesis
Ankle Instability
Other Indications
Septic Arthritis
Arthrofibrosis
Subtalar Arthroscopy
First Metatarsophalangeal Joint Arthroscopy
Tendoscopy/Endoscopy of Tendons
References
Supplemental References
Chapter 51: Arthroscopy of the Lower Extremity
Knee
Basic diagnostic techniques
General principles
Patient positioning
Portal placement
Standard portals
Optional Portals
Insertion of scope
Arthroscopic examination of the knee
Arthroscopic surgery of the meniscus
Classification of meniscal tears
Types of meniscal excisions
Partial Meniscectomy
Subtotal Meniscectomy
General principles
Surgery for specific meniscal tears
Vertical Longitudinal (Bucket-Handle) Tears
Longitudinal Incomplete Intrameniscal Tears
Horizontal, Oblique, Radial, and Complex Tears
Discoid Lateral Meniscus
Meniscal cyst
Arthroscopic repair of torn menisci
Hidden Lesions: Rips, Ramps, and Roots
Radial tears and meniscal root tears
All-Inside Technique
Biologics for Healing
Meniscal replacement
Arthroscopic surgery for other disorders
Loose bodies in the knee joint
Synovial plicae of the knee
Osteochondritis dissecans and chondral defects of the femoral condyles and patella
Osteochondritic Loose Bodies
Osteochondral Autografts
Bone Grafting
Cruciate ligament reconstruction
Anterior Cruciate Ligament Reconstruction
Complications of Anterior Cruciate Ligament Reconstruction
Posterior Cruciate Ligament Reconstruction
Chondromalacia of the patella syndrome
Arthroscopic Medial Parapatellar Plication
Other applications of arthroscopy of the knee
Arthroscopy in fractures around the knee
Arthrofibrosis
Complications associated with knee arthroscopy
Hip
Indications/contraindications
General setup
Portals
Hip capsule
Arthroscopic management of labral tears
Femoroacetabular impingement
Labral Reconstruction
Abductor Tendon Tears
Snapping hips
Revision Hip Arthroscopy
Complications of hip arthroscopy
References
Supplemental References
Chapter 52: Arthroscopy of the Upper Extremity
Shoulder
Indications
Patient Positioning and Anesthesia
Lateral Decubitus Position
Beach-Chair Position
Control of Bleeding During Arthroscopy
Fluid Extravasation
Portal Placement
Posterior Portal
Posteroinferior Seven-O’clock Portal
Anterior Portal
Anteroinferior Five-O’clock Portal (Used With Caution)
Superior Portal
Suprascapular Nerve Portal As Described By Lafosse
Lateral, Posterolateral, and Anterolateral Portals
Portal of Wilmington
Diagnostic Arthroscopy and Arthroscopic Anatomy
Loose Bodies
Synovectomy
Drainage and Debridement
Labral Tears
Biceps Tendon Lesions
Subpectoral Biceps Tenodesis
Anterior Instability
Arthroscopic Bankart-Bristow-Latarjet Technique
Posterior Instability
Multidirectional Instability
Humeral and/or Glenoid Avulsion of the Inferior Glenohumeral Ligament
Hill-Sachs Lesion
Bony Bankart Lesions and Glenoid Fractures
Latarjet Procedure
Subacromial Impingement Syndrome
Partial-Thickness Rotator Cuff Tears
Full-Thickness Rotator Cuff Tears
Massive Contracted Rotator Cuff Tears
Subscapularis Tendon Tears
Acromioclavicular Joint Osteoarthritis
Acromioclavicular Joint Separation
Calcific Tendinitis of the Rotator Cuff
Osteoarthritis
Posterior Ossification of the Shoulder (Bennett Lesion)
Spinoglenoid Cyst
Shoulder Contractures
Suprascapular Nerve Entrapment
Complications
Elbow
Indications
Patient Positioning and Anesthesia
Supine Position
Prone Position
Lateral Decubitus Position
Portal Placement
Evaluation of the Elbow
Loose Bodies
Panner Disease and Osteochondritis Dissecans
Throwing Injuries
Evaluation of Ulnar Collateral Ligament Function
Posterior Elbow Impingement
Posterolateral Synovial Plica Syndrome
Radial Head Resection
Arthrofibrosis
Osteoarthritis
Synovectomy
Tennis Elbow
Olecranon Bursitis
Arthroscopic-Assisted Intraarticular Fracture Care
Pyarthrosis
Complications
Wrist
References
Supplemental References
Part XV: Fractures and Dislocations in Adults
Chapter 53: General Principles of Fracture Treatment
Classification of Fractures
Classification of Soft-Tissue Injuries
Trauma Principles
Open Fractures
Open Fractures Caused by Firearms
Amputation Versus Limb Salvage
Antibiotic Treatment
Treatment of Soft-Tissue Injuries
Debridement
Treatment of Bone Injuries
Fracture Stabilization
Fracture Healing (Bone Regeneration)
Stimulation of Fracture Healing
Bone Grafting
Autologous Bone Grafts
Bone Graft Substitutes
Allograft-Based Bone Graft Substitutes
Growth Factor–Based Bone Graft Substitutes
Cell-Based Bone Graft Substitutes
Ceramic-Based Bone Graft Substitutes
Polymer-Based Bone Graft Substitutes
Miscellaneous Bone Graft Substitutes
Electrical and Ultrasound Stimulation
Factors That Negatively Affect Bone Healing
Principles of Surgical Treatment
General Indications for Surgical Reduction and Stabilization
Contraindications to Surgical Reduction and Stabilization
Disadvantages of Surgical Reduction and Stabilization
Timing of Surgical Treatment
Lambotte’s Principles of Surgical Treatment of Fractures
Biomaterials of Fracture Fixation
Metals
Bioabsorbable Materials
Complications
Biomechanics of Implant Design and Fracture Fixation
Pin and Wire Fixation
Screw Fixation
Machine Screws
Internal Fixation Screws
Cortical Screws
Cancellous Screws
Self-Tapping, Self-Drilling Screws
Locking Screws
Screws Fixation Techniques
Plate and Screw Fixation
Locking Plates
Intramedullary Nail Fixation
Types of Intramedullary Nails
Reamed Versus Unreamed Intramedullary Nailing
External Fixation
Advantages
Disadvantages
Complications
Pin Track Infection
Neurovascular Impalement
Muscle or Tendon Impalement
Delayed Union
Compartment Syndrome
Refracture
Limitation of Future Alternatives
Indications
Accepted Indications
Possible Indications
Fixation of Multiple Closed Fractures
Severely Comminuted Fractures
Ligamentotaxis
Fixation of Fractures in Patients With Head Injuries
Fixation of Fractures in Patients who Require Frequent Transportation for Diagnostic Testing, Therapy, or Other Surgical Procedures
Fixation of Floating Knee Fractures
Assessment of Knee Ligament Stability With Fractures of the Upper Tibia or Lower Femur in Patients in Whom Integrity of Knee Ligaments is Difficult to Assess
