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# Team Bone

Excellence in Bone Research

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## Pages

- [Home](https://teambone.com/) - Mission StatementOur laboratory focuses on:Understanding bone biology and adaptation for enhancing the treatment and prevention of diseases related to the skeletonThe mechanisms and biomechanical manifestations of normal and abnormal bone development and developmental adaptationClinical applications of basic research on osteoporosis and related diseases of skeletal senescence Principal Investigator:Send correspondence to:John G. Skedros, M.D. Utah Orthopaedic Specialists5316
- [Personnel](https://teambone.com/personnel/) - Dr. Skedros has extensive training in skeletal biology, comparative functional morphology, and evolutionary biology. He worked closely with Dennis Bramble, Ph.D. and John Legler, Ph.D. in the Department of Biology at the University of Utah during his undergraduate years. Principal Investigator: John G. Skedros, M.D. View CV Dr. John Skedros is the director of Teambone
- [Publications](https://teambone.com/publications/) - View CV Bone Adaptation Backscattered Electron Imaging Shoulder & Elbow Osteoporosis Knee Studies Other Clinical Studies & Case Reports Abstracts View CV Bone Adaptation Backscattered Electron Imaging Shoulder & Elbow Osteoporosis Knee Studies Other Clinical Studies & Case Reports Abstracts Search Search *These publications are for personal use only. Otherwise, contact the publisher for copyright
- [Alumni](https://teambone.com/alumni/) - Hunter MarshallHunter is now doing research for Intermountain Healthcare. Kendra Keenan, MDKendra is now doing a fellowship at Stanford in neurology with a focus on headaches. She graduated from the University of Utah school of Medicine where she also completed a residency in neurology. Casey Kiser, M.D.Med School: University of UtahResidency: Penn State University in Hershey, PennsylvaniaAfter
- [Links](https://teambone.com/links/) - Dr. Skedros American Academy of Orthopaedic Surgeons (AAOS) American Association of Physical Anthropologists (AAPA) American Society for Bone and Mineral Research (ASBMR) International Bone and Mineral Society (IBMS) Orthopaedic Research Society (ORS) PubMed - Medline Search Engine The Society for Integrative Comparative Biology (SICB) University of Utah School of Medicine (UMED) If you would like
- [Georgie Project](https://teambone.com/georgie-project-2/)
- [Themes](https://teambone.com/themes/) - Teambone has two research limbs: The Basic Research limb was headquartered at the Bone and Joint Research Laboratory at the Veterans Affairs Medical Center in Salt Lake City, Utah (lab directors: Dustin Williams, Ph.D. and Roy Bloebaum, Ph.D.). This limb concentrates on bone's adaptation to mechanical stimuli in the context of bone loss and osteoporosis. We
- [No Access](https://teambone.com/no-access/) - [dlm_no_access]
- [The Value of Bending](https://teambone.com/education-basic/the-value-of-bending/) - The value of bending: Predictability, fluid flow, nutrient delivery, and beneficial signals. If bending creates the dilemma of regionally prevalent, but potentially deleterious, shear and/or tension, then why is it such a common load history? In turn, does this load regime have some less obvious or fundamental biological value even though strain-mode-specific nanostructural/microstructural toughening accommodates
- [Stress Fractures - New Ideas](https://teambone.com/education-basic/stress-fractures-new-ideas/) - Changes in strain distribution caused by changes in load predictability can lead to stress fractures: An example in thoroughbred horses. The role of osteon morphotypes and/or predominant collagen fiber orientation (a hypothesis). We consider the study by John Bertram and Andrew Biewener published in 1988 in the Journal of Theoretical Biology as one of the
- [Resist vs. Accommodate Stress](https://teambone.com/education-basic/resist-vs-accommodate-stress/) - The aim of adaptation is to “accommodate” not “resist” habitual/beneficial strains, at least up to a point. While the best way to avoid fatigue failure may be to decrease microcrack incidence, Martin et al. (1998) argued that bone that is highly resistant to microdamage initiation will be inefficient at controlling microcrack propagation. The trade-off for
- [Amprino’s Rule](https://teambone.com/education-basic/amprinos-rule/) - The idea that primary bone microstructure may reflect bone formation rate was suggested by Amprino (1947) and is a general finding that has been reported by Currey (2002), Stover et al. (1992) and others (de Ricqlès et al., 1991; Mori et al., 2003). This relationship has been demonstrated experimentally in mallard duck limb bones by
- [Cortical Robusticity Threshold Hypothesis](https://teambone.com/education-basic/cortical-robusticity-threshold-hypothesis/) - Cortical Robusticity Threshold Hypothesis – Can the CFO patterns in the human femoral neck be ignored as being adapted for bending? This hypothesis grew out of our attempts to provide reasonable explanations (in the context of functional adaptation) for the unexpected patterns of predominant collagen fiber orientation (CFO) that we have quantified in the cortices
- [Determining the Ontogenetic Phase](https://teambone.com/education-basic/determining-the-ontogenetic-phase/) - In which ontogenetic phase is the bone: attainment, maintenance, or senescence (aged)? It is important to review terms that are used to describe phases of a bone’s ontogeny so that possible genetic, epigenetic, and extra-genetic influences on bone modeling and remodeling can be more precisely considered and discussed. There is an evolving neology for the
- [Sheep and Deer Calcanei as Control Bones](https://teambone.com/education-basic/sheep-and-deer-calcanei-as-control-bones/) - Control Bones can be Important in Bone Adaptation Studies We have found it astonishing that there is very little mention in the bone adaptation literature of using a “control bone”. In other words, a bone that has a well described load history; hence it can be used as a reference for what might be expected
- [The Volume Effect](https://teambone.com/education-basic/the-volume-effect/) - The Stressed “Volume Effect” The stressed “volume effect” helps distinguish fundamental differences in the adaptability of bones from small vs. large animals. The ‘volume effect’ also helps explain why some bones do not form osteons. Material science teaches the crux of the volume effect: larger structures are more prone to failure than small structures. An
- [Multi-Domain Load Hypothesis](https://teambone.com/education-basic/multi-domain-load-hypothesis/) - Evidence of different load-complexity categories/domains within the same bone lead to the development of Teambone’s multi-domain load hypothesis. As illustrated in figure 1 (at top), we have applied the concept of distinct load-complexity ‘domains’ to help make sense of differences in structural and material (histomorphological) characteristics, and their potential “interactions”, between different bones in the
- [Load Complexity Categories](https://teambone.com/education-basic/load-complexity-categories/) - Load-Complexity Categories: Simple, Moderate A, Moderate B, and Complex (Torsion/Shear) The general theme of this section is that regional variations in predominant collagen fiber orientation (CFO) coupled with in vivo strain data suggest that habitual loading of a bone or bone region can be best understood in the context of one of four “load-complexity categories”
- [Shear Resistance-Priority Hypothesis](https://teambone.com/education-basic/shear-resistance-priority-hypothesis/) - Mechanical data that support the basic premise for stating this hypothesis are diagrammatically represented in figure 1 for cortical bone, cancellous bone, and cartilage. As shown, there are three strain modes: shear, tension, and compression. In all cases, shear strains are most deleterious, with tension being a close second in most cases (Burstein et al.,
- [Pre-Yield Adaptations can Influence Post-Yield Behavior](https://teambone.com/education-basic/pre-yield-adaptations-can-influence-post-yield-behavior/) - Using the stress-strain curve for considering mechanisms of bone adaptation produced by remodeling-induced affects on CFO, osteon morphotypes, and osteon population densities What follows is an exercise that considers how primary modifications for pre-yield (elastic) behavior can secondarily have beneficial consequences for post-yield behavior. This exercise helps to clarify why regional patterns of CFO and/or
- [Collagen Fiber Orientation and Osteon Morphotypes](https://teambone.com/education-basic/collagen-fiber-orientation-and-osteon-morphotypes/) - Predominant Collagen Fiber Orientation (CFO) and Osteon Morphotypes Predominant CFO is often strongly strain-mode specific , 1. (see footnote) and regional CFO patterns are often produced by the regional prevalence of specific osteon morphotypes. In order to quantify these relationships, osteon morphotype scoring, first introduced by Martin and co-workers (1996a), has become a useful method
