Orthopaedic Perspective Research Articles

Functional Assessment of Arthropathy—An International Perspective

Treatment of hemophilia aims to minimize structural damage to joints and maximize patients' functional independence and quality of life. From an orthopedic perspective, treatment efficacy can be judged by quantifying the extent of musculoskeletal damage. Joint scores--both clinical and radiologic--have traditionally been measured in patients with hemophilia. However, such scores may lack the sensitivity to detect early changes in the hemophilic joint, and this has prompted the development of more sensitive measures. In addition, scores based on the status of individual joints do not consider the impact of arthropathy on overall musculoskeletal function. It would prove valuable to understand the implications of small differences in clinical/radiologic scores in terms of overall musculoskeletal function and patients' quality of life. The development of functional scores such as the Functional Independence Score for Haemophilia (FISH) and the Haemophilia Activities List (HAL), along with the quality-of-life (QoL) measurement tools, have helped to provide a more comprehensive assessment of health in hemophilia. Such improved understanding should assist with the development of contextually relevant guidelines for the management of hemophilia.

Orthopaedic manifestations of tuberculosis.

An estimated 1 million people will be infected with tuberculosis worldwide in the first 20 years of the 21st century. If the disease is not recognized and treated early the morbidity and mortality of this condition will rise. This article highlights the varying manifestations of tuberculosis from an orthopaedic perspective.

MILITARY SPORTS MEDICINE - THE SOLDIER ATHLETE

Military medicine encompasses a unique subgroup of sports medicine by nature of the active lifestyle and functional requirements of our fighting forces. Sports medicine in the military entails the care and treatment of a diverse group of athletes to include the soldier in basic training, military academy (collegiate) athletes, female soldiers, elite operating forces, and world-class competitors. Compared to their civilian counterparts, as soldiers, these athletes are exposed to unique demands and stresses that result in different injury epidemiology. The purpose of this symposium is to provide an introductory forum to discuss the spectrum of sports medicine in the military to include clinical medicine, research, and epidemiology. The symposium will specifically address three topics. First will be an examination of the relationship between injury and fitness in the military. Second, a primary care perspective will describe common injuries encountered in the military and how these athletic injuries pose a challenge to military readiness. Finally, an orthopaedic perspective will be discussed focusing on injuries encountered in the service academies. The goal is to stimulate interest and initiate unity and cohesion of the diverse specialists involved in sports medicine and care of the military athlete for future research, topics at subsequent meetings, and ultimately integration into the care of our nation's defenders.

Spasticity: orthopedic perspective.

The orthopedic management of spasticity is based on the effects of this neurologic condition on the bones and tissues of the growing child. The goal of such intervention is to maximize function, reduce disability, and facilitate mobility. Goal-directed treatment plans are tailored for each patient and may include a combination of modalities such as physical and occupational therapy, casting, orthoses, and surgery. Physical and occupational therapy is emphasized up to 4 to 5 years of age, whereas surgery is best between 5 and 7 years of age. Education and psychosocial development should be emphasized beginning at age 7 years through adulthood, with surgery reserved for more involved cases of contracture or bony dysplasia. In adulthood, treatment should be focused on integration into society and maximizing functional independence. Although there are many undisputed benefits of therapy, no consensus exists regarding the most beneficial modality, the age group that would benefit most, or whether continued treatment is beneficial in adulthood. Whereas the use of serial casting and tone-reducing casts has lessened, lower extremity orthoses have gained widespread acceptance with improvements in design and fabrication and have been demonstrated to help restore normal heel-toe gait. Surgical techniques such as tendon lengthening, transfer, bony osteotomy, and joint fusion are time-honored techniques that continue to be refined with current advances in the use of computerized gait analysis for preoperative planning. Further research in long-term results and outcomes measurement will be necessary to fully assess the impact of current treatment.

The persistently irritable joint in childhood: An orthopaedic perspective

Persistent joint or periarticular irritability and pain in children can have numerous explanations. This overview explores the diverse range of orthopaedic conditions, both acquired and congenital, that may lead to such a presentation.