Occasional Indications
Design and Application of External Fixators
General Method for Half-Pin Fixators
General Method for Circular Wire Fixators
Ilizarov External Fixator
Rehabilitation
Treatment of Complications From Surgical Treatment of Fractures
Infection
Gas Gangrene
Tetanus
Soft-Tissue Complications
Thromboembolic Complications
Biomechanical Construct Complications
References
Supplemental References
Chapter 54: Fractures of the Lower Extremity
Ankle
Classification
Isolated Fractures of the Medial and Lateral Malleoli
Medial Malleolar Fracture
Stress Fracture of the Medial Malleolus
Lateral Malleolar Fracture
Bimalleolar Fracture
Syndesmotic Injury
Deltoid Ligament Tear and Lateral Malleolar Fracture
Irreducible Fracture or Fracture-Dislocation
Trimalleolar Fracture
Posterior Tibial Lip Fracture
Fracture of the Anterior Tibial Margin at the Ankle Joint
Ankle Fractures in Patients With Diabetes
Open Ankle Fractures
Unstable Ankle Fracture-Dislocation
Tibial Pilon Fracture
Open Reduction and Plate Fixation
Two-Stage Delayed Open Reduction and Internal Fixation
Plating Technique
Minimally Invasive Plating
Posterolateral Approach to Pilon Fractures
Combined Internal and External Fixation
External Fixation and Fibular Plating
Spanning External Fixation
Hybrid External Fixation
Primary Arthrodesis
Fractures of the Tibial Shaft
Treatment
Cast Bracing
Plate and Screw Fixation
Transfixation by Screws
Intramedullary Fixation
Reamed Versus Unreamed Nailing
Intramedullary Nailing of Fractures of the Proximal Third of the Tibial Shaft
Intramedullary Nailing of Fractures of the Distal Tibial Shaft
Anterior Knee Pain After Intramedullary Nailing
Intramedullary Interlocking Nails
Preoperative Planning
External Fixation
Half-Pin Fixators
Preoperative Planning
Complications
Ilizarov External Fixation Device
Ilizarov Method in Open Fractures
Reconstructive Procedures
Preoperative Planning
Complications
Treatment of Delayed Union or Nonunion
Fixation of the Fibula for Tibial Fracture
Deformities of the Foot and Toes After Tibial Fracture
Tibial Plateau Fracture
Fracture Classification
Fracture-Dislocation Classification
Evaluation
Treatment
Fracture of the Lateral Condyle
Ligament Injury With Condylar Fracture
Arthroscopically Assisted Reduction and Fixation of Tibial Plateau Fractures
Fracture of the Medial Condyle
Comminuted Proximal Fractures
Patella
Treatment
Comminuted Patellar Fractures
Distal Femur
Plate and Screw Fixation
Dynamic Condylar Screw Fixation
Intramedullary Nailing
External Fixation
Condylar Fractures of the Femur
Unicondylar Fractures of the Femur
Intercondylar Fractures of the Femur
Locking Condylar Plate Fixation
Less Invasive Stabilization System
Supracondylar Fractures of the Femur
Shaft of the Femur
Traction and Cast Immobilization
External Fixation
Fixation With Plates and Screws
Intramedullary Fixation
Preoperative Planning
Retrograde Nailing of the Femur
Errors and Complications of Intramedullary Fixation
Patient Positioning and Traction
Errors in Nail Insertion
Bent or Broken Nails
Infections
Intramedullary Fixation in Pathologic Fractures
Fracture of the Femoral Shaft With Dislocation of the Hip
References
Supplemental References
Chapter 55: Fractures and Dislocations of the Hip
Femoral Neck Fractures
Classification
Diagnosis
Treatment
Operative Treatment
Implant Choice
Outcomes and Complications
Failure of Fixation
Nonunion and Osteonecrosis
Arthroplasty
Basicervical Femoral Neck Fractures
Intertrochanteric Femoral Fractures
Classification
Treatment
Treatment With Screw–Side Plate Devices
Treatment With Intramedullary Nails
Short or Long Nails for Intertrochanteric Femoral Fractures
Plate Fixation Compared With Intramedullary Nail Fixation
Subtrochanteric Femoral Fractures
Classification
Treatment
Intramedullary Nailing
Plate Fixation
Hip Dislocations and Femoral Head Fractures
Reduction Maneuvers for Posterior Hip Dislocation
Reduction Maneuver for Anterior Hip Dislocation
Fractures of the Ipsilateral Femoral Neck and Shaft
References
Supplemental References
Chapter 56: Fractures of the Acetabulum and Pelvis
Acetabular Fractures
Anatomy
Radiographic Evaluation
Classification
Treatment
Initial Treatment
Indications for Nonoperative Treatment
Nondisplaced and Minimally Displaced Fractures
Fractures With Significant Displacement but in Which the Region of the Joint Involved is Judged to be Unimportant Prognostically
Secondary Congruence in Displaced Both-Column Fractures
Medical Contraindications to Surgery
Local Soft-Tissue Problems, Such as Infection, Wounds, and Soft-Tissue Lesions From Blunt Trauma
Elderly Patients With Osteoporotic Bone
Indications for Operative Treatment
Fracture Characteristics
Incarcerated Fragments in the Acetabulum After Closed Reduction of a Hip Dislocation
Prevention of Nonunion and Retention of Sufficient Bone Stock for Later Reconstructive Surgery
Timing of Surgery
Choice of Surgical Approach
Specific Fracture Patterns
Posterior Wall Fractures
Posterior Column Fractures
Anterior Wall and Anterior Column Fractures
Transverse Fractures
Posterior Column Fracture With Associated Posterior Wall Fracture
Transverse Fracture With Associated Posterior Wall Fracture
T-Shaped Fractures
Anterior Column–Posterior Hemitransverse Fractures
Associated Both-Column Fractures
Postoperative Care
Outcome and Complications
Acute Total Hip Arthroplasty as Treatment of Acetabular Fracture
Complications of Acute Total Hip Arthroplasty for Acetabular Fracture
Total Hip Arthroplasty for Posttraumatic Arthritis
Pelvic Fractures
Anatomy
Radiographic Evaluation
Classification
Treatment
Initial Management
Indications for Nonoperative and Operative Treatment
Timing of Surgery
Choice of Treatment
External Fixation
Internal Fixation of the Anterior Pelvis
Posterior Approach and Internal Fixation
Percutaneous Iliosacral Screw Fixation of Sacroiliac Disruptions and Sacral Fractures (Supine)
Outcomes
References
Supplemental References
Chapter 57: Fractures of the Shoulder, Arm, and Forearm
Clavicle
Treatment options
Plate and screw fixation
Intramedullary fixation
Lateral clavicular fractures
Fractures Around The Shoulder
