1

Basic Sciences   Mark R. Brinker and Daniel P. O’Connor

1

SECTION 1

BONE

1

I

Histologic Features of Bone

1

II

Bone Injury and Repair

11

III

Conditions of Bone Mineralization, Bone Mineral Density, and Bone Viability

20

SECTION 2

JOINTS

39

I

Articular Tissues

39

II

Arthroses

48

SECTION 3

NEUROMUSCULAR AND CONNECTIVE TISSUES

63

I

Skeletal Muscle

63

II

Nervous System

70

III

Connective Tissues

75

SECTION 4

CELLULAR AND MOLECULAR BIOLOGY, IMMUNOLOGY, AND GENETICS OF ORTHOPAEDICS

78

I

Cellular and Molecular Biology

78

II

Immunology

82

III

Genetics

87

SECTION 5

ORTHOPAEDIC INFECTIONS AND MICROBIOLOGY

94

I

Musculoskeletal Infections

94

II

Antibiotics

102

SECTION 6

PERIOPERATIVE PROBLEMS

105

I

Pulmonary Problems

105

II

Other Medical (Nonpulmonary) Problems

108

III

Intraoperative Considerations

110

IV

Other Perioperative Problems

111

SECTION 7

IMAGING AND SPECIAL STUDIES

113

I

Nuclear Medicine

113

II

Arthrography

114

III

Magnetic Resonance Imaging

114

IV

Other Imaging Studies

116

V

Electrodiagnostic Studies

118

SECTION 8

BIOMATERIALS AND BIOMECHANICS

118

I

Basic Concepts

118

II

Biomaterials

120

III

Biomechanics

128

Testable Concepts

137

2

Anatomy   Franklin D. Shuler and Matthew R. Schmitz

143

SECTION 1

INTRODUCTION

143

I

Overview

143

SECTION 2

UPPER EXTREMITY

144

I

Shoulder

144

II

Arm

152

III

Forearm

159

IV

Wrist and Hand

166

SECTION 3

SPINE

175

I

Spine

175

SECTION 4

LOWER EXTREMITY AND PELVIS

182

I

Pelvis and Hip

182

II

Thigh

192

III

Knee and Leg

199

IV

Ankle and Foot

205

Testable Concepts

215

3

Pediatric Orthopaedics   Todd A. Milbrandt and Daniel J. Sucato

217

SECTION 1

BONE DYSPLASIAS (DWARFISM)

218

I

Introduction

218

II

Achondroplasia

218

III

Spondyloepiphyseal Dysplasia

220

IV

Chondrodyspiasia Punctata

220

V

Kniest Syndrome

220

VI

Metaphyseal Chondrodyspiasia

222

VII

Multiple Epiphyseal Dysplasia

222

VIII

Dysplasia Epiphysealis Hemimelica (Trevor Disease)

222

IX

Progressive Diaphyseal Dysplasia (Camurati-Engelmann Disease)

222

X

Mucopolysaccharidosis

222

XI

Diastrophic Dysplasia

223

XII

Cleidocranial Dysplasia (Dysostosis)

223

XIII

Dysplasias Associated with Benign Bone Growth

223

SECTION 2

CHROMOSOMAL AND TERATOLOGIC DISORDERS

224

I

Down Syndrome (Tfisomy 21)

224

II

Turner Syndrome

225

III

Prader-Willi Syndrome

225

IV

Menkes Syndrome

225

V

Rett Syndrome

225

VI

Beckwith-Wiedemann Syndrome

226

VII

Teratogen-lnduced Disorders

226

SECTION 3

HEMATOPOIETIC DISORDERS

226

I

Gaucher Disease

226

II

Niemann-Pick Disease

226

III

Sickle Cell Anemia

226

IV

Thalassemia

227

V

Hemophilia

227

VI

Leukemia

227

SECTION 4

METABOLIC DISEASE/ARTHRITIDES

227

I

Rickets

227

II

Osteogenesis Imperfecta

228

III

Idiopathic Juvenile Osteoporosis

229

IV

Osteopetrosis

229

V

Infantile Cortical Hyperostosis (Caffey Disease)

