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Neglected Musculoskeletal Injuries
Anil K Jain, Sudhir Kumar
CHAPTER 1:
Neglected Musculoskeletal Injuries – Magnitude of Problem
STRATEGIES
CHAPTER 2:
Basic Concepts Regarding Bone Healing and Fracture Care
THE PERIOSTEUM
The Role of Muscle Coverage in Fracture Healing
Shortening
Angular Deformity
Incongruity and Arthritis
Mechanism of Injury
The Surgeon's Training and the Local Physical Environment
The Open Fracture
Nonunion
Success or Failure
Objectivity
Litigation
An Assessment of Current Practices
The Role of the Manufacturing Industry
The Future of Orthopedic Cosmetic Surgeons of the Skeleton
CHAPTER 3:
Biology of Fracture Healing
CHAPTER 4:
Nonunion of Fractures
ASEPTIC NONUNION
Requirements for Aseptic Nonunion are
Reductions of the Fragments
Options for Treatment
Plating
Locked Compression Plate (LCP) for Nonunion in Osteoporotic Bone
Advantages
Disadvantages
New Modes of Failure of Locked Plate
External Fixator
Arthrodesis/Arthroplasty
Amputation
TREATMENT OF HYPERTROPHIC NONUNION
TREATMENT OF ATROPHIC NONUNION
GAP NONUNION
Bone Transport
Bone Grafting
Vascularized Autograft
Shingling
Bone Marrow
Allografts and Bone Graft Substitutes
Low Intensity Ultrasound
Electrical Stimulation
Nonunion in Special Situations
Metaphyseal and Intra-articular NU
Stiff Joint Associated Nonunion
Nonunion Associated with Deformity
Synovial Pseudarthrosis
Nonunion of Specific Bone
Nonunion of Clavicle
Nonunion of Proximal Humerus
NU of Shaft Humerus
Nonunion of Distal End of Humerus
Nonunion of Both Bones of the Forearm
Neglected Fracture Neck of Femur
Treatment of Nonunion (Younger Patient)
Nonunion Intertrochanteric Fracture
Nonunion of Femoral Shaft
Nonunion of Supracondylar Fracture of Femur
Nonunion of the Patella
Nonunion of Tibia
Aseptic Atrophic Type
Hypertrophic Type
CHAPTER 5:
Infected Nonunions of Long Bones
CHAPTER 6:
Myositis Ossificans
ETIOLOGICAL FACTORS
Theories of Genesis
Pathology
Variety
Clinical Features
Investigations
Routine Blood Test
Plain Radiograph
CT Scan
MRI
Bone Scintigraphy
Ultrasonography
Biopsy
Differential Diagnosis
Treatment
Prognosis and Sequelae
CHAPTER 7:
Compartment Syndrome and Volkmann's Ischemic Contracture
SPECIFIC COMPARTMENT SYNDROMES OF THE LOWER EXTREMITY
Compartment Syndrome Around the Pelvis
Anatomy
Surgical Technique
Compartment Syndrome of the Thigh
Anatomy
Surgical Technique
Compartment Syndrome of Leg
Anatomy
Surgical Technique
COMPARTMENT SYNDROME OF THE FOOT
VOLKMANN'S ISCHEMIC CONTRACTURE
Clinical Presentation
Muscle Involvement
Nerve Involvement
Classification
Treatment
Nonsurgical Management
Surgical Treatment
COMMONLY USED METHODS
Mild (Localized) Type
Surgical Technique
Moderate Type
Severe Type
VIC IN LEG AND FOOT
Biomechanics of Pescavovarus (Most Common Deformity)
Management
Operative Management
CHRONIC EXERTIONAL COMPARTMENT SYNDROME
Pathophysiology
Clinical Presentation
Investigation
Treatment
Conclusion
CHAPTER 8:
Post-traumatic Stiff Elbow
STABILITY OF THE ELBOW
WHY ELBOW IS MORE AFFECTED?
Pathology
Causation
CLASSIFICATION
Classification Based on Pathologies
EVALUATION OF THE PATIENT5
TREATMENT
Non-operative Treatment
Arthroscopic Release
INDICATIONS OF SURGERY
Contraindications
Open Release
The Advantages of Lateral Approach
The Anterior Approach
Medial Release
The Advantages of Medial Operative Release
Limitations of Medial Release
Posterolateral Release
Extensive Release
How to Choose Incision
Immediate Postoperative Rehabilitation
Distraction Arthroplasty
Total Elbow Replacement
Excision Arthroplasty
Interpositional Arthroplasty
Ectopic Ossification Around the Elbow
Radiological Assessment
Classification
Treatment
INDICATION OF SURGERY IN ECTOPIC BONE FORMATION AROUND ELBOW
CHAPTER 9:
Neglected Physeal Injuries
CHAPTER 10:
Neglected Spinal Trauma
INCIDENCE AND ETIOLOGICAL FACTORS
Common Etiology7 of Missed Injuries
PATHOLOGICAL CHANGES IN NEGLECTED SPINE INJURY
CLINICAL PRESENTATION
ASSESSMENT OF NEGLECTED SPINAL TRAUMA (LATE PRESENTATION)
Clinical Assessment
Radiological Assessment
DECISION MAKING
Who Requires Surgery in Neglected Spinal Injuries?