Fractures of the scapula
Treatment options
Glenoid fractures
Scapular body or neck fractures
Proximal humeral fractures
Classification
Radiographic evaluation
Nonoperative treatment
Operative treatment
Fixation of specific fracture types
Complications
Fractures of the Humeral Shaft
Indications for operative treatment
Plate osteosynthesis
Implant choice
Approach
Postoperative care
Complications
Intramedullary fixation
Fractures of the Humeral Shaft With Radial Nerve Palsy
Periprosthetic humeral shaft fractures
Distal humeral fractures
Fractures, Dislocations, and Fracture-Dislocations of the Elbow
Fractures of the radial head
Operative treatment
Treatment of mason type II Fractures
Treatment of Mason Type III Fractures
Fractures of the coronoid
Simple elbow dislocations
Fracture-dislocations of the elbow
Treatment
“Terrible triad” injuries of the elbow
Treatment
Complications
Radial head and neck fractures associated with elbow dislocation
Fractures and fracture-dislocations of the olecranon
Fractures
Treatment
Fracture-Dislocations
Fractures of the radial head or neck with dislocation of the distal radioulnar joint (essex-lopresti fracture-dislocation)
Fractures of the proximal third of the ulna with dislocation of the radial head (monteggia fracture-dislocation)
Fractures of the Shafts of the Radius and Ulna
Fractures of the distal third of the radius with dislocation of the distal radioulnar joint (galeazzi fracture-dislocation)
Fractures of the Distal Radius
Classification
Assessment of stability
Treatment options
Closed treatment
Percutaneous pinning
External Fixation
Open reduction and plate fixation
Dorsal Plating
Volar Plating
Fragment-Specific Open Reduction and Internal Fixation of Comminuted Distal Radial Fractures
Complications
References
Supplemental References
Chapter 58: Malunited Fractures
Foot
Phalanges of the Toes
Metatarsals
Tarsals
Talus
Malunion of the Talar Neck
Malunion of the Talar Body
Calcaneus
Ankle
Arthrodesis for Malunited Fractures of the Ankle
Tibia
Shafts of the Tibia and Fibula
Condyles of the Tibia
Inverted-Y Fractures of the Tibial Condyles
Fracture of the Intercondylar Eminence of the Tibia
Patella
Femur and Hip
Condyles of the Femur
Lateral Femoral Condyle
Medial Femoral Condyle
Both Femoral Condyles
Supracondylar Femur
Femoral Shaft
Femoral Malunion in Children
Trochanteric Region of the Femur
Subtrochanteric Osteotomy for Coxa Vara and Rotational Deformities
Cervicotrochanteric Region of the Femur
Acetabulum
Pelvis
Three-Stage Reconstruction for Pelvic Malunions
Scapula
Clavicle
Midshaft Malunions of the Clavicle
Humerus
Proximal Humerus
Evaluation
Treatment
Acromioplasty and Osteotomy
Arthroplasty
Humeral Shaft
Middle Third
Distal Humerus
Forearm
Proximal Third of the Radius and Ulna
Radial Head
Radial Neck
Olecranon
Proximal Third of the Ulna with Anterior Dislocation of the Radial Head (Monteggia Fracture)
Synostosis Between the Radius and the Ulna
Shafts of the Radius and Ulna in Adults
Forearm Malunions with Distal Radioulnar Joint Instability
Shaft of the Ulna
Distal Radius
Clinical Evaluation
Radiographic Evaluation
Operative Treatment
Extraarticular Malunion with Dorsal Angulation
Osteotomy and Grafting of the Radius
Extraarticular Malunion with Volar Angulation
Intraarticular Malunions
Salvage Procedures
Distal Radioulnar Joint Incongruity and Arthrosis
Carpus
Hand
References
Supplemental References
Chapter 59: Delayed Union and Nonunion of Fractures
Definitions
Delayed union
Nonunion
Etiology and Pathophysiology
General Treatment of Nonunions
Preoperative workup
Considerations before surgery
Status of soft tissues and neurovascular structures
Status of bones
Reduction and preparation of nonunions
Bone grafting
Ceramics
Stabilization of fragments
Plating
Intramedullary nailing
External fixation
Arthroplasty
Amputation
Low-intensity ultrasound
Electrical and electromagnetic stimulation
Extracorporeal shock-wave therapy
Factors Complicating Nonunion
Infection
Conventional treatment
Active treatment
Polymethyl methacrylate antibiotic Beads
Deformity, shortening, and segmental Bone loss
Ilizarov method
Taylor spatial frame method
Corticotomy
Nonunion of Specific Bones
Tibia
Medial malleolus
Tibial shaft
Role of the Fibula in Tibial Nonunion Treatment
Internal fixation
Plate Fixation
External fixation
Distal tibia
Fibula
Lateral malleolus
Fibular shaft
Patella
Femur
Supracondylar area
Femoral shaft
Peritrochanteric and subtrochanteric region
Femoral neck
Osteotomy
Prosthetic Replacement
Arthrodesis
Pelvis and acetabulum
Clavicle
Humerus
Proximal third
Humeral shaft
Distal humerus
Proximal third of the ulna with dislocation of the radial head
Forearm bones
Both radius and ulna
Radius or ulna alone
Distal End of the Radius
Proximal end of ulna
Distal end of ulna
References
Supplemental References
Chapter 60: Acute Dislocations
Indications for Open Ankle
Ankle
Patella
Acute Dislocations of the Patella
Intraarticular Dislocations of the Patella
Knee
Proximal Tibiofibular Joint
Hip
Complications
Pubic Symphysis and Sacroiliac Joints
Sternoclavicular Joint
Acromioclavicular Joint
Etiology and Classification
Clinical Findings
Treatment
Shoulder
Elbow
Dislocation of The Radial Head
Dislocation of Radial Head and Fracture of Proximal Third of Ulna (Monteggia Fracture)
Fracture-Dislocation of Elbow with Severe Damage of Soft Structures
Distal Radioulnar Joint
References
Supplemental References
Chapter 61: Old Unreduced Dislocations
Foot
Ankle
Proximal Tibiofibular Joint
Knee
Patella
Hip
Chronic Anterior Dislocations
Chronic Posterior Dislocations
Sternoclavicular Joint
Posterior Dislocations
Acromioclavicular Joint
Shoulder
Treatment
Closed Reduction
Open Reduction
Anterior Dislocations
Posterior Dislocations
Hemiarthroplasty
Total Shoulder Arthroplasty
Elbow
Closed Reduction
Open Reduction
Elbow Arthroplasty
Anterior Dislocation of the Radial Head
References
Supplemental References
Part XVI: Peripheral Nerve Injuries of the Upper and Lower Extremities
Chapter 62: Peripheral Nerve Injuries
Anatomy of the Spinal Nerves
Components of Mixed Spinal Nerves
Motor
Sensory
Sympathetic
Gross Anatomy
