Erica Taylor

Orthopedic Complications of Overweight in Children and Adolescents

OBJECTIVE. Few studies have quantified the prevalence of weight-related orthopedic conditions in otherwise healthy overweight children. The goal of the present investigation was to describe the musculoskeletal consequences of pediatric overweight in a large pediatric cohort of children that included severely overweight children. METHODS. Medical charts from 227 overweight and 128 nonoverweight children and adolescents who were enrolled in pediatric clinical studies at the National Institutes of Health from 1996 to 2004 were reviewed to record pertinent orthopedic medical history and musculoskeletal complaints. Questionnaire data from 183 enrollees (146 overweight) documented difficulties with mobility. In 250, lower extremity alignment was determined by bilateral metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements made from whole-body dual-energy x-ray absorptiometry scans. RESULTS. Compared with nonoverweight children, overweight children reported a greater prevalence of fractures and musculoskeletal discomfort. The most common self-reported joint complaint among those who were questioned directly was knee pain (21.4% overweight vs 16.7% nonoverweight). Overweight children reported greater impairment in mobility than did nonoverweight children (mobility score: 17.0 ± 6.8 vs 11.6 ± 2.8). Both metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements showed greater malalignment in overweight compared with nonoverweight children. CONCLUSIONS. Reported fractures, musculoskeletal discomfort, impaired mobility, and lower extremity malalignment are more prevalent in overweight than nonoverweight children and adolescents. Because they affect the likelihood that children will engage in physical activity, orthopedic difficulties may be part of the cycle that perpetuates the accumulation of excess weight in children.

HIV/AIDS and the African-American Community: A State of Emergency

HIV and AIDS disproportionately affect African Americans more than any other racial or ethnic group in the United States. Representing only 13% of the U.S. population, African-American adults and adolescents comprise more than half of all HIV/AIDS cases reported to the Centers for Disease Control and Prevention. The present incidence and prevalence of HIV/AIDS in the black community in the United States is of crisis proportions. The situation as it stands today is tantamount to a state of emergency for African Americans.

Novel Nanostructured Scaffolds as Therapeutic Replacement Options for Rotator Cuff Disease

Rotator cuff injuries represent an extremely common cause of upper extremity disability1, resulting in substantial shoulder pain and dysfunction. Young athletes, middle-aged workers, and a substantial portion of the elderly population can sustain acute or degenerative rotator cuff injuries, which prevent them from working, playing sports, enjoying hobbies, or performing activities of daily living2,3. Active people, including athletes, are highly susceptible to rotator cuff problems, particularly as they advance in age4. It has been estimated that approximately 300,000 rotator cuff surgical procedures are performed each year in the United States. Traditionally, surgical repair of a rotator cuff consists of reapproximating the tendon edge to an anatomic footprint with the specific type of repair used (open, mini-open, or arthroscopic) dependent on the size, shape, and chronicity of the tear5,6. The disadvantages of the open techniques include a larger dissection and longer operating time, while the arthroscopic repairs have been associated with a limited amount of working area, a longer learning curve, and a higher percentage of recurrent lesions compared with the open or mini-open repair techniques7. In the past decade, surgical procedures that utilize autografts, cadaveric allografts, or patch grafts made from biological and synthetic materials have been developed to repair massive rotator cuff tears8-11. Several factors limiting the extensive use of these procedures include donor site morbidity, the limited availability of autografts, and the risk of disease transmission with allografts. Recent studies have shown advantages with the use of synthetic augmentation devices to support the healing of a torn rotator cuff, but few of the commercially available matrices truly mimic the biomechanical behavior of a natural rotator cuff tendon12. The integration of biological, chemical, and engineering principles to design a suitable bioresorbable rotator cuff scaffold serves as the basis for the tissue-engineered approach employed in the present investigation. The objective of this study was to develop a novel therapeutic strategy to support and accelerate the healing of a torn rotator cuff. A tissue-engineering approach with use of a nanostructured resorbable polymeric scaffold was hypothesized to produce a matrix with cellular and biomechanical properties suitable to provide initial strength and enhance the rate of regenerative repair. The components of this investigation included (1) fabrication of a nanofiber polymeric scaffold, (2) in vitro biological characterization, (3) development of an original rodent model, and (4) in vivo biomechanical characterization.