Persistent functional and social benefit 5 years after a multidisciplinary arthritis training program

Objective: To assess the sustainable benefits of a professional, multidisciplinary training program for patients with rheumatoid arthritis. Design: Two studies with different observation periods. Study I was a prospective, randomized trial for 1 year. Study II was a noncontrolled observation over 5 years. Setting: The 9-day program for eight patient groups encompassed a multidisciplinary cooperation between rheumatologists, orthopedists, physicotherapists, psychologists and social workers. Patients: Sixty-eight consecutive patients with rheumatoid arthritis participated in an arthritis training program either immediately after enrollment in the program or after 1 year. Interventions: The program covered the following fields: pathogenesis of rheumatoid arthritis, drug therapy, physicotherapy, practical exercise in remedial gymnastics, use of joint protection devices, orthopedic perspectives, psychological counseling, dietetics, information about unproven cures and social assistance. Main Outcome Measures: Clinical outcome was assessed by self-report questionnaires: (1) Stanford Health Assessment Questionnaire, (2) Freiburg Questionnaire of Coping with Illness, (3) Beck Depression Inventory, and (4) a 21-point scale to evaluate cognitive-behavioral and environmental impact. Results: A significant and persistent improvement of all investigated parameters was demonstrated in the 1-year controlled trial. Between the end-point of the 1-year study and the 5-year evaluation, this improvement increased even more for functional status and coping with illness, whereas depression returned to baseline values. These effects were seen even without reinforcement of the training. Conclusion: A professional, multidisciplinary approach to educate patients with rheumatoid arthritis leads to a significant and sustained improvement of the clinical outcome and is an approach that should be established as a part of conventional therapy.

Differential diagnosis in an orthopaedic perspective between muscle and neurogenic pain

Differential diagnosis in an orthopaedic perspective between muscle and neurogenic pain

Book Reviews

Book reviewed in this article:Developmental Disabilities: Delivery of Medical Care for Children and Adults Edited by I. Leslie Rubin and Allen C. CrockerThe Dysmorphic Child: An Orthopaedic Perspective By Michael J. GoldbergPerinatal Brain Lesions (Contemporary Issues in Fetal and Neonatal Medicine, Vol. 5) Edited by Karen E. Pape and Jonathan S. Wiggles WorthCleft Palate: the Nature and Remediation of Communication Problems Edited by Jackie StrengelhofenLanguage and Communication in Mentally Handicapped People Edited by Mchael Beveridge, Gina Conti‐Ramsden and Ivan LeudarAutism: Explaining the Enigma By Uta Frith

Orthopedic perspective on joint replacement

Orthopedic perspective on joint replacement

The Dysmorphic Child. An Orthopaedic Perspective.

The Dysmorphic Child. An Orthopaedic Perspective.

Management of spine trauma and deformity: an orthopaedic perspective.

This presentation concerns orthopaedic surgery and discusses the present state of art and possible future developments pertaining to the management of injury of the spine and other deforming conditions. It briefly highlights some of the recent advances in the area of neuroradiographic evaluation, closed management and surgical management of traumatic and other deforming conditions of the spine.

Lyme arthritis in children. An orthopaedic perspective.

The cases of forty-three children with clinical and serological evidence of Lyme arthritis that was diagnosed between August 1983 and July 1985 were evaluated. The mean length of follow-up was twenty months, with a range of five to thirty months. All of the children lived in or had visited an area where the disease was known to be endemic. Arthritis was the presenting feature in more than half of the children, and half of the children had initially consulted an orthopaedic surgeon, none of whom made the correct diagnosis. Only twenty patients had a history of erythema chronicum migrans, the characteristic rash that precedes the arthritis, and for only nineteen children was there any recollection of having been bitten by a tick. Three patients had Bell palsy and one had a popliteal cyst in conjunction with the arthritis. All of the patients had oligoarticular involvement. The knee was involved in all but two patients. Recurrent attacks of synovitis were common. Effusion was the only radiographic abnormality that was observed, and it was found in thirty-two patients. The sedimentation rate was elevated in thirty of thirty-six patients. Immunofluorescent serology for Lyme disease, which is sensitive and specific, was uniformly positive. Of thirty-three patients who were treated with oral administration of penicillin or tetracycline alone, thirty-one responded, while two patients who had recurrent attacks of the disease responded to parenteral administration of antibiotics. The remaining ten patients responded to combinations of orally and parenterally administered antibiotics. Longer follow-up is needed to further document the apparently low rate of relapse after antibiotic therapy in this young population.

Spinal Instability: Orthopedic Perspective and Prevention

Spinal Instability: Orthopedic Perspective and Prevention