Microscopic Anatomy
Internal Topography of Peripheral Nerves
Neuronal Degeneration and Regeneration
Classification of Nerve Injuries
Effects of Peripheral Nerve Injuries
Motor
Sensory
Reflex
Autonomic
Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
Clinical Presentation
Treatment
Etiology of Peripheral Nerve Injuries
Clinical Diagnosis of Nerve Injuries
Diagnostic Tests
Imaging
Electrodiagnostic Studies
Nerve Conduction Velocity
Electromyography
Tinel Sign
Sweat Test
Skin Resistance Test
Electrical Stimulation
General Considerations of Treatment of Nerve Injuries
Factors That Influence Regeneration After Neurorrhaphy
Age
Gap Between Nerve Ends
Delay Between Time of Injury And Repair
Level of Injury
Condition of Nerve Ends
General Considerations for Surgery
Indications
Time of Surgery
Instruments and Equipment
Anesthesia
Preparation and Draping
Technique of Nerve Repair
Endoneurolysis (Internal Neurolysis)
Partial Neurorrhaphy
Neurorrhaphy and Nerve Grafting
Methods of Closing Gaps Between Nerve Ends
Mobilization
Positioning of Extremity
Transposition
Bone Resection
Nerve Grafting
Nerve Crossing (Pedicle Grafting)
Source of Nerve for Interfascicular Nerve Grafting
Nerve Allografts
Synthetic Nerve Conduits
Techniques of Neurorrhaphy
Results of Operation
Cervical Plexus
Spinal Accessory Nerve
Treatment
Results of Suture of the Spinal Accessory Nerve
Nerve Transfers
Upper Extremity Nerve Injuries
Suprascapular Nerve
Examination
Treatment
Long Thoracic Nerve
Axillary Nerve
Examination
Treatment
Methods of Closing Gaps
Results After Axillary Nerve Injury
Tendon and Muscle Transfers for Paralysis of the Deltoid
Musculocutaneous Nerve
Examination
Treatment
Methods of Closing Gaps
Results After Injury to the Musculocutaneous Nerve
Radial Nerve
Examination
Treatment
Methods of Closing Gaps
Results of Suture of the Radial Nerve
Critical Limit of Delay of Suture
Ulnar Nerve
Examination
Treatment
Methods of Closing Gaps
Results of Suture of the Ulnar Nerve
Critical Limit of Delay of Suture
Nerve Reconstruction
Median Nerve
Examination
Treatment
Methods of Closing Gaps
Results of Suture of the Median Nerve
Critical Limit of Delay of Suture
Lumbar Plexus
Femoral Nerve
Examination
Treatment
Methods of Closing Gaps
Results of Suture of the Femoral Nerve
Sacral Plexus
Sciatic Nerve
Examination
Treatment
Methods of Closing Gaps
Results of Suture of the Sciatic Nerve
Critical Limit of Delay of Suture
Common, Superficial, and Deep Peroneal Nerves
Examination
Treatment
Methods of Closing Gaps
Results of Suture of the Peroneal Nerve
Critical Limit of Delay of Suture
Tendon Transfer for Peroneal Nerve Paralysis
Tibial Nerve
Examination
Treatment
Approach to the Tibial Nerve in the Popliteal Fossa
Methods of Closing Gaps
Results of Suture of the Tibial Nerve
References
Supplemental References
Part XVII: Microsurgery
Chapter 63: Microsurgery
Microvascular Techniques
Replantation
Results
Replantation team
General considerations
Indications and contraindications
Age
Severity of injury
Level of injury and part amputated
Warm ischemia (anoxic) time
Preexisting deformity or disability
Conditions that might preclude replantation
Management and transportation of patient and part
Preoperative preparation
Order of repair
Management of bones and joints
Transposition of digits
Tendon repair
Flexor tendons
Extensor tendons
Vessel repair
Order of vessel repair
Management of circulatory compromise after replantation
Complications
Rehabilitation
Monitoring techniques after microvascular surgery
Revascularization
Special techniques
Single-Stage Tissue Transfer (Free Flaps)
Indications and advantages
Contraindications and disadvantages
Selection of free flaps
Upper extremity
Lower extremity
Preoperative requirements
General plan of procedure
General postoperative care
Monitoring
Free groin flap
Vascular anatomy
Anterolateral thigh flap
Vascular anatomy
Scapular and parascapular flap
Vascular anatomy
Lateral arm flap
Vascular anatomy
Muscle and Musculocutaneous Free Flaps
Latissimus dorsi transfer
Vascular anatomy
Serratus anterior flap
Vascular anatomy
Tensor fasciae latae muscle flap
Vascular anatomy
Gracilis muscle transfer
Vascular anatomy
Rectus abdominis transfer
Vascular anatomy
Functioning Neuromuscular Transfers
Free Vascularized Bone Transplant
Indications
Preoperative planning
Free vascularized fibular transfer
Free vascularized medial femoral condyle flap
Composite Free Tissue Transfers From the Foot
Neurovascular anatomy
Dorsalis pedis flap
First web space, pulp, and hemipulp neurovascular free flaps
Great toe wraparound flap
Thumb and Finger Reconstruction
Single-stage transfer of the great toe
Indications
Preoperative planning
Second and third toe transplantation
Preoperative preparation
Vascularized Free Flaps Containing Joints and Epiphyses
References
Supplemental References
Part XVIII: The Hand
Chapter 64: Basic Surgical Technique and Postoperative Care
Preoperative Planning and Preparation
Perioperative Antibiotics
Arrangement and Routine in the Operating Room
Choice of Anesthesia
Brachial plexus blocks
Intravenous regional anesthesia
Peripheral nerve blocks
Digital nerve blocks
Local infiltration
WALANT approach
WALANT Administration
Preparation and Draping for Elective Surgery
Tourniquet
Instruments
Basic Skin Technique
Incisions
Finger incisions
Thumb incisions
Palmar incisions
Basic skin closure techniques
Care After Surgery
Splinting
References
Supplemental References
Chapter 65: Acute Hand Injuries
History
Examination
Splinting
Anesthesia
Tourniquet
Cleansing and Draping of Hand
Considerations for Amputation
Order of Tissue Repair
Arterial Injuries
Considerations for Skin Closure
Methods and Indications for Skin Closure
Direct Suture
Skin Grafts
Skin Flaps
Coverage of Specific Areas with Flaps
Management of Donor Area
Grafts and Flaps
Free Grafts
Split-Thickness Skin Grafts
Obtaining Skin Grafts with A Dermatome
Free Full-Thickness Grafts
Skin Flaps
Local Flaps
Local Flaps in Fingers
Local Flaps From the Dorsum of the Hand
Cross Finger Flaps
Forearm Flaps For Hand Coverage
Radial Forearm Flap
Posterior Interosseous Flap
Abdominal Flaps