OVERVIEW OF SURGICAL PROCEDURES FOR NEGLECTED SPINAL INJURIES
Atlantoaxial Injuries
Subaxial Cervical Spine
Neglected Bifacetal Dislocations
Post-traumatic Cervical Kyphosis (Due to Vertebral Burst Fracture Malunion)
Post-traumatic Thoracic and Lumbar Spine Deformity
COMPLICATIONS OF SURGERY IN POST-TRAUMATIC SPINAL DEFORMITY
Neurologic Injury
Infection
PREVENTION OF NEGLECTED SPINAL INJURIES
Clinical Assessment
Investigations
Clearing the Spine in Polytrauma
THORACOLUMBAR SPINE
Spinal Injuries that are Prone for Late Onset Deformity
CONCLUSION
CHAPTER 11:
Rehabilitation of Neglected Spinal Cord Injuries
PATHOANATOMY
Etiological Factors
PATHOPHYSIOLOGY
CLINICAL FEATURES
Motor and Sensory Deficit
Autonomic Deficit
COMPLICATIONS
Clinical Features of Neglected SCI
INVESTIGATIONS
TREATMENT
PRINCIPLES OF REHABILITATION
Physical Rehabilitation
Neglected Tetraplegic Hand
Neglected Neurogenic Bladder
Neurogenic Bowel Dysfunction
Wheelchair Prescription and Assistive Technology
Pressure Ulcers
Spasticity
Respiratory Complications
Heterotopic Ossification
Osteoporosis and Fracture
Pain
Other Complications
Educational Classes
Sexual Rehabilitation
Fertility Management
Peer Counseling
Psychological Rehabilitation
Sports and Recreational Activities
Social Rehabilitation
Vocational Rehabilitation
Home Care Services and Reintegration into the Community
OUTCOMES
FOLLOW-UP
CONCLUSION
CHAPTER 12:
Neglected Fracture Neck of Femur
PATHOLOGY OF NEGLECTED FRACTURE NECK OF FEMUR
STAGING/CLASSIFICATION OF THE NEGLECTED FEMORAL NECK FRACTURE
Stage I (Fig. 12.2A)
Stage II (Fig. 12.2B)
Stage III (Figs 12.2C and D)
PRESENTING SYMPTOMS (CLINICAL FEATURES)
INVESTIGATIONS
FACTORS AFFECTING THE OUTCOME
TREATMENT
Muscle Pedicle Bone Graft
McMurray's Osteotomy
Pauwel's VY Osteotomy
Closed Reduction, Internal Fixation and Double Fibular Graft
Replacement Arthroplasty
Hemiarthroplasty
Total Hip Arthroplasty
How to Choose the Operative Procedure
In Stage I
In stage II
In stage III
Complications
Complications at Donor Site
Complications of McMurray's Osteotomy
Complications of Osteotomies with Internal Fixation (Abduction osteotomy and Pauwel's VY osteotomy)
CHAPTER 13:
Muscle Pedicle Bone Grafting in the Treatment of Neglected Fracture Neck of Femur
REVIEW OF LITERATURE
CHARACTERISTICS OF A NEGLECTED FEMORAL NECK FRACTURE
CLINICAL FEATURES
IMAGING
TREATMENT OF NEGLECTED FRACTURES
Head Sacrificing
Head Preserving Category
How a Muscle Pedicle Graft is Useful
Common Muscle Pedicle Bone Grafts6,13–24,39,40,49,50 (MPBG)
Uses of Muscle Pedicle Graft6,13–24,39,40, 49, 50
Limitations of Muscle Pedicle Graft
PRINCIPLES OF VARIOUS MUSCLE PEDICLES INCLUDING BLOOD SUPPLY
Quadratus Femoris Graft13,16,17,22,39–41 (Figs 13.1 and 13.2)
Based on Lateral Epiphyseal Vessels
Basic Steps
Gluteus Medius Muscle Pedicle Graft
Based on Superior Gluteal Artery
Tensor Fascia Lata Muscle Pedicle Bone Graft22,24,41 (Figs 13.4A to C)
Anterior Trochanteric Muscle Pedicle Graft49
Periosteal Grafting
CHAPTER 14:
Neglected Pediatric Femoral Neck Fractures
DEFINITION OF A NEGLECTED CASE
CAUSES OF NEGLECT/DELAYED REPORTING
RELEVANT ANATOMY
MECHANISM OF INJURY
PECULIARITIES OF PEDIATRIC FEMORAL NECK FRACTURES
HOW A NEGLECTED CASE DIFFERS FROM A FRESH CASE
CLASSIFICATION
CLINICAL EXAMINATION
RADIOLOGICAL EXAMINATION
Modern Investigations (MRI/Bone Scan)
TREATMENT
Evolution of Treatment in Cases with Delayed Presentation