229

VI

Marfan Syndrome

230

VII

Ehlers-Danlos Syndrome

230

VIII

Homocystinuria

230

IX

Juvenile Idiopathic Arthritis

230

X

Ankylosing Spondylitis

231

SECTION 5

BIRTH INJURIES

231

I

Brachial Plexus Palsy

231

II

Congenital Muscular Torticollis

232

III

Congenital Pseudarthrosis of the Clavicle

232

SECTION 6

CEREBRAL PALSY

232

I

Introduction

232

II

Classification

232

III

Orthopaedic Assessment

233

IV

Spasticity Treatment

233

V

Gait Disorders

234

VI

Spinal Disorders

235

VII

Hip Subluxation and Dislocation

236

VIII

Knee Abnormalities

236

IX

Foot and Ankle Abnormalities

237

X

Hand Management

237

SECTION 7

NEUROMUSCULAR DISORDERS

237

I

Arthrogrypotic Syndromes

237

II

Myelodysplasia (Spina Bifida)

238

III

Myopathies (Muscular Dystrophies)

240

IV

Polymyositis and Dermatomyositis

242

V

Hereditary Neuropathies

242

VI

Myasthenia Gravis

243

VII

Anterior Horn Cell Disorders

243

VIII

Acute Idiopathic Postinfectious Polyneuropathy (Guillain-Barre Syndrome)

243

IX

Overgrowth Syndromes

244

SECTION 8

CONGENITAL DISORDERS

244

SECTION 9

PEDIATRIC SP1NE

244

I

Scoliosis

244

II

Adolescent Idiopathic Scoliosis

244

III

Infantile Idiopathic Scoliosis

247

IV

Juvenile Idiopathic Scoliosis

247

V

Early-Onset Scoliosis

247

VI

Neuromuscular Scoliosis

248

VII

Congenital Scoliosis

248

VIII

Congenital Kyphosis

249

IX

Neurofibromatosis

250

X

Other Spinal Abnormalities

251

XI

Kyphosis

252

XII

Cervical Spine Disorders

253

SECTION 10

UPPER EXTREMITY PROBLEMS

255

I

Sprengel Deformity

255

II

Fibrotic Deltoid Problems

255

SECTION 11

LOWER EXTREMITY PROBLEMS: GENERAL

255

I

Introduction

255

II

Rotational Problems of the Lower Extremities

255

SECTION 12

HIP AND FEMUR

257

I

Developmental Dysplasia of the Hip

257

II

Congenital Coxa Vara

261

III

Legg-Calve-Perthes Disease (Coxa Plana)

261

IV

Slipped Capital Femoral Epiphysis

263

V

Proximal Femoral Focal Deficiency

264

VI

Leg-Length Discrepancy

265

VII

Lower Extremity Inflammation and Infection

265

SECTION 13

KNEE AND LEG

268

I

Leg

268

II

Tibial Bowing

269

III

Osteochondritis Dissecans

271

IV

Osgood-Schlatter Disease

271

V

Discoid Meniscus

271

SECTION 14

FOOT

271

I

Clubfoot (Congenital Talipes Equinovarus)