- [Modeling-Remodeling Synergism/Compensation](https://teambone.com/education-basic/modeling-and-remodeling-do-they-compensate-for-each-other/) - Many investigators have suggested that strong correlations between the outcomes of modeling (e.g., adjustments in cortical thickness or moments of inertia) remodeling (e.g., increased porosity or osteon density; reduced mineral content) reflect their synergism/ compensation in affecting local or whole-bone performance (Beck et al., 2000, van der Meulen et al., 2001, Ural and Vashishth, 2006,
- [The Modeling-Remodeling “Division of Labor”](https://teambone.com/education-basic/the-modeling-remodeling-division-of-labor/) - It can be argued that many examples of structural/material associations that have been shown in limb-bone diaphyses are circumstantial, bearing little relevance in the context of highly coupled functional adaptation. Additionally, existing knowledge of the capacity for intercellular communication in bone suggests that it is not sufficient for achieving the high level of coordination between
- [Osteoporosis Facts](https://teambone.com/education-basic/osteoporosis-facts/) - Who Has Osteoporosis? Femoral neck fractures can result in severe impairment of mobility and lifestyle, and in the elderly they are also associated with a mortality rate that can exceed 20% within two years of fracture (Boonen et al., 2004; Adachi et al., 2010; Ma et al., 2011). It is estimated that nearly 30 million
- [Trajectorial Hypothesis](https://teambone.com/education-basic/trajectorial-hypothesis/) - History In 1892, Julius Wolff published his seminal monograph on bone "remodeling" (transformation),* or the observation that the external shape and/or internal cancellous architecture of a bone can change in response to stresses acting on it. Based on observations, assumptions, predictions, and personal tenacity, Wolff's general ideas have become known as "Wolff's law" of bone
- [Cell Communication](https://teambone.com/education-basic/cell-communication/) - Cellular mechanisms of mechanotransduction in bone tissue The capacity of bone tissue to alter its mass and structure in response to mechanical demands has long been recognized, but the most proximate mechanisms involved remain poorly understood. There is currently a growing consensus that the network of interconnected osteocytes and bone lining cells provides the cellular
- [Turkey Ulna Model](https://teambone.com/education-basic/turkey-ulna-model/) - Team Bone has examined the widely-studied turkey ulna model in the context of ultrastructure (collagen fiber orientation), microstructure, and geometry. See these studies: (Skedros et al., 2003; Skedros and Hunt, 2004) (see these papers on this website). Implications for Functional Adaptation of Cortical Bone Regional and age-related variations in the structural and material organization of
- [Artiodactyl Calcaneus Model and Trajectorial Theory](https://teambone.com/education-basic/artiodactyl-calcaneus/) - History — How and why did Team Bone start studying artiodactyl calcanei as a way to better understand Wolff’s trajectorial hypothesis of cancellous (trabecular) bone adaptation? In 1892, Julius Wolff (Fig 1) published his seminal monograph on bone "remodeling" (transformation)*see footnote the observation that the external shape and/or internal cancellous architecture of a bone can
- [Fluid Flow in Bone](https://teambone.com/education-basic/fluid-flow/) - Summary of Fluid Flow Research From: an early Bone Fluid-Flow Workshop with our updates Remodeling in the Development of Stress Fractures Stress fractures in bone result from repetitive loading. As such, they have often been regarded as mechanical fatigue-driven processes. However, while bone readily sustains fatigue microdamage during the course of repeated loading at the
- [Modeling-Remodeling](https://teambone.com/education-basic/modelingremodeling/) - Wolff’s Law, Bone Formation, Modeling and Remodeling After nearly 25 years of work in skeletal anatomy, adaptation, and orthopaedics, Julius Wolff published his seminal 1892 work on bone 'transformation' (known today as bone remodeling and modeling). Wolff's work and his general view of how a limb bone's morphology develops has evolved into a nebulous concept
- [Biomechanics of Bone](https://teambone.com/education-basic/biomechanics-of-bone/) - Basic Biomechanical Concepts: The Foundation for Interpreting Local Load History Using Bone Histomorphology 1. The structural vs. material distinction. A sound understanding of basic mechanical concepts is necessary for accurately assessing many of the issues that must be considered (Table 1) when interpreting a bone's load history through the examination of its structural and material
- [Basic Biology of Bone](https://teambone.com/education-basic/basic-biology-of-bone/) - Bone is a composite tissue consisting of mineral, matrix (collagen and non-collagenous proteins), cells, and water. The mineral is hydroxyapatite, which is an analog of the naturally occurring crystalline calcium phosphate. Hydroxyapatite crystals, as distinct from geologic apatites, are very small and imperfect, containing fewer hydroxyl groups and many impurities such as carbonate, fluoride, acid
- [References](https://teambone.com/education/education-clinical/total-joint-arthroplasty/references/) - 1) Chapman's Orthopaedic Surgery, 3rd Edition© 2001 by Lippincott Williams & Wilkins Philadelphia, PA USA 2) Gubston FH. Polycentric Knee arthroplasty. J Bone Joint Surg 1971 1; 53-B:272 3) Kellegren JH, Lawrence JS, Bier F. Genetic Factors in Generalized Osteoarthrosis. Ann Rheum Dis 1963;22:237. 4) Doherty M, Watt I, Dieppe P. Influence of Primary Generalized
- [Total Shoulder Arthroplasty](https://teambone.com/education/education-clinical/total-joint-arthroplasty/total-shoulder-arthroplasty/) - The shoulder is the most mobile joint in the body. (Figure 46) This makes arthroplasty of the shoulder joint fundamentally different than arthroplasty of the knee or hip. Nevertheless, many of the same principles of implant fixation and arthroplasty technique are very similar. The success of shoulder replacement surgery is very dependant on the surrounding
- [Osteotomy of The Knee](https://teambone.com/education/education-clinical/total-joint-arthroplasty/osteotomy-of-the-knee/) - Realignment osteotomies are based on the assumption that excessive force carried across the joint from abnormal limb alignment leads to accelerated degeneration within the affected joint or joint compartment. Cadaveric models have demonstrated increased contact pressures in knees that undergo varus or valgus malalignment of the tibia. With time, the excessive pressure leads to breakdown
- [Fusion of the Hip and Knee Joints](https://teambone.com/education/education-clinical/total-joint-arthroplasty/fusion-of-the-hip-and-knee-joints/) - Hip Arthrodesis Fusion of the hip is generally reserved for young heavy laborers with end stage DJD who would likely cause their total hip construct to rapidly deteriorate because of the excessive stresses it would experience. Surgical fusions are performed for these young adults with advanced arthritis (most commonly post traumatic DJD) who have a
- [Total Knee Arthroplasty and Revisions](https://teambone.com/education/education-clinical/total-joint-arthroplasty/total-knee-arthroplasty-and-revisions/) - The original principles developed by Sir John Charnley in the hip were translated to the knee by Gunston in the late 1960’s and published in JBJS in 1971. (35) From this beginning, in 1997, a total of 277,000 knee arthroplasties were performed, reflecting annual increases in the 1990s of more than 10%. (36) In addition,
- [Total Hip Arthroplasty and Revisions](https://teambone.com/education/education-clinical/total-joint-arthroplasty/total-hip-arthroplasty-and-revisions/) - The birth of modern day arthroplasty began in the early 1960’s when Sir John Charnley introduced cemented metal-poly-ethylene components for the hip. The original principles that he put forward with this device have yielded one of the most successful procedures in the entire canopy of medicine. Charnley’s total hip principles of 1)Resurfacing of both sides
- [Post-Traumatic Arthritis](https://teambone.com/education/education-clinical/total-joint-arthroplasty/post-traumatic-arthritis/) - Intra-articular fracture is one of the leading contributors to the development of secondary osteoarthritis. Articular fractures not only cause focal necrotic death to mechanically disrupted chondrocytes, but also induce a cascade of chondrocyte apoptosis.(20,21,22) Chondrocyte apoptosis exacerbates articular damage and correlates with the severity of secondary osteoarthritic changes. Principles of anatomic reduction of the involved
- [Rheumatoid Arthritis](https://teambone.com/education/education-clinical/total-joint-arthroplasty/rheumatoid-arthritis/) - Rheumatoid arthritis(RA) is a progressive systemic autoimmune disease of the synovial joints. It is characterized by symmetric erosive synovitis that often results in severe joint destruction despite medical therapy. RA often presents with associated fatigue and lassitude before the symmetric polyarthralgias erupt. Later on there is limitation of motion due to pain or joint destruction.