Factors to be Considered before Surgery
Some General Considerations Regarding Management
Suggested Treatment Guidelines
Type I Fractures
Type II and III Fractures
Type IV Fractures
COMPLICATIONS
Coxa Vara
Avascular Necrosis
Premature Physeal Closure
CHAPTER 15:
Neglected Traumatic Dislocation of Hip
CHAPTER 16:
Total Hip Arthroplasty for Neglected Hip Trauma
TOTAL HIP ARTHROPLASTY FOR NEGLECTED TROCHANTERIC FRACTURES
Choice of Implants
Technical Tips
Results
THA FOR NEGLECTED DISLOCATION OF THE HIP
Choice of Implants
Technical Tips
Results
TOTAL HIP REPLACEMENT FOLLOWING NEGLECTED ACETABULAR FRACTURES
Choice of Implants
Technical Tips
Results
CONCLUSION
CHAPTER 17:
Neglected Trochanter and Subtrochanteric Fractures
FACTORS AFFECTING TREATMENT
MANAGEMENT
Radiological Examination
Computerized Axial Tomography and MRI
Indications for Operative Treatment
Management of Trochanteric Nonunions
Treatment with Flexible Intra-medullary Nails
Treatment with Rigid Intra-medullary Nail
Treatment with Extramedullary Splinting
Inter-trochanteric Osteotomy
MANAGEMENT OF SUBTROCHANTERIC NONUNIONS
Intra-medullary Splinting
Extra-medullary Splinting
MALUNITED TROCHANTERIC FRACTURES
Preoperative Planning
Intertrochanteric Osteotomy in Trochanteric Fractures with Failed Osteosynthesis
Replacement Arthroplasty
CHAPTER 18:
Neglected Diaphyseal Fractures
CAUSES OF NEGLECT
CLINICAL PROBLEMS
Nonunion
Malunion
SHORTENING
CHAPTER 19:
Neglected Knee Trauma
NEGLECTED DISTAL FEMUR FRACTURES
Distal Femur Nonunions
Management
Fracture Reduction
Choice of Implant in Distal Femur Nonunions
Nails Vs Plates
External Fixators
DISTAL FEMUR MALUNIONS
Intra-articular
Extra-articular
Problem of Stiff Knee
Role of Total Knee Arthroplasty
Role of Knee Arthrodesis
NEGLECTED EXTENSOR MECHANISM INJURIES
NEGLECTED PATELLAR TENDON RUPTURES
Management
NEGLECTED FRACTURES OF PATELLA
Role of Patellectomy
NEGLECTED QUADRICEPS TENDON RUPTURE
NEGLECTED DISLOCATIONS AROUND KNEE
NEGLECTED FEMOROTIBIAL (KNEE) DISLOCATIONS
Role of Ilizarov Fixator
Role of Total Knee Arthroplasty
Role of Knee Arthrodesis
NEGLECTED PATELLOFEMORAL DISLOCATIONS
Management
NEGLECTED PROXIMAL TIBIOFIBULAR DISLOCATIONS
Management
NEGLECTED PROXIMAL TIBIA FRACTURES
Management
Reconstruction Surgeries
Rationale for Reconstruction
Nonunion
Intra-articular Nonunions
MALUNIONS
Intra-articular Malunions of Proximal Tibia
Arthroplasty for Proximal Tibial Fractures
CHAPTER 20:
Tibialization of Fibula for Mangled Leg
CHAPTER 21:
Neglected Injuries of the Ankle and Foot
NEGLECTED ANKLE SPRAINS
Introduction
Frequency
Pathoanatomy
Clinical Features
Investigations
Treatment
Nonoperative Treatment
Operative Treatment
NEGLECTED ANKLE FRACTURES
Introduction
Clinical Features and Investigations
Treatment
Neglected Lisfranc Joint Injuries
Introduction
History
Anatomy
Etiology
Investigations
Treatment
NEGLECTED INJURIES OF TARSAL BONES
Neglected Talar Fractures
a) Malunion of talar neck fractures
b) Malunion of talar body
Neglected Calcaneus Fractures
Clinical Features
Investigations
Treatment
CHAPTER 22:
Neglected Adult Elbow Trauma
CHAPTER 23:
Neglected Dislocation of the Elbow
PATHOLOGICAL ANATOMY
CLINICAL PRESENTATION
Imaging
Treatment
Close Reduction
Open Reduction
Operative Technique
Postoperative Treatment
Results
CHAPTER 24:
Nonunion Intercondylar Fracture of Humerus
TREATMENT
