JUNE 2008 VOLUME XXXVII NUMBER 6 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

107	Unusual Doesn't Mean Unusable: Why Information About Uncommon Injuries or Conditions Is Important James H. Beaty, MD Dr. Beaty, this journal’s Associate Editor of Pediatric Orthopedics, is Chief of Staff, Campbell Clinic, Memphis, Tennessee. Abstract not available. Am J Orthop. 2008;37(6): E107, E119.
108	Volar Forearm Compartment Syndrome Following Flexor Digitorum Profundus Muscle Rupture in a 3-Year-Old Girl Gene Choi, MD, James L. Huang, MD, Vincent Fowble, MD, and James Tucci, MD Dr. Choi is Resident, Department of Orthopaedic Surgery, Kingsbrook Jewish Medical Center, New York, New York. Abstract not available. Introduction provided instead. In the pediatric population, compartment syndrome in the upper extremity is a potentially devastating complication associated with many different etiologies, including fracture complications, vascular insufficiency, burns, and osteomyelitis.1-3 Fractures account for the majority of compartment syndromes described in children.1,3-7 We describe a case of forearm compartment syndrome in a 3-year-old girl with a flexor digitorum profundus muscle belly rupture and no associated fracture. To our knowledge, there have been no such reported cases of this type of injury causing compartment syndrome in this age group. Am J Orthop. 2008;37(6):E108-E109.
110	Knee Dislocation in a 9-Year-Old Boy Bart Eastwood, DO, Henry W. Albers, MD, and Michael Albert, MD Dr. Eastwood is Staff Orthopaedic Surgeon, Avera St. Anthony’s Hospital, O’Neill, Nebraska. Abstract not available. Introduction provided instead. A traumatic knee dislocation is an exceedingly rare occurrence in children, with at best scant citations in the orthopedic literature. Treatment is unique in this age group, because of the limited reconstructive options available for the open growth plates about the knee. Compared with the ligamentous structures, the physis is generally considered the weaker link within the knee of children, and therefore most injuries described have involved the growth plates about the knee.1 In the orthopedic literature, we found only 2 cases of knee dislocations in children younger than 10 years; in 1 of these cases, there was not much detail or follow-up.2-4 In addition, these 2 cases were managed before magnetic resonance imaging and arthroscopy were in common use. Here we describe our experience in treating and following up the case of a complete posterior lateral knee dislocation sustained by a 9-year-old boy in a football game. Am J Orthop. 2008;37(6):E110-E112.
113	Development of Bilateral Lower Extremity Marjolin Ulcers After Childhood Burns Jason Tank, BS, Tom Scharschmidt, MD, and Scott D. Weiner, MD Mr. Tank is Medical Student, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio. Abstract not available. Introduction provided instead. A Marjolin ulcer is a carcinoma, usually squamous cell, that originates in a chronically irritated or traumatized area, most commonly secondary to a deep tissue burn. The cancer is commonly aggressive and carries with it a poorer prognosis than a traditional squamous cell carcinoma does.1 The lesion commonly presents unilaterally with localized pain, foul-smelling discharge, and hemorrhage usually on the extremities or trunk, often with a time lag of decades from initial injury to malignancy.2 In a literature search, we identified only 2 instances of bilateral presentation. In this report, we describe a rare clinical case of bilateral lower extremity Marjolin ulcers and detail the common clinical presentation, treatment options, and prognosis of this aggressive carcinoma. Am J Orthop. 2008;37(6):E113-E115.
116	Open Tibiotalar Dislocation Without Associated Fracture in a 7-Year-Old Girl Martin R. W. Grotz, MD, Kaliopi Alpantaki, MD, Fareed H. Y. Kagda, MD, Costas Papacostidis, MD, Dominique Barron, FRCR, and Peter V. Giannoudis, MD, EEC (Ortho) Dr. Grotz is Trauma Fellow, Department of Trauma and Orthopaedics, Leeds General Infirmary University Hospital, Leeds, England. Abstract not available. Introduction provided instead. Complete tibiotalar dislocations without associated fractures are relatively rare injuries. In the literature, the earliest description of such an injury dates back to 1939, when Wilson and colleagues1 reported on 16 cases (including 2 of their own) of ankle dislocation without associated fracture. Since then, case reports and small case series in adults have appeared sporadically.2-10 Pure dislocations in children are rare. Dislocations are usually accompanied by fracture or deformity. Our literature search found only 1 pediatric case of closed posterior tibiotalar dislocation, described by Nusem and colleagues11 in 1999. Earlier, Lovell12 reported on a pediatric ankle dislocation, but it was a Bosworth-type injury without fracture of the fibula rather than a true tibiotalar dislocation. Pure posterior dislocation of the ankle joint has never been described in a pediatric patient. In this article, we report on the case of a 7-year-old girl who sustained an open tibiotalar dislocation, treated with immediate reduction and then formal débridement, lateral collateral ligament and anterior capsular repair, and transcalcaneal Kirschner-wire (K-wire) pinning to maintain reduction. A review of the literature is also presented. Am J Orthop. 2008;37(6):E116-E118.