- [Evaluating Periarticular Pain in the Clinic:](https://teambone.com/education/education-clinical/total-joint-arthroplasty/evaluating-periarticular-pain-in-the-clinic/) - When evaluating any periarticular pain, the realization of an accurate and timely diagnosis can be facilitated by asking the following questions: A) Is the pain articular or non-articular? (is it in the joint or not) B) Is the problem inflammatory? C) Is the problem acute or chronic? D) What is the pattern of joints involved?
- [An overview of Degenerative Joint Disease:](https://teambone.com/education/education-clinical/total-joint-arthroplasty/an-overview-of-degenerative-joint-disease/) - Osteoarthritis (OA), also known as degenerative joint disease (DJD) is the final common pathway to which all joint disease deteriorates. Post traumatic, septic and other inflammatory arthropathies have components of DJD in their end stages. OA imposes an enormous disease burden currently affecting approximately 40 million people in the U.S. and is expected to impair
- [Total Joint Arthroplasty](https://teambone.com/education/education-clinical/total-joint-arthroplasty/) - Overview Clinical evaluation Rheumatoid arthritis Post-traumatic arthritis Total Hip Arthroplasty Total Knee Arthroplasty Joint Arthrodesis Osteotomy of the Knee Total Shoulder Arthroplasty References
- [Stress Fractures](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/stress-fractures/) - Overview Stress fractures are common athletic overuse injuries. Although there are numerous risk factors that contribute to the development of stress fractures, they generally result from repeated overloading of the bone that exceeds its remodeling capability. Most stress fractures occur in the lower extremity. Common sites for stress fractures include the tibia, fibula, metatarsals, tarsal
- [Ankle Sprains](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/ankle-sprains/) - Overview Ankle injuries are one of the most common injuries in sports. It is estimated that there are over 23,000 ankle sprains per day in the United States. Most of these injuries are uneventful and heal with time, but approximately 20% go on to have recurrent instability. Anatomy The ankle joint is formed by the
- [Cartilage Injuries - Knee](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/cartilage-injuries-knee/) - Overview Articular cartilage plays an important role in joint load bearing and motion. The cartilage surface provides joints with a smooth, lubricated surface that minimizes friction. Its biomechanical properties are directly related to its composition. Articular cartilage is composed mainly of water (65-80%), type II collagen (10-20%), and proteoglycans. Articular cartilage injuries can either be
- [Meniscal Injuries](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/meniscal-injuries/) - Overview Meniscal knee injuries are very common. Historically, the menisci were not felt to be important structures and total menisectomies used to be a common operation performed for meniscal tears. However, we have learned that the menisci play an important role in load transmission, improving joint congruity, and joint stabilization. It is estimated that the
- [Anterior Cruciate Ligament (ACL) Injuries](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/anterior-cruciate-ligament-acl-injuries/) - Overview The anterior cruciate ligament is a very common injury with an estimated 100,000 new ACL injuries reported each year in the United States. It is a very common sports related injury in both men and women athletes. However, ACL injuries are 2-8 times more common in female athletes than in men competing in the
- [Patellofemoral Instability – Patellar Dislocations](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/patellofemoral-instability-patellar-dislocations/) - Anatomy The patella is a sesmoid bone located within the quadriceps tendon. The patella articulates directly with the distal femur forming the patellofemoral articulation. It increases the mechanical advantage of the quadriceps by increasing the functional lever arm. The patella is kept centered within the femoral trochlear groove by many soft tissue stabilizers including the
- [Shoulder Instability](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/shoulder-instability/) - Overview The shoulder is the most mobile joint in the body. The glenohumeral joint is rather shallow and only 25-30% of the humeral articular surface comes into contact with the glenoid at one time. The shoulder relies on static and dynamic soft tissue constraints for stability. Due to the increased mobility of the glenohumeral joint
- [Rotator Cuff/Impingement](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/rotator-cuffimpingement/) - Rotator Cuff Anatomy The rotator cuff is composed of the tendinous portions of four muscles: the supraspinatus, infraspinatus, teres minor and the subscapularis. The rotator cuff acts as a major stabilizer to the glenohumeral joint. The cuff musculature provides dynamic stability to the glenohumeral joint, keeping the humeral head within the shallow glenoid cavity during
- [Orthopaedic Sports Medicine - Compiled by Stephen K. Aoki, MD](https://teambone.com/education/education-clinical/orthopaedic-sports-medicine/) - Rotator Cuff/Impingement Shoulder Instability Patellofemoral Instability ACL Injuries Meniscal Injuries Cartilage Injuries Ankle Sprains Stress Fractures
- [Ankylosing Spondylitis](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/ankylosing-spondylitis/) - Description: A chronic seronegative inflammatory disease affects the axial skeleton, especially the sacroiliac joints, hip joints, and spine extraskeletal involvement of aorta, lung, uvea Disease onset is during young adulthood, typically affecting adolescent boys HLA-B27surface antigen is found in 88-96% of patients Limited chest wall expansion best screening criteria Elevated ESR (sedimentation rate) is present
- [Tumors of the Spine](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/tumors-of-the-spine/) - The spine is the frequent site for metastasis Certain tumors have a unique manifestation in the vertebrae Malignant tumors most common in lumbar spine (lumbar > thoracic > cervical) Malignant tumors more commonly in vertebral body than posterior elements Metastatic breast cancer Metastasis Most common tumors of the spine Spread to vertebral body first, then
- [Osteomyelitis Of The Spine](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/osteomyelitis-of-the-spine/) - Description: Constitutes 1% of pyogenic skeletal infections Pathogenic organisms can infect vertebral bodies, intervertebral discs, or the spinal canal Spine infected through local extension from adjacent infection or else from seeding of distant organ hematogenously or via lymphatic system Bacteria can be directly introduced by surgery, trauma, intravenous or intradural injection or catheterization Most frequently
- [Osteoporosis and Vertebral Compression Fractures](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/osteoporosis-and-vertebral-compression-fractures/) - Description: Osteoporosis is a decline in overall bone mass in the axial and appendicular skeleton Affects 15-20 million people in the US Peak bone mass is reached between ages 16-25 years With age, bone resorption exceeds bone formation Women are at increased risk in the 15-20 years after menopause, directly linked to estrogen deficiency Certain
- [Spinal Stenosis of the Lumbar Spine](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/spinal-stenosis-of-the-lumbar-spine/) - Description: Any developmental of acquired narrowing of the spinal canal, nerve root canals, or intervertebral foramina that results in compression of neural elements Pathophysiology: A small amount of canal narrowing occurs with age The narrowest part of the canal is L2 – L4 Volume increases in flexion and decreases in extension Causes of pathologic narrowing
- [Lumbar Disc Herniation](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/lumbar-disc-herniation/) - Description: Seen in all age groups, most common ages 35-45 Risk factors include: smoking, sedentary work and full-time motor vehicle driving Sciatica is found in 40% of patients 50% recover in 1 month, 96% function normally in 6 months Pathophysiology: Disc herniation is preceded by degenerative changes inside disc Circumferential tears in annulus progress to