271

II

Forefoot Adduction

273

III

Pes Cavus

274

IV

Pes Calcaneovalgus

274

V

Tarsal Coalitions

275

VI

Calcaneovalgus Foot

275

VII

Juvenile Bunions

275

VIII

Kohler Disease

276

IX

Flexible Pes Planus

276

X

Habitual Toe Walking

277

XL

Accessory Navicular

277

XII

Ball-and-Socket Ankle

277

XIII

Congenital Toe Disorders

277

Testable Concepts

278

4

Sports Medicine   Matthew D. Milewski, Jennifer A. Hart, and Mark D. Miller

285

SECTION 1

KNEE

286

I

Anatomy and Biomechanics

286

II

Diagnostic Techniques

290

III

Knee Arthroscopy

294

IV

Meniscal Injuries

294

V

Ligament Injuries

298

VI

Osteochondral Lesions

304

VII

Synovial Lesions

307

VIII

Patellofemoral Disorders

307

IX

Pediatric Knee Disorders

309

SECTION 2

THIGH, HIP, AND PELVIS

310

I

Contusions

310

II

Muscle Injuries

311

III

Bursitis

311

IV

Nerve Entrapment Syndromes

311

V

Bone Disorders

311

VI

Intraarticular Disorders

312

VII

Femoroacetabular Impingement

312

VIII

Other Hip Disorders

313

IX

Hip Arthroscopy

313

SECTION 3

LEG, FOOT, AND ANKLE

314

I

Nerve Entrapment Syndromes

314

II

Muscle Injuries

314

III

Tendon Injuries

314

IV

Chronic Exertional Compartment Syndrome

315

V

Fractures

315

VI

Other Foot and Ankle Disorders

316

VII

Ankle Arthroscopy

318

SECTION 4

SHOULDER

319

I

Anatomy and Biomechanics

319

II

Diagnostic Techniques

321

III

Shoulder Arthroscopy

323

IV

Shoulder Instability

324

V

Impingement Syndrome/Rotator Cuff Disease

326

VI

Superior Labral and Biceps Tendon Injuries

329

VII

Acromioclavicular and Sternoclavicular Injuries

330

VIII

Muscle Ruptures

331

IX

Calcifying Tendinitis and Shoulder Stiffness

332

X

Nerve Disorders

332

XI

Other Shoulder Disorders

333

SECTION 5

ELBOW

335

I

Tendon Injuries

335

II

Ligament Injuries

335

III

Articular Injuries

337

IV

Elbow Stiffness

339

V

Elbow Arthroscopy

339

SECTION 6

HAND AND WRIST

339

I

Tendon Injuries

339

II

Ligament Injuries

340

III

Fractures

341

IV

Ulnar Wrist Pain

342

V

Post-Traumatic Dysfunction of the Wrist and Hand

343

VI

Wrist Arthroscopy

343

SECTION 7

HEAD AND SPINE

344

I

Head Injuries

344

II

Cervical Spine Injuries

345

III

Thoracic and Lumbar Spine Injuries

345

SECTION 8

MEDICAL ASPECTS OF SPORTS MEDICINE

346

I

Preparticipation Physical Examination

346

II

Muscle Physiology

346

III

Exercise

346

IV

Delayed-Onset Muscle Soreness

346

V

Cardiac Abnormalities in Athletes

346

VI

Metabolic Issues in Athletes

346

VII

Ergogenic Drugs

346

VIII

Female Athlete-Related Issues

347

IX

Other Sports-Related Injuries and Issues

347

Testable Concepts

349

5

Adult Reconstruction   Edward J. McPherson

353

SECTION 1

HIP DYSPLAS1A—ADULT PRESENTATION

355

I

Natural History

355

II

Spectrum of Presentation

355

III

Classification of Adult Hip Dysplasia

355

IV

Acetabular Dysplasia

355

V

Proximal Femoral Dysplasia

355

VI

Clinical Syndrome Associated with Dysplasia

355

VII

Dysplasia Treatment

357

SECTION 2

HIP ARTHRITIS ASSESSMENT

359

I

Physical Examination Tests for Hip Irritability

359

II

Studies

359

SECTION 3

HIP ARTHRITIS TREATMENT

360

I

Nonoperative

360

II

Operative

360

SECTION 4

OSTEONECROSIS OF THE HIP

362

I

Occurrence

362

II

Etiology

362

III

Clinical Presentation

362

IV

Imaging

362

V

Staging

362

VI

Treatment

362

SECTION 5

TOTAL HIP ARTHROPLASTY

363

I

Indications

363

II

Implant Fixation

363

III

Bone Ongrowth Fixation

365

IV

Hydroxyapatite

365

V

Primary THA—Fixation Selection

366

VI

Femoral Stem Loading

366

VII

Femoral Stress Shielding

366

VIII

Femoral Stem Breakage

368

SECTION 6

REVISION THA

368

I

Presentation

368

II

Acetabular Side

368

III

Femoral Side

370

SECTION 7

OSTEOLYSIS IN THA

371

I

Introduction

371

II

Ostedysis Process

372

III

Osteolysis Around THA Prosthesis—Effective Joint Space

372

IV

Particle Debris Formation—Linear versus Volumetric Wear

373

V

Osteolysis—Radiographic Findings in THA

374

VI

Osteolysis Reduction

374

SECTION 8

PERIPROSTHETIC THA FRACTURE

374

I

Time of Fracture

374

II

Perioperative Fracture

374

III

Late Fracture

374

SECTION 9

TOTAL ARTICULAR RESURFACING

375

I