Random Pattern Abdominal Pedicle Flaps
Axial Pattern Flaps
Filleted Grafts
Skin Coverage
Granulating Areas
Scars
Methods of Correcting Linear Scars
Methods of Correcting Area Scars
References
Supplemental References
Chapter 66: Flexor and Extensor Tendon Injuries
Flexor Tendons
Examination
Basic tendon techniques
Suture material
Suture configurations
End-to-End Suture Techniques
Double Right-Angled Suture
Fish-Mouth End-To-End Suture (Pulvertaft)
Tendon-to-Bone Attachment
Suture Anchor Tendon Attachment
Timing of flexor tendon repair
Partial flexor tendon lacerations
Primary flexor tendon repair
Zone I
Zone II
Zone III
Zone IV
Zone V
Delayed repair of acute injuries
Primary suture of flexor tendons
Flexor Tendon Injuries In Children
Flexor tendon ruptures
Treatment
Postrepair rupture
Repair of flexor tendon of thumb
Zone I
Zone II
Zone III
Zone IV
Zone V
Secondary repair and reconstruction of flexor tendons
Flexor tendons of fingers
Zone I (Distal Half of Finger)
Zone II (Critical Area of Pulleys)
Zones III, IV, and V (Forearm and Palm)
Donor tendons for grafting
Palmaris Longus
Plantaris Tendon
Long Extensors of Toes
Extensor Indicis Proprius, Extensor Digitorum Communis of Index
Flexor Digitorum Sublimis
Complications
“Lumbrical Plus” Finger
“Quadriga” Effect
Reconstruction of flexor tendon pulleys
Reconstruction of finger flexors by two-stage tendon graft
Long Flexor of Thumb
Flexor tenolysis after repair and grafting
Adherence of tendons
Adherence of a Tendon to a Fracture Site
Extensor Tendons
Anatomy
Examination
Extensor tendon repair
Zone I
Extensor Tendon Rupture
Acute Transection of Extensor Tendon
Correction of an old Mallet Finger Deformity by Tendon Transfer or Tendon Graft
Zone II
Zone III
Rupture or Acute Transection of the Central Slip of the Extensor Expansion (Boutonniere Deformity)
Chronic Boutonniere Deformity (Secondary Repair and Reconstruction)
Zone IV
Zone V
Traumatic Dislocation of the Extensor Tendon at the Metacarpophalangeal Joint
Zone VI
Zone VII
Zone VIII
Zone IX
Secondary repair of extensor tendons
Extensors of the thumb
Zones TI and TII
Zones TIII and TIV
Zone TV
References
Supplemental References
Chapter 67: Fractures, Dislocations, and Ligamentous Injuries of The Hand and Wrist
Principles of Treatment
Open Fractures and Dislocations
Basic Fracture Techniques
Thumb
Bennett Fracture
Complications
Rolando Fracture (Comminuted First Metacarpal Base) and Other Fractures Involving the First Carpometacarpal Joint
Thumb Carpometacarpal Joint Dislocation
Thumb Metacarpophalangeal Fractures and Dislocations
Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Rupture
Chronic Ulnar Collateral Ligament Reconstruction
Radial Collateral Ligament Injuries
Finger Metacarpals
Carpometacarpal Fracture-Dislocations
Intraarticular Fracture of the Fifth Metacarpal Base
Finger Metacarpophalangeal Dislocations
Metacarpal Shaft or Neck Fractures
Metacarpal Head Fractures
Minicondylar Plate Fixation
Wiring Techniques
Phalanges
Fracture of The Middle or Proximal Phalanx
Proximal Interphalangeal Joint Fracture-Dislocation
Closed Reduction and Extension Block Splinting
Dynamic External Splint Reduction
Interphalangeal Dislocations
Unstable Proximal Interphalangeal Joint Secondary to Chronic Collateral Ligament Rupture
Undiagnosed Interphalangeal Dislocations
Distal Phalangeal Fractures
Mallet Finger
Intraarticular Fractures
Complications of Hand Fractures
Malunion
Nonunion
Contracture
References
Supplemental References
Chapter 68: Nerve Injuries at the Level of the Hand and Wrist
Evaluation
Preoperative Assessment
Type of Injury
Sensibility Evaluation
Motor Function
Sudomotor Function
Postoperative Assessment
Sensibility Evaluation
Motor Function
Subjective Evaluation
Sudomotor Function
Nerve Regeneration
Primary and Delayed Primary Nerve Repair
Timing of Repair
Indications
Secondary Nerve Repair
Indications
Suturing of Nerves
Nerve Grafts
Indications
Sources of Nerve Grafts
Alternative Nerve Graft Material
Management of Specific Nerve Injuries
Digital Nerves
Nerve Transfers to Restore Digital Sensation
Ulnar Nerve at the Wrist
Deep Branch of the Ulnar Nerve
Dorsal Branch of the Ulnar Nerve
Median Nerve at the Wrist
Median Nerve in the Palm
Superficial Radial Nerve
Traumatic Neuromas
Neurovascular Island Grafts
References
Supplemental References
Chapter 69: Wrist Disorders
Anatomy
Circulation
Biomechanics and kinematics
Diagnosis of Wrist Conditions
History
Physical examination
Radiographic techniques
Other diagnostic techniques
Arthroscopy of the Wrist
Indications
Complications
Equipment
Positioning and preparation of the patient
General principles
Fractures and Dislocations of the Carpal Bones, Including Kienböck Disease
Fractures of the scaphoid
Etiology
Anatomy and blood supply of the scaphoid bone
Diagnosis and treatment
Nondisplaced, Stable Scaphoid Fractures
Displaced, Unstable Scaphoid Fractures
Nonunion of Scaphoid Fractures
Styloidectomy
Excision of the Proximal Fragment
Excision of the Distal Scaphoid
Proximal Row Carpectomy
Malpositioned Nonunion of Scaphoid Fractures (“Humpback” Deformity)
Vascularized Bone Grafts
Arthrodesis of the Wrist
Naviculocapitate fracture syndrome and capitate fractures
Fractures of other carpal bones
Fracture of the hamate
Trapezium and trapezoid fractures
Fractures of the lunate and kienböck disease
Joint leveling procedures
Capitate Shortening
Osteotomies of the distal radius
Core decompression
Lunate revascularization procedures
Prosthetic lunate replacement
Distal Radioulnar and Ulnocarpal Joint Injuries
Anatomy
Diagnosis and treatment
Lesions of the triangular fibrocartilage complex, including traumatic distal radioulnar joint instability
Physical Examination
Radiographic Evaluation
Arthroscopic Evaluation
Classification
Treatment of Traumatic Lesions of the Triangular Fibrocartilage Complex (Palmer Class 1)
Chronic instability of the distal radioulnar joint
Procedures to stabilize the distal radioulnar joint
Ulnar Impaction-Abutment and Distal Radioulnar Joint Arthritis
Ulnar Shortening Procedures
Procedures to stabilize the unstable proximal ulnar segment after distal ulnar excision
Arthrodesis of the wrist