292	Guest Editorial Quality Measures—Getting at What Really Matters William A. Grana, MD, MPH Dr. Grana, this journal’s Associate Editor for Sports Medicine, is a Professor at the Department of Orthopaedic Surgery, University of Arizona Health Sciences Center, Tucson, Arizona. Abstract not available. Am J Orthop. 2008;37(6):292.
294	Coracoclavicular Stabilization Using a Suture Anchor Technique Darren J. Friedman, MD, O. Alton Barron, MD, Louis Catalano, MD, Joseph P. Donahue, MD, and George Zambetti, MD Dr. Friedman is Chief Resident, Department of Orthopaedic Surgery, St. Luke’s Roosevelt Hospital Center, New York, New York. Multiple fixation options exist for coracoclavicular stabilization, but many are technically demanding and require hardware removal. In the study reported here, we reviewed a specific fixation technique that includes suture anchors moored in the base of the coracoid process. We retrospectively reviewed 24 consecutive cases of patients who underwent coracoclavicular stabilization with a suture anchor for a type III or type V acromioclavicular (AC) joint separation or a group II, type II or type V distal clavicle fracture. Eighteen of the 22 patients had full strength and painless range of motion (ROM) in the affected extremity by 3 months and at final follow-up (minimum, 24 months; mean, 39 months). Two patients were lost to follow-up. Four patients had early complications likely secondary to documented noncompliance. Two of these 4 patients underwent reoperation with a similar procedure and remained asymptomatic at a minimum follow-up of 15 months. One patient underwent osteophyte and knot excision 7 months after surgery and remained asymptomatic at 30 months. Our results suggest that coracoclavicular stabilization using a suture anchor technique is a safe and reliable method of treating acromioclavicular joint separations and certain distal clavicle fractures in the compliant patient. Am J Orthop. 2008;37(6):294-300.
302	Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allografts in Revisions and in Patients Older Than 30 Michael W. Grafe, MD, and Peter R. Kurzweil, MD Dr. Grafe is Attending Surgeon, Redwood Orthopaedic Surgery Associates, Santa Rosa, California. We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor. Am J Orthop. 2008;37(6):302-308.
310	Incidence and Variance of Knee Injuries in Elite College Football Players James Bradley, MD, Nicholas J. Honkamp, MD, Patrick Jost, BS, Robin West, MD, John Norwig, ATC, and Lee D. Kaplan, MD Dr. Bradley is Clinical Assistant Porfessor, Department of Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Knee injuries are among the most common musculoskeletal injuries in US football players. The literature includes little information about the role of player position and risk for knee injury. We hypothesized that the incidence of knee injury in elite collegiate US football players is high and that type of injury varies by player position. We evaluated 332 elite collegiate US football players at the 2005 National Football League Combine. All players underwent radiographic examinations, including plain x-rays and/or magnetic resonance imaging when necessary. All knee pathologic conditions and surgical procedures were recorded. Data were analyzed by player position to detect any trends. Fifty-four percent (179) of the 332 players had a history of knee injury; knee injuries totaled 233 (1.3/player injured). Eighty-six players (25.9%) had a total of 114 surgeries. The most common injuries were medial collateral ligament injury (n = 79), meniscal injury (n = 51), and anterior cruciate ligament (ACL) injury (n = 40). The most common surgeries were arthroscopic meniscectomy (n = 39), ACL reconstruction (n = 35), and arthroscopic meniscal repair (n = 13). A history of knee injury was most common in defensive linemen (68% of players), tight ends (57%), and offensive linemen (57%). Knee surgery was more commonly performed on running backs (36%) and linebackers (34%). There were no significant associations between type or frequency of specific injuries with regard to player position. Knee injuries are common injuries in elite collegiate football players, and one fourth of these players undergo surgical procedures. However, there were no statistically significant differences in type or frequency of injuries by player position. Am J Orthop. 2008;37(6):310-314.
315	Bilateral Femoral Insufficiency Fractures Presenting as Knee Pain in a Patient With Hypophosphatemic Vitamin D–Resistant Rickets Douglas W. Pahl, MD, and Christopher Kisok Kim, MD Dr. Pahl is Orthopaedic Spine Surgery Fellow, Twin Cities Spine Center, Minneapolis, Minnesota. Abstract not available. Am J Orthop. 2008;37(6):315-317.
319	Avascular Necrosis of the Femoral Head Following Intramedullary Nailing of the Femur in a Skeletally Mature Young Adult: A Case Report Richard M. Graves, MD, and Kenneth C. Sands, MD Dr. Graves is Orthopaedic Resident, Department of Orthopedic Surgery, William Beaumont Army Medical Center, El Paso, Texas. Avascular necrosis (AVN) of the femoral head is a well-documented complication of intramedullary nailing (IMN) of femoral shaft fractures in adolescents and children (age range, 10 years to 13 years 10 months). In adults, AVN after IMN has been reported in association with femoral neck fractures, intra-articular hip injuries, steroid use, and various other medical conditions. With those factors set aside, the literature includes only 1 case of AVN after IMN in an adult. Now we report the case of a previously healthy, skeletally mature young adult male who, at age 16 years 0 month, was treated with IMN after a traumatic femoral shaft fracture and subsequently developed AVN of the femoral head. Am J Orthop. 2008;37(6):319-322.
323	A New Technique for Establishing and Maintaining an Anteromedial Knee Portal Eric M. Parsons, MD, and James V. Bono, MD Dr. Parsons is Orthopaedic Surgeon, Lake Orthopaedic Associates, Willoughby, Ohio. Precise placement of the anteromedial portal is critical to the safety and efficacy of knee arthroscopy. Our described technique establishes and maintains a properly placed portal with minimal capsular violation using a needle arthrotomy and the outer shaver barrel as a cannula. This technique has the dual benefit of optimizing instrument access to the knee without large portal arthrotomies and reducing postoperative pain and swelling by minimizing fluid extravasation. Am J Orthop. 2008;37(6):323-324.

back to top