Advantage

375

II

Relative Contraindication

375

III

Complication

375

SECTION 10

THA—MISCELLANEOUS

375

I

THA—Nerve Injury

375

II

THA Anatomy

376

III

THA—Specific Complications

376

IV

Venous Thrombosis in THA

376

V

THA—Surgical Approach

376

VI

THA—Implant Facts

376

SECTION 11

THA—JOINT STABILITY

377

I

Incidence of THA Dislocation

377

II

Risk Factors for Dislocation

377

III

Dislocating THA—Assessment

377

IV

Component Design

377

V

Primary Arc Range

377

VI

Lever Range

378

VII

Component Design—Best Range in THA

378

VIII

Component Alignment

378

IX

Soft Tissue Tension

379

X

Soft Tissue Function

381

XI

Dislocating THA—Treatment

382

SECTION 12

THA—ARTICULAR BEARING TECHNOLOGY

385

I

Bearing Types

385

II

Hard-on-Soft Bearing

385

III

Hard-on-Hard Bearing

389

SECTION 13

KNEE ARTHRITIS ASSESSMENT

392

I

Clinical Presentation

392

II

Imaging Studies

392

SECTION 14

KNEE ARTHRITIS TREATMENT

392

I

Nonoperative

392

II

Operative

392

SECTION 15

TOTAL KNEE ARTHROPLASTY

394

I

Indications

394

II

TKA Survival

394

III

Technical Goals of TKA

394

IV

Preoperative Planning for TKA

394

V

Bone Cuts in TKA—Goals

396

VI

Coronal Plane Ligament Balancing in TKA

396

VII

Flexion Deformity

397

VIII

Sagittal Plane Balancing in TKA

397

IX

TKA—Complications

398

SECTION 16

TKA DESIGN

400

I

Design Categories

400

II

Cruciate-Retaining Primary TKA Design

400

III

Cruciate-Sacrificing Primary TKA Design

401

IV

Posterior Stabilized Primary TKA Design

401

V

Anterior Stabilized Primary TKA Design

403

VI

Tibial Rotating Platform in Primary TKA

404

VII

Modularity in Primary TKA

405

VIII

Constraint in TKA

405

SECTION 17

REVISION TKA

408

I

Preoperative Evaluation

408

II

Surgical Approach

408

III

Implant System

408

IV

Modular Bearing Change for Premature Excessive Wear

408

V

Revision TKA—Technique

408

VI

Revision TKA—Patella

408

SECTION 18

PATELLAR TRACKING IN TKA

408

I

Introduction

408

II

Q Angle in TKA

409

III

TKA Techniques to Optimize Patellar Tracking

409

IV

Intraoperative Assessment of Maltracking

412

V

Postoperative Assessment of Maltracking

412

VI

Patella Baja

412

VII

Patellar Resurfacing versus Nonresurfacing

413

SECTION 19

CATASTROPHIC WEAR IN TKA

414

I

Premature Failure of TKA Implant

414

II

Factors Involved in Catastrophic Wear

414

III

Polyethylene Thickness

414

IV

Articular Geometry

414

V

Knee Kinematics

414

VI

Surgical Technique

414

VII

Polyethylene Processing

414

VIII

Perfect Storm Scenario for Catastrophic Wear

416

IX

Measures to Mitigate Catastrophic PE Wear

416

SECTION 20

SHOULDER ARTHROPLASTY

417

I

Glenohumeral Arthritis and Glenoid Wear

417

II

Shoulder Arthroplasty—Contraindications

417

III

Charcot Arthropathy

417

IV

Shoulder Hemiarthroplasty

417

V

Total Shoulder Arthroplasty

418

VI

Rotator Cuff Arthropathy

419

VII

Reverse Total Shoulder Arthroplasty

419

SECTION 21

PERIPROSTHETIC JOINT INFECTION

421

I

Risk Factors

421

II

Biofilm

421

III

Diagnosis

422

IV

Treatment Algorithm

422

V

Infection Prevention—Total Joint Replacement

422

VI

Wound Coverage in TKA

423

Testable Concepts

424

6

Disorders Of The Foot And Ankle   Anish R. Kadakia and Todd A. Irwin

429

SECTION 1

BIOMECHANICS OF THE FOOT AND ANKLE

430

I

Anatomy

430

II

Forefoot

433

III

Foot Positions versus Foot Motions

433

IV

The Gait Cycle

434

SECTION 2

PHYSICAL EXAMINATION OF THE FOOT AND ANKLE

436

I

Inspection

436

II

Vascular Examination

438

III

Neurologic Examination

438

IV

Motor Examination

439

V

Palpation and Stability

439

VI

Range of Motion

440

SECTION 3

RADIOGRAPHIC EVALUATION OF THE FOOT AND ANKLE

441

I

Weight-Bearing Views

441

II

Imaging Procedures

442

SECTION 4

ADULT HALLUX VALGUS

442

I

Overview

442

II

Pathoanatomy

442

III

Surgical Procedures

444

IV

Surgical Complications

448

SECTION 5

JUVENILE AND ADOLESCENT HALLUX VALGUS

448

I

Factors

448

SECTION 6

HALLUX VARUS

449

I

Cause

449

II

Nonoperative Treatment

449

III

Operative Treatment

449

SECTION 7

LESSER-TOE DEFORMITIES

451

I

Anatomy and Function

4S1

II

Hammer-Toe Deformity

451

III

Claw-Toe Deformity (Intrinsic Minus Toe)