Carpal Ligament Injuries and Instability Patterns
Instability classification
Progressive perilunar instability
Rotary subluxation of the scaphoid
Anterior dislocation of the lunate
Palmar transscaphoid perilunar dislocations
Dorsal transscaphoid perilunar dislocations
Triquetrolunate and midcarpal instabilities
Other instability patterns
Treatment options for wrist ligament injuries and instability
Capsulodesis
Limited wrist arthrodesis
Indications for Triscaphe Arthrodesis
Contraindications for Triscaphe Arthrodesis
Other limited wrist arthrodeses
Triquetrohamate Arthrodesis
Osteoarthritis of the Wrist
References
Supplemental References
Chapter 70: Special Hand Disorders
Aneurysm, Thrombosis, and Embolism in Radial, Ulnar, and Digital Arteries
Thermal Burns
Electrical Burns
Radiation Burns
Chemical Burns
Frostbite
Injection Injuries
Shotgun Injuries
Wringer Injuries
Extravasation Injuries
Focal Dystonia of the Hand
Psychoflexed and Psychoextended Hands (Dysfunctional Postures)
Factitious Hand Syndromes
References
Supplemental References
Chapter 71: Paralytic Hand
Principles of Tendon Transfer
Planning Tendon Transfer
Evaluating Muscles for Tendon Transfer
Timing of Tendon Transfer
Technical Considerations for Tendon Transfer
Restoration of Pinch
Restoration of Thumb Opposition
Correction of Thumb Deformity
Tendon Transfers to Restore Opposition
Restoration of Adduction of the Thumb
Restoration of Abduction of the Index Finger
Restoration of Intrinsic Function of the Fingers
Peripheral Nerve Palsies
Radial Nerve Palsy
Low Ulnar Nerve Palsy
High Ulnar Nerve Palsy
Low Median Nerve Palsy
High Median Nerve Palsy
Combined Low Median and Ulnar Nerve Palsy (At the Wrist)
Combined High Median and Ulnar Nerve Palsy (Above the Elbow)
Severe Paralysis From Damage to the Cervical Spinal Cord or Other Causes
Tetraplegia
Classification
Principles of Management
Elbow Extension
Forearm Pronation
Wrist Extension
Key Pinch
References
Supplemental References
Chapter 72: Cerebral Palsy of the Hand
Patient Evaluation
Nonoperative Management
Operative Management
Goals
Principles
Pronation Contracture of the Forearm
Flexion Deformities of the Wrist and Fingers
Thumb-in-Palm Deformity
Treatment
Swan-Neck Deformity
References
Supplemental References
Chapter 73: Arthritic Hand
Rheumatoid Arthritis
Osteoarthritis
Systemic Lupus Erythematosus
Psoriatic Arthritis
Reiter Syndrome
Gout
Scleroderma (Progressive Systemic Sclerosis)
Nonoperative Treatment of Synovitis and Tenosynovitis
Rheumatoid Nodules
Staging of Operations
Finger Deformities Caused by Rheumatoid Arthritis
Intrinsic Plus Deformity
Swan-Neck Deformity
Intrinsic Release
Boutonniere Deformity
Interphalangeal Joint Arthroplasty
Proximal Interphalangeal Joint Implant Arthroplasty
Distal Interphalangeal Joint Deformities
Ulnar Drift or Deviation of the Fingers
Mild-to-Moderate Ulnar Drift
Severe Ulnar Drift and Metacarpophalangeal Dislocation
Extensor Tenosynovitis
Extensor Tendon Rupture
Flexor Tendon Rupture
Persistent Proximal Interphalangeal Joint Synovitis
Flexor Tenosynovitis
Finger Joint Arthrodesis
Distal Interphalangeal Joint Arthrodesis
Deformities of the Thumb
Classification
Type I
Type II
Type III
Type IV
Osteoarthritis
Correction of Arthritic Thumb Deformities
Synovectomy
Soft-Tissue Reconstruction
Arthroplasty
Trapeziometacarpal Ligament Reconstruction
Trapeziometacarpal Arthroplasty
Implant Arthroplasty
Arthrodesis of Thumb Joints
Trapeziometacarpal Arthrodesis
Rheumatoid Deformities of the Wrist
Synovitis of the Wrist
Wrist Arthrodesis and Arthroplasty
Distal Radioulnar Joint Arthroplasty
Total Wrist Arthroplasty
References
Supplemental References
Chapter 74: Compartment Syndromes and Volkmann Contracture
Definition and History
Anatomy
Etiology
Diagnosis
Management
Acute compartment syndrome of the forearm
Established volkmann contracture of the forearm
Muscle sliding operation of flexors for established volkmann contracture
Established Intrinsic Muscle Contractures of the Hand
Adducted thumb
References
Supplemental References
Chapter 75: Dupuytren Contracture
Pathogenesis
Prognosis
Nonoperative Treatment
External Beam Radiation
Collagenase Injections
Manipulation
Percutaneous Needle Aponeurotomy
Operative Treatment
References
Supplemental References
Chapter 76: Stenosing Tenosynovitis of the Wrist and Hand
Stenosing Tenosynovitis
De quervain disease
Trigger finger and thumb
Bowler’s thumb
References
Supplemental References
Chapter 77: Compressive Neuropathies of the Hand, Forearm, and Elbow
Carpal Tunnel Syndrome
Diagnosis
Treatment
Surgical release
Endoscopic release
Unrelieved or recurrent carpal tunnel syndrome
Ulnar Tunnel Syndrome
Cubital Tunnel Syndrome and Tardy Ulnar Nerve Palsy
Revision cubital tunnel surgery
Pronator Syndrome and Anterior Interosseous Syndrome
Examination
Treatment
Radial Tunnel Syndrome
Examination
Treatment
References
Supplemental References
Chapter 78: Tumors and Tumorous Conditions of the Hand
Classification
Diagnosis
Treatment
Benign Tumors
Lipoma
Infiltrating Lipomas
Lipoblastomas
Intraneural Lipofibromas
Giant Cell Tumor of the Tendon Sheath (Xanthoma)
Benign Tumors of Fibrous Origin
Recurring Digital Fibrous Tumor of Childhood or Infantile Digital Fibromatosis
Juvenile Aponeurotic Fibroma or Calcifying Aponeurotic Fibroma
Fibroma
Desmoid Tumor
Neurofibroma
Glomus Tumor
Hemangioma
Lymphangioma
Neurilemoma (Schwannoma)
Osteoid Osteoma
Enchondroma
Benign Osteoblastoma
Aneurysmal Bone Cyst
Giant Cell Tumors of Bone
Osteochondroma
Synovial Chondromatosis
Malignant Tumors
Osteogenic Sarcoma
Chondrosarcoma
Epithelioid Sarcoma
Squamous Cell Carcinoma
Basal Cell Carcinoma
Malignant Melanoma
Fibrosarcoma
Metastatic Tumors
Rhabdomyosarcoma
Ewing Sarcoma
Tumorous Conditions
Ganglion
Epidermoid Cyst (Inclusion Cyst)
Sebaceous Cyst
Mucous Cyst
Congenital Arteriovenous Fistula
Pyogenic Granuloma
Foreign Body Granuloma
Gout
Traumatic Neuroma
Déjérine-Sottas Disease
Calcinosis
Calcinosis Circumscripta
Turret Exostosis
Carpometacarpal Boss
Epidermolysis Bullosa
Paget Disease
References
Supplemental References
Chapter 79: Hand Infections
Factors Influencing Hand Infections