- [Spondylolisthesis](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/spondylolisthesis/) - Definition: the slipping forward of one vertebra upon another. Incidence is approximately 6% of population. Common in gymnasts, football players, weightlifters. Spondylolysis is the presence of a bony defect at the pars interarticularis, the space between the superior and inferior facet, and can lead to spondylolysthesis Etiology (Wiltse classification): Type I = dysplastic deficiency of
- [Scoliosis - Abnormal curvature of the spine](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/scoliosis-abnormal-curvature-of-the-spine/) - Four 70° curves, different patterns: Left-to-right lumbar, thoracolumbar, thoracic, and combined thoracic and lumbar curves. Description: Curve is in coronal plane Often a rotational component Classified by age of onset – infantile, adolescent, adult Curvature named according to side of convexity and spinal level of the apex Incidence of 1% in general population Types of
- [Spinal Cord Injuries](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/spinal-cord-injuries/) - Understanding of the complete neurological exam, including cranial nerves, sensorimotor pathways in the cord and nerve roots is essential to diagnosing injury. There are four classically described incomplete spinal cord lesions. Anterior Cord Syndrome: Typically a cervical spine injury Characterized by alteration in the function of the long tracts in the white matter in the
- [Spine Trauma](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/spine-trauma/) - There are five important steps in the treatment of a neurologic deficit associated with spinal cord injury: immobilization, medical stabilization, spinal alignment, surgical decompression if compression of neurologic structures exists, and spinal stabilization. Immobilization: should be carried out at the scene of the injury sandbags to support the head or a rigid cervical collar are
- [Clinical Evaluation](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/clinical-evaluation/) - A careful history is the first part of a clinical evaluation as this is where most diagnoses are made. Primary disorders of the spine as well possible systemic processes which affect the spine (metastatic disease or spondyloarthropathies) must be considered Location, quality, chronicity, prior surgery, exacerbating or relieving factors should all be sought. Spine disorders
- [Anatomy of the Spine](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/anatomy-of-the-spine/) - Description: The spinal column typically consist of 33 vertebrae. Seven cervical, 12 thoracic, and five lumbar vertebrae compose the movable presacral spine; five fused segments form the sacrum with four or five irregular ossicles caudal to the sacrum forming the coccyx The gross anatomic appearance is one of cervical lordosis, thoracic kyphosis, and lumbar lordosis
- [Orthopaedic Disorders of the Spine - Compiled by Kathryn Schabel, MD](https://teambone.com/education/education-clinical/orthopaedic-disorders-of-the-spine/) - Spinal Anatomy Clinical Evaluation Spine Trauma Spinal Cord Injuries Scoliosis Spondylolisthesis Lumbar Disc Herniation Spinal Stenosis Osteoporosis and Compression Fractures Osteomyelitis of the Spine Tumors of the Spine Ankylosing Spondylitis References Frontera: Essentials of Physical Medicine and Rehabilitation, 1st ed., Copyright © 2002 Hanley and Belfu Canale: Campbell's Operative Orthopaedics, 10th ed., Copyright © 2003
- [Battered Child Syndrome](https://teambone.com/education/education-clinical/pediatric-trauma/battered-child-syndrome/) - As child abuse can be sexual, psychological or physical, the term battered child syndrome was introduced to describe only the physical manifestations of such atrocities. Kemp, in 1962, described this entity as a pattern of repeated episodes of severe physical injury inflicted by a caregiver. There is, of course, no exact pattern of injuries that
- [Spine Trauma in Children](https://teambone.com/education/education-clinical/pediatric-trauma/spine-trauma-in-children/) - Perhaps the most significant difference between the pediatric and adult spines is the marked increase in elasticity in the spine of the growing child. The bones and ligaments of the child’s spine can tolerate up to four times as much stretch as the spinal cord they contain. This may be the explanation for the clinical
- [Common Lower Extremity Injuries in Children](https://teambone.com/education/education-clinical/pediatric-trauma/common-lower-extremity-injuries-in-children/) - Fractures of the Femur Proximal Femur Fractures Hip fractures in children are of interest because of the frequency of complications rather than the frequency of the fractures. Hip fractures in children are rare compared to hip fractures in adults with osteoporotic bone, and the fracture patterns and classification are different. Unlike hip fractures in adults,
- [Pediatric Pelvic Injuries](https://teambone.com/education/education-clinical/pediatric-trauma/pediatric-pelvic-injuries/) - Of paramount importance in the evaluation and treatment of pelvic injuries in children is the recognition of the higher likelihood of associated soft organ injury. Given the presence of significantly more cartilage in the pediatric pelvis when compared to that of the adult, the child’s pelvis is much more likely to undergo elastic deformation and
- [Common Upper Extremity Injuries in Children](https://teambone.com/education/education-clinical/pediatric-trauma/common-upper-extremity-injuries-in-children/) - Clavicle Injuries The Clavicle is the first bone to ossify (between the fifth and sixth weeks of fetal life), and the last bone in which physeal closure is observed (approximately 25 years of age). Fractures of the clavicle can occur in any age group, from neonate to adult, and can involve any portion of the
- [Pediatric Polytrauma](https://teambone.com/education/education-clinical/pediatric-trauma/pediatric-polytrauma/) - Trauma is the leading cause of mortality in children over 1 year of age. A child with multiple injuries incurred as the result of a significant trauma should be cared for in a trauma center with a dedicated and coordinated trauma system. Head injuries tend to be responsible for the most morbidity and mortality in
- [Introduction to Pediatric Trauma](https://teambone.com/education/education-clinical/pediatric-trauma/introduction-to-pediatric-trauma/) - There are certain inherent mechanical and biologic differences between the child and the adult that the treating physician must consider when selecting appropriate treatment, and when providing the patient and family with prognostic information. Mechanically speaking, children differ from adults in that their bone exhibits a much higher degree of elasticity. Long bones in particular
- [Pediatric Trauma - Compiled by Bill Gowski, M.D.](https://teambone.com/education/education-clinical/pediatric-trauma/) - Introduction Pediatric Poyltrauma Common Upper Extremity Injuries Pediatric Pelvic Injuries Common Lower Extremity Injuries Pediatric Spine Trauma Battered Child Syndrome References: Orthopaedic Knowledge Update: Pediatrics, 1996, American Academy of Orthopaedic Surgeons Rockwood and Green’s Fractures in Children: 1996, Lippincott Principles of Orthopaedic Medicine and Surgery; Wiesel, Delahay, 2001, W.B. Saunders Company Current Diagnosis and
- [Plantar Fasciitis](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/plantar-fasciitis/) - Description: Microtrauma to plantar fascia near its attachments leading to attempted repair and chronic inflammation The most common cause of heel pain May be associated with a calcaneal spur No clear single etiology for pain No single treatment Common in runners and dancers Symptoms: Calcaneodynia (heel pain) "First step pain" in morning Pain along
- [Tarsal Tunnel Syndrome](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/tarsal-tunnel-syndrome/) - Definition: Compressive neuropathy of posterior tibial nerve behind medial malleolus Symptoms & Signs: Poorly localized dysesthesias in plantar aspect of foot Aggravated by activity, alleviated by rest Often nocturnal pain Burning Tapping over tarsal tunnel = worsening symptoms (Tinel’s sign) Decreased two-point discrimination sensation Etiology: Space occupying lesion in tarsal tunnel Ganglion Synovial cyst Lipoma