Surgical Procedure2,9,10
Outcome
CHAPTER 25:
Late Presentation of Supracondylar Fracture of the Humerus in Children
CHAPTER 26:
Cubitus Varus – Problem and Solution
INVESTIGATIONS
TREATMENT
Pentalateral Osteotomy13 (Fig. 26.2)
The Reverse V Osteotomy
Pre-operative Planning18 (Fig. 26.3)
Advantages
Ilizarov Technique19,20
Arc Osteotomy21 (Fig. 26.4)
Dome Corrective Osteotomy22 (Fig. 26.5)
Lateral Closing Wedge Osteotomy (Fig. 26.6)
Modified French Osteotomy (Fig. 26.7)
Age of Operation
Choice of Osteotomy
Method of Fixation17
COMPLICATIONS OF CUBITUS VARUS
Cause of Postero-lateral Rotatory Instability
TREATMENT
Lateral Condylar Prominence
CHAPTER 27:
Neglected Pediatric Monteggia Injury
CHAPTER 28:
Neglected Lateral Condylar Fractures of the Humerus in Children
CHAPTER 29:
Neglected Distal Radius Fractures
MALUNION
Anatomy
Biomechanical Alterations Following Distal Radius Malunion
History and Physical Examination
Radiographic Evaluation
Nonsurgical Treatment
EXTRA-ARTICULAR MALUNION
Operative Treatment
Nascent Malunions
Mature Malunions
OSTEOTOMY TECHNIQUE
APPROACH
DORSAL MALUNIONS
Dorsal Approach: Opening Wedge Osteotomy
Surgical Technique
Volar Approach
Surgical Technique
VOLAR MALUNIONS
ULNAR MALUNIONS
INTRA-ARTICULAR MALUNIONS
Goals and Indications
Imaging
Management
Operative Technique62,63
Prognosis
NONUNION
Etiological Factors
Imaging
Treatment Options
ARTHRITIS
Radiocarpal Arthritis
DISORDERS OF THE DISTAL RADIOULNAR JOINT (DRUJ) ASSOCIATED WITH DISTAL RADIUS MALUNION
Pathoanatomy
Clinical Examination
Radiographic Evaluation
Management
Extra-articular Incongruity of the DRUJ
Intra-articular Incongruity of the Druj
Hemiresection Arthroplasty
Derangement or Osteoarthritis of the Druj
Darrach's Procedure
Sauvé-Kapandji Procedure
Prosthetic Replacement of Ulnar Head
Critical Steps
Postoperative Management
Rotational Deformity of the Radius Affecting the DRUJ
Ulnocarpal Abutment
Symptomatic or Painful Nonunion of the Ulnar Styloid
Capsular Contracture of the DRUJ
CONCLUSIONS
CHAPTER 30:
Neglected Fractures and Dislocations of the Hand
SURGICAL INCISIONS
Principles of Treatment
Phalangeal Fractures
Distal Phalanx
Mallet Finger
Proximal or Middle Phalanx Fractures
Intra-articular Fractures
Distal Metaphalangeal (DIP) Joint
Proximal Interphalanged (PIP) Joint
Metacarpal Fracture
Shortening
Thumb
Intra-articular Fractures of Thumb
Arthrodesis
CHAPTER 31:
Neglected Tendon Injuries of Hand
NEGLECTED FLEXOR TENDON INJURIES OF THE HAND
Causes of Tendon Injuries
Diagnosis
Treatment
Indications for Tendon Grafting
1. Single-stage Tendon Grafting
Surgical Principles
Aftercare
Technical alternatives
Flexor Tendon Injury in Zone III (Lumbrical zone)
Complications
2. Two-staged Tendon Grafting (also called as Staged Flexor Tendon Reconstruction)
Surgical Principles
Complications
ZONES OF INJURY
MANAGEMENT
Zone 1 (Chronic Mallet Finger)
Zone II
Zone III
Zones IV and V
Zone VI
Zone VII
Zone VIII and IX
CHAPTER 32:
Neglected Peripheral Nerve Injuries
CHAPTER 33:
Knee Contracture
DEFINITION
Knee Contracture in Extension
Treatment
Manipulation
Quadricepsplasty
Thompson Quadricepsplasty
Surgical Procedure
The Judet Quadricepsplasty
Surgical Procedure
Arthroscopy Assisted Quadricepsplasty9,15,20
Surgical Procedure
Knee Contrcture in Flexion
Treatment
Putty Modified Method
Yount's Method
INDEX
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