General Approach to Hand Infections
Paronychia
Chronic Paronychia
Felon
Subfascial Space Infections
Web Space Infection (Collar Button Abscess)
Deep Fascial Space Infections
Subaponeurotic Space Infections
Tenosynovitis
Infections of Radial and Ulnar Bursae
Septic Arthritis
Finger Joint Infections
Wrist Infections
Osteomyelitis
Human Bite Injuries
Animal Bite Injuries
Miscellaneous and Unusual Infections
Herpetic Infections
Infections in Drug Addicts
Infections in Patients With Acquired Immunodeficiency Syndrome
Necrotizing Fasciitis
Gas Gangrene (Clostridial Myonecrosis)
Mycobacterial Infections
Tuberculosis
Nontuberculous Mycobacterial Infections
Fungal Infections
Pyoderma Gangrenosum
References
Supplemental References
Chapter 80: Congenital Anomalies of the Hand
Principles of Management
Incidence and Classification
Embryology
Malformations Upper Extremity
Proximal-Distal Axis
Transverse Deficiencies
Prosthetic Management
Surgical Treatment
Intersegmental Deficiency
Phocomelia
Treatment
Anteroposterior Axis
Radial Longitudinal Deficiency
Nonoperative Treatment
Operative Treatment
Ulnar Longitudinal Deficiency
Nonoperative Treatment
Operative Treatment
Congenital Pseudarthrosis of the Ulna; Radioulnar Synostosis; Congenital Dislocation of the Radial Head
Madelung Deformity
Treatment
Unspecified
Shoulder (Sprengel Deformity, Congenital Muscular Torticollis, Pseudarthrosis of the Clavicle)
Arthrogryposis
Malformations of Hand Plate
Proximal Distal Axis
Brachydactyly (Hypoplastic Hands and Digits)
Nonoperative Treatment
Operative Treatment
Anteroposterior Axis
Radial (Thumb) Deficiency/Hypoplastic Thumb
Type I Hypoplasia (Shortened Thumb)
Type II Hypoplasia (Adducted Thumb)
Type II and Type III Hypoplasia (Abducted Thumb)
Type IV Hypoplasia (Pouce Flottant or Floating Thumb)
Type V Hypoplasia (Absent Thumb)
Pollicization for Reconstruction of the Thumb
Complications
Preaxial Polydactyly (Duplicate Thumb)
Treatment
Triphalangeal Thumb
Treatment
Ulnar Dimelia
Treatment
Postaxial Polydactyly
Treatment
Malformations Unspecified
Soft Tissue
Syndactyly
Treatment
Camptodactyly
Treatment
Thumb in Palm (Clasped Thumb)
Nonoperative Treatment
Operative Treatment
Skeletal
Clinodactyly (Delta Phalanx)
Treatment
Kirner Deformity
Treatment
Complex
Synpolydactyly (Central Polydactyly)
Treatment
Cleft Hand
Treatment
Apert Syndrome
Treatment
Deformations
Constriction Ring Syndrome (Amniotic Band Syndrome)
Treatment
Trigger Fingers
Treatment
Dysplasias
Hypertrophy
Macrodactyly
Treatment
References
Supplemental References
Part XIX: The Foot and Ankle
Chapter 81: Surgical Techniques
Preoperative Preparation
Instruments
Patient positioning
Tourniquet
Surgical Antiseptic
Perioperative Medical Management
Prophylactic antibiotics
Prophylactic anticoagulation
Perioperative Pain Management
Regional anesthesia
Forefoot block and ankle block
Popliteal sciatic nerve block (prone)
Lateral popliteal nerve block
References
Supplemental References
Chapter 82: Disorders of the Hallux
Hallux Valgus (Bunion)
Preoperative assessment and management
Postoperative considerations
Soft-tissue procedures
Combined soft-tissue and bony procedures
Osteotomy of the distal first metatarsal
Minimally invasive osteotomy
Osteotomy of the proximal first metatarsal
Proximal phalangeal osteotomy
Triple osteotomy
Arthrodesis of the first metatarsophalangeal joint
Special circumstances
Hallux valgus in the case of metatarsus adductus
Hallux valgus in men
Hallux valgus in athletes
Hallux valgus in cerebral palsy
Juvenile and adolescent hallux valgus (10 to 19 years old)
Complications after surgery for hallux valgus
Preventing complications
Transfer metatarsalgia
Recurrent deformity after simple bunionectomy
Recurrent Hallux Valgus With Normal Distal Metatarsal Angle After Bunionectomy
Recurrent Valgus Deformity with Abnormal Distal Metatarsal Articular Angle
Recurrent Deformity After Basilar Metatarsal Osteotomy and First Web Space Dissection or Release
Recurrent Deformity in Elderly Patients With Osteoarthritis
Complications after chevron osteotomy
Metatarsal Shortening
Acquired hallux varus and intrinsic minus hallux
Anatomy and pathogenesis
Correction of Dynamic (Multiplanar) Hallux Varus
Claw Toe (Intrinsic Imbalanced Hallux)
Limitation of Metatarsophalangeal Joint Motion
Hallux Extensus
Neuroma and Hematoma
Stress Fractures of the Lesser Metatarsal
Complications of resection arthroplasty of the first metatarsophalangeal joint (keller procedure)
Cock-Up Hallux
Metatarsalgia
Complications after arthrodesis of the first metatarsophalangeal joint
Hallux Rigidus
Nonoperative treatment
Operative treatment
Arthrodesis of the first metatarsophalangeal joint
Resection arthroplasty (keller procedure)
Proximal phalangeal extension osteotomies
Conditions of the sesamoid
Treatment
Arthritis of the Interphalangeal Joint
References
Supplemental References
Chapter 83: Disorders of Tendons and Fascia and Adolescent and Adult Pes Planus
Disorders of the Posterior Tibial Tendon
Classification
Diagnosis
Treatment
Stage I disease (tenosynovitis)
Stage II disease
Subtalar Arthroereisis
Stage III disease
Medial Column Stabilization
Stage IV disease
Posterior tibial tendon insufficiency
Insufficiency of posterior tibial tendon secondary to accessory navicular
Kidner Procedure
Pes planus and tarsal coalition
Calcaneonavicular coalition
Arthrodesis for Calcaneonavicular Coalition
Talocalcaneal coalition
Radiographic Findings
Treatment
Disorders of the Achilles Tendon
Insertional achilles tendinopathy
Diagnosis
Treatment
Noninsertional achilles tendinopathy
Disorders of the Anterior Tibial Tendon
Diagnosis
Treatment
Tenosynovitis
Insertional tendinosis
Complete rupture
Disorders of the Peroneal Tendons
Diagnosis
Treatment
Peroneal tendinitis
Subluxation of the Peroneal Tendons
Intrasheath peroneal tendon subluxation
Tears and ruptures of the peroneal tendons
Distal peroneal longus tendinitis associated with os peroneum: The painful os peroneum syndrome
Injuries of the Flexor Tendons
Flexor hallucis longus tendinitis and impingement
Diagnosis
Treatment
Flexor hallucis longus tear