- [Lesser Toe Deformities](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/lesser-toe-deformities/) - Mallet Toe Deformity Definition: A flexion deformity of the distal interphalangeal joint Either flexible or fixed Often the 2nd digit due to excessive length in comparison to other toes Symptoms & Signs: Pain over dorsal aspect of distal interphalangeal joint (DIP) Pain at tip of toe from striking ground Callus formation Ulceration Nail deformity Physical Exam:
- [Amputations of the Lower Extremity](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/amputations-of-the-lower-extremity/) - Background: Over 130,000 amputations performed in 1997 68% of amputees carry diagnosis of diabetes Goals of amputation are to optimize function and minimize morbidity Reasons to amputate: Peripheral vascular disease associate with diabetes Infection Trauma Frostbite Burn Tumor Types of lower extremity amputations: Toe Ray – phalanges with all/part of metatarsal 5th ray most common,
- [Diabetic Foot](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/diabetic-foot/) - dry, scaly, swollen, clumsy limb that the patient dissociates from the rest of the body because of the loss of sensory feedback Pathophysiology Breakdown of the skin Stems from diminished sensation from neuropathic disease Trauma from unappreciated local stress on feet Autonomic neuropathy dries and cracks skin, exposing to infection Autonomic neuropathy impedes normal reactive
- [Cavus Deformity](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/cavus-deformity/) - Definition: Abnormal elevation in longitudinal arch Results in decreased plantar weight-bearing area Places stress on metatarsal heads Generalized stiffness of joints is common - decreased range of motion Hindfoot often in varus position Clawing of toes Altered gait pattern Increased pressure on lateral foot, then 1st metatarsal head Etiology: Charcot-Marie-Tooth disease Congenital clubfoot Anterior horn
- [Adult Flatfoot – Pes Planus Deformity](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/adult-flatfoot-pes-planus-deformity/) - Description: o Progressive flattening of medial longitudinal arch o Was not present at birth (congenital flatfoot) o Gait abnormality – excessive hindfoot valgus with initial ground contact o Abduction of forefoot o Foot fatigue from inadequate support of longitudinal arch Above: From left to right, cavus deformity, normal foot, pes planus (flatfoot) deformity Etiology: o
- [Degenerative Ankle: Fusion vs. Arthroplasty](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/degenerative-ankle-fusion-vs-arthroplasty/) - A) Post-traumatic arthritis B) Following tibiotalar arthrodesis (fusion) Definition: o Loss of tibiotalar joint space, destruction or degeneration of cartilage Etiology of Arthritis: o Posttraumatic o Chronic degenerative, idiopathic (osteoarthritis) o Inflammatory (rheumatoid) o Septic (infection) o Metabolic (gout) Symptoms: o Pain with weight-bearing o Progressive and significant decrease in activity due to pain Physical
- [Hallux Valgus](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/hallux-valgus/) - Definition: Aka bunion, is lateral deviation of the proximal phalanx with subsequent medially directed pressure against the first metatarsal head o Congruent = no MTP joint subluxation o Incongruent = lateral subluxation of proximal phalanx on the metatarsal head Description: o Weakening of first metatarsophalangeal (MTP) medial joint capsule, contracture of lateral joint capsule o
- [Orthopaedic Foot & Ankle - Compiled by Kathryn Schabel, MD](https://teambone.com/education/education-clinical/orthopaedic-foot-ankle/) - Bunions Degenerative Ankle Adult Flatfoot Cavus Deformity Diabetic Foot Amputations Lesser Toe Deformities Tarsal Tunnel Syndrome Plantar Fasciitis References DeLee: DeLee and Drez's Orthopaedic Sports Medicine, 2nd ed., Copyright © 2003 Elsevier Frontera: Essentials of Physical Medicine and Rehabilitation, 1st ed., Copyright © 2002 Hanley and Belfus Mann & Coughlin: Surgery of the Foot
- [Hand Review Questions](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/hand-review-questions/) - 1. A patient with carpometacarpal joint arthritis of the thumb undergoes trapezium excision and interposition arthroplasty. One year after treatment, radiographs reveal that there has been 25% subsidence of the thumb metacarpal compared with its preoperative height. This degree of subsidence will have what effect on the surgical outcome? a- Will not affect functional outcome
- [Replantation of the Hand and Digits](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/replantation-of-the-hand-and-digits/) - Reattachment or replantation of a severed hand digits is frequently indicated. Factors affecting the decision to perform replantation include the level of amputation and the nature of injury along with the patient's age, occupation, medical history, and associated risk factors. The most common amputation injury results from power saws. The mechanism of amputation and the
- [Deformities of the Hand](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/deformities-of-the-hand/) - There are several deformities common to the hand that can occur as a result of traumatic injury, congenital abnormality, or degenerative disease states. Once hand deformities become relatively established, they can be difficult to significantly alter by splinting, exercise, or other nonoperative treatment. Mallet Finger Mallet finger is a flexion deformity of the terminal interphalangeal
- [Trigger Finger and Thumb](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/trigger-finger-and-thumb/) - Trigger finger is an often painful snapping, triggering, or locking of the finger as it is flexed and extended. This is due to a localized inflammation or a nodular swelling of the flexor tendon sheath that doesn't allow the tendon to normally glide back and forth under a pulley. It occurs in the superficial and
- [Elbow Tenopathies](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/elbow-tenopathies/) - Lateral Epicondylitis Lateral epicondylitis (tennis elbow), a familiar term used to described a myriad of symptoms about the lateral aspect of the elbow, occurs more frequently in nonathletes than athletes, with a peak incidence in the early fifth decade and a nearly equal gender incidence. Lateral epicondylitis can occur during activities that require repetitive supination
- [De Quervain's Disease](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/de-quervains-disease/) - In 1895, a Swiss surgeon, Fritz de Quervain, published 5 case reports of patients with tender thickened first dorsal compartments at the wrist. The condition subsequently has borne his name. De Quervain’s disease is an entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist, resulting in pain with thumb motion. It
- [Dupuytren's Contracture](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/dupuytrens-contracture/) - Many people find that as they age it becomes increasingly difficult to fully extend or stretch their fingers. In many cases, arthritis or some other joint disease may be to blame. But a condition in the palm of the hand may also cause the fingers to contract. Dupuytren’s (pronounced du-pwe-trahns’) contracture is a fairly common
- [Common Fractures of Carpal Bones](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/common-fractures-of-carpal-bones/) - Introduction The diagnosis of fractures and dislocations of the carpal bones can be difficult for several reasons. The outlines of the eight tightly packed bones are inevitably superimposed in most radiographic views. Even in the anteroposterior view at least one bone overlies another. All views must be interpreted with a thorough understanding of the normal
- [Rheumatoid Arthritis in the Hand](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/rheumatoid-arthritis-in-the-hand/) - Rheumatoid arthritis involves inflammation in the lining of the joints affecting several different joints, most commonly the MCP joint. It is typically chronic, which means it lasts a long time, and can be a disease of flare-ups. RA is a systemic disease that affects the entire body and is one of the most common forms
