Andrew G. Georgiadis

Team approach: Single-event multilevel surgery in ambulatory patients with cerebral palsy

>> Assessment of the ambulatory patient who has cerebral palsy (CP) involves serial evaluations by orthopaedic surgeons, neurosurgeons, rehabilitation specialists, and therapists as well as 3-dimensional gait analysis (3DGA). The most common subtype of CP in ambulatory patients is diplegia, and the

The Cavovarus Foot in Hereditary Motor and Sensory Neuropathies

The cavovarus foot is a complex deformity involving a spectrum of changes to the hindfoot, midfoot, forefoot, and ankle. While cavovarus deformity can occur secondary to many congenital, neurological, or posttraumatic causes, the prototypical form is that of Charcot-Marie-Tooth (CMT) disease, the most common inherited neuropathy. The first known cases of cavovarus foot deformity were reported by Aran in the Archives Generales de Medicine in 18501. Professor Jean Martin Charcot and his student Pierre Marie coined the term “peroneal muscular atrophy” in 1886, with clinical descriptions of distal muscle weakness beginning in the legs and hands2. Howard Henry Tooth, in his Cambridge MD dissertation in the same year, wrote on “the peroneal type of progressive muscular atrophy” and provided illustrations of hindfoot varus and wasting of the peronei and foot extensors (Fig. 1)3. Charcot-Marie-Tooth disease has now become synonymous with the hereditary motor and sensory neuropathies (HMSNs), of which nearly fifty genetic subtypes have been described4. These neuropathies constitute a genetically and phenotypically heterogeneous group of peripheral nerve disorders that are …

Anterior Knee Pain in Children and Adolescents: Overview and Management

Abstract Anterior knee pain (AKP) is a common presenting complaint for pediatricians and orthopaedic surgeons and is often seen in young athletes. AKP is multifactorial and has a broad differential diagnosis. The growth changes, biomechanics, and anatomy around the knee add to the complexity of diagnosis and treatment of AKP. Common causes of AKP include Osgood‐Schlatters disease, patellar tendinitis, and patellofemoral instability. In the diagnosis of AKP, it is important to rule out serious and morbid causes of pain, including infection and tumor. It is crucial to complete a detailed history and physical examination and obtain appropriate imaging studies. In general, the majority of patients will respond to nonoperative measures targeted to correct neuromuscular control and kinetic chain dysfunction.

Hip Vascularity: A Review of the Anatomy and Clinical Implications.

Throughout development, the vascular supply to the proximal femur and acetabulum undergoes a series of changes during which it is susceptible to injury. Before age 3 months, the ligamentum teres and lateral epiphyseal arteries are the dominant supply to the developing head. The dominant supply shifts to the lateral epiphyseal vessels by age 18 months. The distinct metaphyseal and epiphyseal circulations of the adult proximal femur form in adolescence when an increasingly rich metaphyseal circulation supplies the subphyseal region, terminating at the physeal plate. The acetabular blood supply derives from two independent systems, with the dominance of each changing throughout maturity. Most descriptions of the vascular contributions to the proximal femur and acetabulum have been gross anatomic and histologic studies. Advanced imaging studies (eg, CT angiography, perfusion MRI) have added to our understanding of the vascular anatomy of the proximal femur and acetabulum, its changes throughout development, and its clinical implications.