Flexor digitorum longus tendon injury
Painful Heel
Etiology
Clinical and radiographic findings
Treatment
References
Supplemental References
Chapter 84: Lesser Toe Abnormalities
Metatarsophalangeal Joint Instability
Etiology
Anatomy and Biomechanics
Diagnosis
Treatment
Axial Plane Deformity of the Metatarsophalangeal Joint
Hammer Toe and Claw Toe
Etiology
Clinical Findings
Treatment
Soft-Tissue Procedures (Girdlestone; Taylor; Parrish; Mann and Coughlin)
Bone and Joint Procedures
Mild Deformity
Moderate Deformity
Severe Deformity
Correction of Severe Deformity With Dislocation of the Metatarsophalangeal Joint
Correction of a Dislocated Second Metatarsophalangeal Joint With Shortening Metatarsal Osteotomy
Amputation For Severe Deformity
Mallet Toe
Etiology
Treatment
Combined Hammer Toe and Mallet Toe Deformity With Associated Double Corns
Complications and Revision Surgery of Hammer Toe Deformities
Corns (Helomata and Clavi)
Etiology and Clinical Findings
Treatment
Hard Corn
Soft Corn (Interdigital Corn)
Plantar Corn (Intractable Plantar Keratosis)
Excessive Metatarsal Length and Diffuse Plantar Keratosis and Metatarsalgia
Bunionette (Tailor’s Bunion)
Treatment
Resection
Osteotomy of the Metatarsal
Freiberg Infraction
Brachymetatarsia
References
Supplemental References
Chapter 85: Arthritis of the Foot
Inflammatory and Degenerative Arthritis
Signs and symptoms
Nonoperative Treatment
Forefoot
Etiology of joint destruction
Treatment
Avoiding complications in foot surgery
Forefoot arthroplasty
Arthrodesis of the first metatarsophalangeal joint in the rheumatoid patient
Midfoot
Treatment
First metatarsal-medial cuneiform arthrodesis
Midfoot arthrodesis
Hindfoot
Treatment
Tibiotalocalcaneal and ankle arthrodeses
References
Supplemental References
Chapter 86: Diabetic Foot
Diabetic Foot
Epidemiology
Basic science
History and physical examination
Ulcer classification
Laboratory evaluation
Imaging
Treatment
Patient education
Total contact casting
Treatment of Peripheral Neuropathy
Surgical management
Trauma in diabetic patients
Charcot Arthropathy
Background
Natural history
Pathogenesis
Classification
Treatment
References
Supplemental References
Chapter 87: Neurogenic Disorders
Tarsal Tunnel Syndrome
Anatomy and Etiology
Clinical Findings and Diagnosis
Treatment
Anterior Tarsal Tunnel Syndrome (Deep Peroneal Nerve Entrapment)
First Branch of Lateral Plantar Nerve Entrapment
Medial Plantar Nerve Entrapment
Sural Nerve Entrapment
Superficial Peroneal Nerve Entrapment
Interdigital Neuroma
Pathologic Findings
Signs and Symptoms
Treatment
Cavus Foot
Etiology
Physical Findings
Radiographic Findings
Treatment
Flexible Forefoot-Driven (Plantar-Flexed First Ray) Cavovarus Deformity
Proximal First Metatarsal Osteotomy and Plantar Fasciotomy
Combined Mild Forefoot-Driven and Hindfoot-Driven Varus Deformity
Osteotomy of the Calcaneus
Stiff, Moderate Midfoot Cavovarus Deformity
Stiff, Severe Cavovarus Deformity Associated With Arthrosis
Claw Toes
Summary of Cavus Foot Evaluation and Treatment
References
Supplemental References
Chapter 88: Disorders of Nails
Anatomy
Trauma
Dystrophic Nails (Onychogryposis, Onychomycosis)
Other Lesions of the Nails
Subungual exostosis
Subungual and periungual fibromas
Glomus tumor
Malignant melanoma
Ingrown Toenail (Onychocryptosis, Unguis Incarnatus)
Etiology
Nonoperative management
Stage I (inflammatory stage)
Stage II (abscess stage)
Stage III (granulation stage)
Operative management
Long-Term Follow-Up
References
Supplemental References
Chapter 89: Fractures and Dislocations of the Foot
Fractures of the Calcaneus
Intraarticular Fractures
Mechanism
Radiographic Evaluation
Classification
Treatment
Decision-Making in Calcaneal Fractures
Soft-Tissue Injury (Open Calcaneal Fractures)
Complications and Prevention
Wound Necrosis, Dehiscence, and Infection
Loss of Reduction of Major Fragments
Malreduction
Sural Nerve and Peroneal Tendon Injuries
Results
Late Complications
Calcaneal Fracture Malunion
Subtalar Arthrodesis
Extraarticular Fractures
Fractures of the Calcaneal Tuberosity
Fractures of the Sustentaculum Tali
Fractures of the Anterior Process of the Calcaneus
Fractures of the Talus
Anatomy
Talar Head Fractures
Treatment
Talar Neck Fractures
Treatment
Type I Fractures
Types II, III, and IV Fractures
Malunion of the Talar Neck
Osteonecrosis of the Talar Body After Talar Neck Fracture
Talar Body Fractures
Fractures of the Lateral or Posterior Process of the Talus
Lateral Process Fractures
Posterior Process Fractures
Talar Body Extrusion
Subtalar Dislocations
Midfoot Fractures and Dislocations
Navicular/Cuboid/Cuneiform Fractures
Fracture-Dislocations of the Tarsometatarsal Articulation (Lisfranc Joint)
Classification
Evaluation and Treatment
Metatarsals
Fracture of the Proximal Portion of the Fifth Metatarsal
Inlay Bone Graft
Distal Fifth Metatarsal Fracture
Stress Fractures of the Metatarsals
Complications
Acute Fractures of the Metatarsals
Phalangeal Dislocations
Interphalangeal Joint of the Hallux
First Metatarsophalangeal Joint Dislocation
First Metatarsophalangeal Joint Sprain
Phalangeal Fractures
Sesamoid Fractures
Treatment
Osteochondritis of the Sesamoid
Other Conditions of the Sesamoid
References
Supplemental References
Chapter 90: Sports Injuries of the Ankle
Acute Ligamentous Injuries
Anatomy
Diagnosis
Inversion and Eversion Stress Tests
Anteroposterior Stress Test (Anterior Drawer Sign)
Stress View of the Ankle Mortise and Syndesmosis
Magnetic Resonance Imaging
Treatment
Repair of Acute Rupture of the Deltoid Ligament
Repair of Acute Rupture of the Ligaments of the Distal Tibiofibular Joint
Repair of Acute Rupture of the Lateral Ligaments
Chronic Instability After Injury
Lateral Repair of Chronic Instability
Medial Repair of Chronic Instability
Peroneal Tendon Subluxation and Dislocation
Internal Derangements
Occult Lesions of the Talus and Calcaneus
Sinus Tarsi Syndrome
Osteochondral Ridges of the Talus and Tibia (Anterior and Posterior Impingement Syndromes)
Osteochondral Lesions of the Talus (Osteochondral Fracture, Transchondral Fracture, Dome Fracture of the Talus)
Arthroscopic Treatment
References
Supplemental References