- [Molecular Genetics and Orthopedics](https://teambone.com/education/education-clinical/orthopedic-basic-science/molecular-genetics-and-orthopedics/) - Skeletal Dysplasias The following section will be a discussion of the basic science and molecular genetics of several diseases with orthopedic issues. It is not meant to be a full description of each disease; rather, it will briefly discuss how the advances in molecular biology and gene discovery are advancing our understanding of diseases that
- [Growth factors of Bone](https://teambone.com/education/education-clinical/orthopedic-basic-science/growth-factors-of-bone/) - Osteoconductive This term describes factors which help form bone by providing a scaffold on which cells, such as osteoblasts, lay down vascularized new bone. Perhaps the most simple example is freeze dried bone graft, which is devoid of living tissue but contains the inherent framework to build new bone. Ceramics also possess this ability and
- [Fracture Healing](https://teambone.com/education/education-clinical/orthopedic-basic-science/fracture-healing/) - Fracture healing and the management of fractures is field that has seen great advances in the last 30 years. To understand how these advances are employed one must understand the biology of fracture repair. Once a fracture has occurred, almost immediately changes occur to the bone and surrounding tissue. Blood vessels clot, the normal vascular architecture of the
- [Remodelling](https://teambone.com/education/education-clinical/orthopedic-basic-science/remodelling/) - Bone remodeling occurs throughout life. It is estimated that in the first year of life 80-100% of bone is replaced by the remodeling process. In adults, this slows to a rate of 1-5% per year. The remodeling process is a dynamic process that responds to outside forces such as load demands and muscular attachments. In
- [Carpal Ligament Injuries and Instability Patterns](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/carpal-ligament-injuries-and-instability-patterns/) - Abnormalities in carpal bone relationships were noted on radiographs obtained in the early 1900s. Subsequent reports focused on the so-called rotational instability of the carpal scaphoid until attention was drawn to the subject in 1972. Describing posttraumatic loss of alignment of the carpal bones, carpal instability patterns have been grouped into four types: (1) dorsiflexion
- [Carpal Tunnel Syndrome](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/carpal-tunnel-syndrome/) - Carpal tunnel syndrome is the most common entrapment neuropathy of the upper extremity. The carpal tunnel is a fibro-osseous canal bound volarly by the transverse carpal ligament; the floor and walls are formed by the carpal bones. The transverse carpal ligament attaches radially to the scaphoid and trapezium and ulnarly to the pisiform and hamate.
- [Anatomy of the Hand](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/anatomy-of-the-hand/) - The movements of the hand are accomplished by two sets of muscles and tendons: the flexors, for bending the fingers and thumb, and the extensors, for straightening out the digits. The flexor muscles are located on the anterior (volar) surface of the forearm and are attached by tendons to the phalanges of the fingers. The
- [Basic Anatomy & Pathology of the Hand](https://teambone.com/education/education-clinical/basic-anatomy-pathology-of-the-hand/) - Basic Anatomy Carpal Tunnel Syndrome Carpal Instability Rheumatoid arthritis Scaphoid Fractures Dupuytren's Contracture De Quervain's disease Epicondylitis Trigger Finger Deformities of the Hand Microsurgery/Replant Review Questions
- [Torsional & Angular Deformities In Children](https://teambone.com/education/education-clinical/pediatric-orthopaedics/torsional-angular-deformities-in-children/) - Rotational Abnormalities The most common reason for children to seek orthopaedic evaluation, except for trauma, is for suspected torsional or angular deformities of the lower extremities. Most are normal. Studies have show that measurements of torsion and angulation have wide ranges of normal. Values within 2 standard deviations of the mean are termed physiologic variations, those beyond are called deformities.
- [Leg Length Discrepancy](https://teambone.com/education/education-clinical/pediatric-orthopaedics/leg-length-discrepancy/) - Defined as difference in rate of growth between two limbs: - usually due to abnormal physeal growth - fracture malunions - bone loss from osteomyelitis or tumor resections Evaluation includes determination of whether shortening is true or apparent. Apparent limb length discrepancy (LLD) may be due to: - suprapelvic obliquity o scoliosis - intrapelvic obliquity o pelvic fracture - infrapelvic obliquity o hip
- [Bone Dysplasias](https://teambone.com/education/education-clinical/pediatric-orthopaedics/bone-dysplasias/) - Bone Dysplasias A. Intro a. Dysplasia is defined as a generalized developmental abnormality occurring because of a pathologic organization of cells within a specific tissue type. There are greater than 200 described skeletal dysplasias. b. Many classifications have been put forth, classically they were based on pattern of involvement. Newer classifications are more often based
- [Clubfoot (congenital equinovarus CEV)](https://teambone.com/education/education-clinical/pediatric-orthopaedics/clubfoot-congenital-equinovarus-cev/) - There are three types of cev: positional, idiopathic congenital and teratologic. Positional Clubfoot The infant’s foot is in equinovarus but does not have a deep posterior or plantar medial crease and is thought to be the result of intrauterine positioning of the foot. The foot can be passively brought to a plantigrade position and is amenable
- [Cerebral Palsy](https://teambone.com/education/education-clinical/pediatric-orthopaedics/cerebral-palsy/) - Cerebral Palsy (CP) is a term referring to a static encephalopathy occurring secondary to a brain lesion either caused prior to birth (prenatal), at birth (perinatal) or after birth (postnatal). These are generally hypoxic in nature, but can also be due to congenital brain malformation. The incidence is 2:1,000 births and is increasing slightly as more premature
- [Legg-Calvé-Perthes Disease (LCPD)](https://teambone.com/education/education-clinical/pediatric-orthopaedics/legg-calve-perthes-disease-lcpd/) - LCPD is an osteonecrosis of the femoral head that occurs because of unknown reasons STEPHANIE. This apparent idiopathic osteonecrosis has been associated with second hand smoke, older parental ages, low normal patient stature and protein C&S deficiencies. There is however no known definitive causes. It can, although rarely, run in families. Presentation: Perthes occurs generally between 3-9 years of
- [Developmental Dysplasia of the Hip](https://teambone.com/education/education-clinical/pediatric-orthopaedics/developmental-dysplasia-of-the-hip/) - Introduction Developmental Dysplasia of the Hip (DDH) encompasses a spectrum of disorders including acetabular dysplasia, hip subluxation, and hip dislocation. In dysplasia, the hip is “reduced” (acetabular articular cartilage is congruent with femoral hear articular cartilage) but the acetabular roof is steep or the acetabular depth is shallow. Hip subluxation refers to a dysplastic hip that is also unstable, allowing the femoral
- [Slipped Capital Femoral Epiphysis (SCFE)](https://teambone.com/education/education-clinical/pediatric-orthopaedics/slipped-capital-femoral-epiphysis-scfe/) - Introduction SCFE occurs through the unfused growth plate of the proximal femur where the femoral head slips posteriorly on the femoral neck. Serious consequences of the problem, such as gait disturbance, post-traumatic arthritis, chondrolysis and osteonecrosis of the femoral head can occur, leading to lifelong disability. Prompt diagnosis and treatment of this problem is essential. Presentation
- [Pediatric Orthopaedics](https://teambone.com/education/education-clinical/pediatric-orthopaedics/) - Slipped Capital Femoral Epiphysis Developmental Hip Dysplasia Perthes Disease Cerebral Palsy Club Foot Bone Dysplasias Limb Length Inequality Torsional & Angular Deformities