452

IV

Mallet-Toe De-formity

452

V

Crossover-Toe Deformity

453

VI

Metatarsophalangeal Instability

454

VII

Freiberg Disease

454

VIII

Fifth-Toe Deformities

455

SECTION 8

HYPERKERATOTIC PATHOLOGIES

456

I

Hard Corns (Helomata Durum)

456

II

Soft Corns (Helomata Molle)

456

III

Intractable Plantar Keratosis

457

IV

Bunionette Deformity (Tailor’s Bunion)

457

SECTION 9

SESAMOIDS

459

I

Anatomy

459

II

Deformities

459

SECTION 10

ACCESSORY BONES

461

SECTION 11

NEUROLOGIC DISORDERS

461

I

Interdigital Neuritis (Morton Neuroma)

461

II

Recurrent Neuroma

462

III

Tarsal Tunnel Syndrome

463

IV

Anterior Tarsa! Tunnel Syndrome

464

V

Sequelae of Upper Motor Neuron Disorders

465

VI

Charcot-Marie-Tooth Disease

466

VII

Peripheral Nerve Injury and Tendon Transfers

468

SECTION 12

ARTHRITIC DISEASE

468

I

Crystalline Disease

468

II

Seronegative Spondyloarthropathy

469

III

Rheumatoid Arthritis

470

IV

Osteoarthritis

472

SECTION 13

POSTURAL DISORDERS

478

I

Pes Planus (Flatfoot) Deformity

478

II

Pes Cavus Deformity

480

SECTION 14

TENDON DISORDERS

483

I

Achilles Tendon

483

II

Peroneal Tendons

483

III

Posterior Tibial Tendon

483

IV

Anterior Tibial Tendon

483

V

FHL—Stenosing FHL Tenosynovitis

483

SECTION 15

HEEL PAIN

484

I

Plantar Heel Pain

484

II

Posterior Heel Pain

485

SECTION 16

THE DIABETIC FOOT

488

I

Pathophysiology

488

II

Clinical Problems

488

SECTION 17

TRAUMA

490

I

Phalangeal Fractures

490

II

Metatarsal Fractures

490

III

First Metatarsophalangeal Joint Injuries

492

IV

Tarsometatarsal Fractures and Dislocations (Lisfranc Injury)

492

V

Midfoot Injuries (Excluding Lisfranc Injuries)

497

VI

Ankle Fractures

501

VII

Talus Fractures

501

VIII

Calcaneus Fractures

504

IX

Peritalar (Subtalar) Dislocations

506

X

Compartment Syndrome

508

Testable Concepts

510

7

Hand, Upper Extremity, And Microvascular Surgery   Lance M. Erunton and A. Bobby Chhabra

517

I

Anatomy

517

II

Distal Radius Fractures

521

III

Carpal Fractures and Instability

523

IV

Metacarpal and Phalangeal Injuries

529

V

Tendon Injuries and Overuse Syndromes

532

VI

Distal Radioulnar Joint, Triangular Fibrocartilage Complex, and Wrist Arthroscopy

537

VII

Nail and Fingertip Injuries

540

VIII

Soft Tissue Coverage and Microsurgery

542

IX

Vascular Disorders

546

X

Compression Neuropathy

549

XI

Nerve Injuries and Tendon Transfers

556

XII

Arthritis

559

XIII

Idiopathic Osteonecrosis of the Carpus

563

XIV

Dupuytren Disease

564

XV

Hand Tumors

566

XVI

Hand Infections

568

XVII

Congenital Hand Differences

572

XVIII

Elbow

576

Testable Concepts

582

8

Spine   William C. Lauerman and Clark C. Baumbusch

589

I

Introduction

589

II

Cervical Spine

590

III

Thoracic/Lumbar Spine

599

IV

Sacrum and Coccyx

614