Reconstruction options for acetabular revision

This article summarizes reconstruction options available for acetabular revision following total hip arthroplasty. A thoughtful methodology to the evaluation and treatment of patients with implant failure after joint replacement is essential to guarantee accurate diagnoses, appropriate triage to reconstruction options, and optimal clinical outcomes. In the majority of patients who undergo acetabular revision, factors such as bone loss and pelvic discontinuity provide a challenge in the selection and implementation of the proper reconstruction option. With advanced evaluation algorithms, imaging techniques, and implant designs, techniques have evolved to rebuild the compromised acetabulum at the time of revision surgery. However, clinical outcomes data for these techniques continue to lag behind the exponential increase in revision hip arthroplasty cases predicted to occur over the next several years. We encourage those involved in the treatment of patients undergoing hip replacement surgery to participate in well-designed clinical studies to enhance evidence-based knowledge regarding revision acetabular reconstruction options.

Tissue Engineering of Bone: A Primer for the Practicing Hand Surgeon

RACTURES OF THE UPPER EXTREMITY are exceedingly common, representing more than 2,000,000 emergency room visits annually in the United States, as reported by the American Academy of Orthopaedic Surgeons. 1 Whether conservative or operative management is employed, the outcomes of different methods of treatment can be evaluated in various ways, including the potential for reconstituting acceptable anatomic alignment, recovering sufficient clinical function, and optimizing patient satisfaction. By and large, a successful result in traumatic hand surgery is largely influenced by the capacity for the normal physiologic reaction to fracture to take place. This series of events, summarized as initial inflammation, soft callus formation, and hard callus formation, ideally results in adequate ultimate bone remodeling. 2 When this natural healing process does not—or cannot—occur, as is the case for fracture nonunions or marked traumatic bone loss, consideration for surgical intervention is warranted. Complex fracture geometry and stability can present challenges to the hand surgeon, particularly in situations where vascular supply is limited 3 (eg, scaphoid fractures), soft tissue coverage is suboptimal (eg, dorsal hand injuries), or a marked amount of comminution or intra-articular involvement is present. 4 To overcome these obstacles, methods to augment standard internal and external fixation procedures through use of bone grafts (autograft and allograft) and bone-graft substitutes have been developed and implemented in upper-extremity surgery. 5

Tethered Thumb Sign: A Unique Observation in the Physical Examination of de Quervain Tenosynovitis

To the Editor: Stenosing tenosynovitis of the first dorsal compartment of the wrist is a painful condition that we see frequently. Because radial-sided wrist pain can be attributed to pathologies outside the first compartment, the clinician should ensure that an accurate assessment of the upper extremity is performed to confirm the diagnosis and guide appropriate treatment. A key examination tool is the maneuver characterized by Eichoff and Finklestein, in which the patient clenches the thumb in the palm while the wrist is moved into ulnar deviation. This test can be quite painful at times. Thus, we advise first using an adjunctive tool developed by the senior author (A.I.F.). This proposed maneuver elicits a characteristic response in many of the patients who have de Quervain tenosynovitis. The patient places his or her hands onto the table in a resting position. The clinician then grasps the fingers and brings both wrists into gentle ulnar deviation, allowing the thumb to remain free. In absence of pathology, the thumb follows the cascade of the rest of the hand into ulnar deviation. However, if there is stenosis of the first dorsal compartment, the thumb is tethered and remains aligned with the forearm while the rest of the hand falls into ulnar deviation (Fig. 1). We liken the finding of a tethered thumb to an accentuated tenodesis effect of the extensor pollicis brevis and abductor pollicis longus tendons, leading to the fixed position of the thumb with passive wrist ulnar deviation. We believe that this clinical maneuver can support the diagnosis of de Quervain tenosynovitis and assist in determin-