- [Giant Cell Tumor](https://teambone.com/education/education-clinical/orthopedic-tumors/giant-cell-tumor/) - The giant cell tumor (GCT) is a mostly benign lesion that is classically known for the presence of numerous giant cells. However, giant cells are also frequently encountered in other tumors that include anuerysmal bone cyst, solitary bone cyst, chondroblastoma, osteoblastoma/osteoid osteoma, and hemorrhagic osteosarcoma. Giant cells are also frequently noted in chronic exposure to foreign bodies
- [Fibrous Dysplasia](https://teambone.com/education/education-clinical/orthopedic-tumors/416-2/) - Fibrous Dysplasia (FD) is a disease that strongly predominates in women in the first three decades of life. There are two basic forms of the disease that include monostotic (meaning a single bone) or polystotic (meaning multiple bones). The polystotic version is rare and tends to involve multiple bones on a unilateral side. It can strike any bone but has a predilection for
- [Metastatic Bone Lesions](https://teambone.com/education/education-clinical/orthopedic-tumors/metastatic-bone-lesions/) - Metastatic bone lesions are the predominant malignancy to effect bone, with 15 times the occurrence rate of the next most common bone malignancy. There are 5 tumors notorious for their capacity to spread to bone that include Breast, Lung, Thyroid, Renal Cell and Prostate (a popular memory aid is BLT Kosher Pickle.) Primarily they spread to spine, but lung cancer
- [Rhabdomyosarcoma](https://teambone.com/education/education-clinical/orthopedic-tumors/rhabdomyosarcoma/) - Rhabdomyosarcoma (RMS) has three known subtypes including: Embryonal, Alveolar, & Pleiomorphic each with distinct characteristics. Embryonal RMS has a predilection for the ages of 0-15 years and predominates in males. This type is mostly found about the head and neck but the botryoid variants (meaning “cluster of grapes” after its usual gross appearance) are commonly found in the vagina. Akin
- [Osteosarcoma](https://teambone.com/education/education-clinical/orthopedic-tumors/osteosarcoma/) - Osteosarcoma describes a sarcomatous lesion with characteristic bony elements. There are at least 9 different types of osteosarcoma. In this chapter we will discuss only the following: classic/intramedullary, periosteal, parosteal, secondary, and telangectatic. Classic or high-grade intramedullary osteosarcoma is the most common and predominately affects males in 2nd and 3rd decade. It involves the metaphyseal region of bone and is usually located about
- [Langerhans Cell Histiocytosis](https://teambone.com/education/education-clinical/orthopedic-tumors/langerhans-cell-histiocytosis/) - Langerhans Cell Histiocytosis (LCH) has collected many pseudonyms over the years including histiocytosis X and eosinophilic granuloma (EG). It has twice the prevalence in male patients compared to females and strikes in the 5-15 year old range. Lesions are usually solitary but 10% will have two to three foci. It most commonly affects the skull but also carries a predilection for the spine. Symptoms
- [Enchondroma](https://teambone.com/education/education-clinical/orthopedic-tumors/enchondroma/) - Enchondroma is a benign tumor of bone that represents a hamartomatous process. Usually the lesions are asymptomatic and will present as an incidental finding or pathologic fracture. Fifty percent of these lesions will involve small tubular bones of the hands and feet, where pathologic fractures are common. There is no age, race, or gender predilection. The lesions tend to involve the metaphyseal regions of the proximal
- [Ewing’s Sarcoma](https://teambone.com/education/education-clinical/orthopedic-tumors/ewings-sarcoma/) - Ewing’s Sarcoma strikes predominately male patients in the 5-25 age range. It most commonly involves the pelvis, femur, and tibia; however, it is capable of involving any bone in the body. This lesion closely resembles pediatric neuroblastoma that strikes under the age of five. Also, it is directly related to the Primitive Neuroectodermal Tumor (PNET) in that these tumors share the genetic translocation t(11,22). In
- [Solitary Bone Cyst](https://teambone.com/education/education-clinical/orthopedic-tumors/solitary-bone-cyst/) - The Solitary Bone Cyst (SBC) also known as the simple bone cyst & unicameral bone cyst (UBC) is found mostly in the 5-15 year old range with a male predominance. Most lesions are found in the proximal humerus (50%) and upper femur (25%). SBCs are always found on the metaphyseal side of the physis. In fact, these lesions
- [Aneurysmal Bone Cyst](https://teambone.com/education/education-clinical/orthopedic-tumors/aneurysmal-bone-cyst/) - The Aneurysmal Bone Cyst (ABC) is a benign tumor of bone found most commonly in female patients between 10 and 20 years of age. It has a predilection for the femur; though, also commonly found in the tibia, spine and pelvis. Two-thirds of spinal lesions will present in the posterior elements; a distinction it shares with osteoid osteoma, Giant Cell Tumor (GCT),
- [Fundamentals of Musculoskeletal Tumors](https://teambone.com/education/education-clinical/orthopedic-tumors/fundamentals-of-musculoskeletal-tumors/) - Musculoskeletal tumors represent a wide array of benign and malignant conditions. By far, benign conditions predominate at a rate of 200 to 1. Malignant tumors that arise from mesenchymal tissue are termed sarcomas and have an overall incidence of 9000 cases in the United States. Sarcomas can be highly aggressive with an estimated 50% mortality rate and tend to affect
- [Orthopedic Tumors - Compiled by R. Trent McKay, M.D.](https://teambone.com/education/education-clinical/orthopedic-tumors/) - Fundamentals of Tumor Aneurysmal Bone Cyst Solitary Bone Cyst Ewing’s Sarcoma Enchondroma Langerhan’s Cell Histiocytosis Osteosarcoma Rhabdomyosarcoma Metastatic Bone Lesions Fibrous Dysplasia Giant Cell Tumor
- [Biomechanics & Biomaterials](https://teambone.com/education/education-clinical/orthopedic-basic-science/biomechanics-biomaterials/) - Understanding biomechanics plays a large role in orthopedics. It is particularly useful for describing the behavior of bones under stress and important in understanding orthopedic implants. Approaching biomechanics first requires an understanding of basic biomechanical terms. Loading Simply means applying a force to an object. In biomechanics there are three basic methods of loading (Figure
- [Articular Cartilage Anatomy](https://teambone.com/education/education-clinical/orthopedic-basic-science/articular-cartilage-anatomy/) - Articular cartilage is divided into four basic layers. (Figure 12) The most superficial is called the tangential zone and makes up 10-20% of the cartilage thickness. The surface contains fine filamentous fibers that run tangential to the weight bearing surface and chondrocytes in this region are oriented parallel to the surface. This region of the
- [Articular Cartilage](https://teambone.com/education/education-clinical/orthopedic-basic-science/articular-cartilage/) - Articular Cartilage Composition Articular cartilage is a unique structure that provides a low friction surface for gliding joints, as well as shock absorption and load transduction to the underlying subchondral bone. Articular cartilage achieves coefficients of friction that are one-tenth to one-one hundredth of ice-on-ice at the freezing point. It is composed of water (70%),
- [Bone Growth](https://teambone.com/education/education-clinical/orthopedic-basic-science/bone-growth/) - The Growth Plate The growth plate is divided into multiple zones (Figure 8). These zones include the reserve zone, proliferative zone, and the hypertrophic zone. The reserve zone is the area closest to the secondary center of ossification. It has epiphyseal vessels the pass through this area but do not provide it with oxygen and
- [Bone Formation](https://teambone.com/education/education-clinical/orthopedic-basic-science/bone-formation/) - Bone Formation There are two types of bone formation that occur during development. The first is called intramembranous ossification and is the primary method of forming the clavicles and skull bones. In this process, osteoblasts cluster within fibrous membranes to form a center of ossification. They begin secreting collagenous fibers that are subsequently calcified until
- [Bone Composition](https://teambone.com/education/education-clinical/orthopedic-basic-science/bone-composition/) - Introduction Bones have multiple functions that include structural support and protection for vital organs, support and leverage for movement and manipulation, repository for essential minerals and housing for the hematopoietic system. Bone Composition Thirty-five percent of bone is composed of a flexible extracellular matrix consisting mostly of collagen. The remaining sixty-five percent is composed of
- [Orthopedic Basic Science - Compiled by R. Trent McKay, M.D.](https://teambone.com/education/education-clinical/orthopedic-basic-science/) - Bone Bone Composition Bone Formation Bone Growth Articular Cartilage Articular Cartilage Composition Articular Cartilage Anatomy Biomechanics & Biomaterials Remodeling Fracture Healing Bone Growth factors Molecular Genetics in Orthopedics
- [Foot](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/foot/) - A. Talus The talus is the second-most commonly fractured tarsal bone. The talus is very mobile, articulating within three joints that together account for 90% of the motion of the foot. This mobility makes the talus susceptible to injury and makes anatomic reduction of talus fractures critical to maintaining hindfoot function. Anatomy – The talus
- [Plafond and Ankle](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/plafond-and-ankle/) - A. Fractures of the Tibial Plafond Fractures of the tibial plafond are generally high-energy axial-loading injuries, such as in falls from heights or car wrecks. They are sometimes called pilon fractures after the French for “hammer” or “pestle,” referring to the manner in which the talus strikes the plafond. They are also occasionally seen in
- [Tibia and Fibula Shaft](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/tibia-and-fibula-shaft/) - Fracture of the tibial diaphysis (with or without fracture of the tibia) is the most common long-bone injury. It occurs in a bimodal distribution, with the highest risk in young males ages 15-19, gradually decreasing in incidence through middle age, with a second peak in elderly (osteoporotic) men and women. Five common mechanisms of tibial
- [Distal Femur, Knee, and Tibial Plateau](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/distal-femur-knee-and-tibial-plateau/) - A. Distal Femur Fractures A distal femur fracture is variably defined as a fracture of the femur 9-15 cm proximal to the articular surface of the femoral condyles. These fractures may be supracondylar or intracondylar. Distal femur fractures are relatively rare (7% of all femur fractures), and occur in a bimodal distribution with a peak
- [Femoral Shaft Fractures](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/femoral-shaft-fractures/) - Femoral shaft fractures are usually high-energy fractures. They may be associated with significant blood loss into the thigh compartments (2-3 units if closed, more if open or bilateral). In addition, associated injuries (pelvic fractures, femoral neck fractures, 50% incidence of ipsilateral meniscal pathology) may alter the treatment of prognosis. Clinically, these patients will present with
- [Proximal Femur](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/proximal-femur/) - A. Hip Dislocations and Femoral Head Fracture i. Hip Dislocations Hip dislocations are an uncommon injury, usually associated with motor vehicle accidents (dashboard injuries) or other high energy mechanisms. They are associated with other fractures up to 50% of the time, including ipsilateral acetabular, femoral neck, and femoral head fractures. Classification of hip dislocations is
- [Pelvis and Acetabulum](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/pelvis-and-acetabulum/) - A. Pelvic Ring Fractures Pelvic ring fractures represent one of the few true life-threatening emergencies in orthopaedics. Prompt recognition of unstable pelvic ring injuries and appropriate treatment are critical to preserving life and preventing significant disability. Anatomy – The bony pelvis is composed of the two innominate bones joined anteriorly in the midline by the
- [Spine](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/spine/) - Spinal fractures occur in approximately 6% of all trauma patients, and in these patients, 15-20% have multilevel injury. Half of these patients will present with a neurological deficit. Treatment of these injuries begins in the field. With high energy mechanism, stiff cervical collar and backboard immobilization should be initiated. These precautions should be maintained until
- [Shoulder](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/shoulder/) - The shoulder is a complex articulation that allows a wide range of positioning of the hand in space. This mobility comes from the numerous articulations in and around the shoulder as well as the ligaments and muscles that control and constrain that movement. Anatomy – The term “shoulder” generally refers to the glenohumeral joint, although
- [Forearm and Elbow Fractures](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/forearm-and-elbow-fractures/) - A. Midshaft Radius and Ulna Fractures Fractures of the shaft of the radius and ulna usually occur from a direct blow to the arm, as in a motor vehicle accident, motorcycle accident, assault, gunshot, or sports-related, or in a fall from a height. Fracture of one or both of the radius or ulna may be
- [Wrist and Hand](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/wrist-and-hand/) - A. Phalangeal Fractures and Dislocations Proximal and Middle Phalanx Fractures – Transverse proximal phalanx fractures tend to angulate apex volar due to the pull of the lateral bands proximally and the central slip distally. These fractures may be closed reduced and treated with the MCP joint flexed to 90 degrees and the PIP joint in
- [Orthopedic Terminology](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/orthopedic-terminology/) - Describing Fractures To adequately describe an injury to someone who can’t see the patient or the radiographs, it is important to understand orthopedic terminology and use it correctly to create a coherent and succinct picture. Following an accepted framework, it is possible to quickly break down a complex injury to its clinically relevant elements and
- [Adult Orthopedic Trauma - Compiled by Bryce Allen](https://teambone.com/education/education-clinical/adult-orthopedic-trauma/) - Orthopedic Terminology Describing Injuries Basics of Orthopedic Treatment Compartment Syndrome Wrist and Hand Forearm and Elbow Shoulder Spine Pelvis and Acetabulum Proximal Femur Femoral Shaft Distal Femur, Knee, and Tibial Plateau Tibia and Fibula Shaft Plafond and Ankle Foot Based on information from Rockwood and Green’s Fractures in Adults, 5th ed.
- [Introduction to 4th Year Orthopaedic Clerkship](https://teambone.com/education/education-clinical/introduction-to-4th-year-orthopaedic-clerkship/) - Welcome to Orthopaedics at the University of Utah; the department is delighted to have you doing a rotation with us. Orthopaedics is an operative field primarily involved in the health and well-being of the musculoskeletal system. Surgery of the spine, upper and lower extremities in both children and adults as well as non-operative management of pathology in
- [Sample DXA Reports – Men](https://teambone.com/osteoporosis/sample-dxa-reports-men/) - , 2002 Dr. Salt Lake City, UT Re: (DOB: ;) Dear Dr. : On x/x/2002 we performed a DXA bone density test on your patient X. A Lunar Prodigy DXA scanner was used to evaluate hip and lumbar regions in the AP projection. The interpretation of the scan is enclosed. The results show OSTEOPOROSIS of
- [Sample DXA Reports - Women](https://teambone.com/osteoporosis/sample-dxa-reports-women/) - , 2002 Salt Lake City, UT Re: (DOB: ;) Dear Dr. : On x/x/2002 we performed a DXA bone density test on your patient X. A Lunar Prodigy DXA scanner was used to evaluate hip and lumbar regions in the AP projection. The interpretation of the scan is enclosed. The results show OSTEOPOROSIS of the lumbar spine and OSTEOPENIA
- [Selection Of References Questionnaire:](https://teambone.com/osteoporosis/selection-of-references-questionnaire/) - Selection of references used to construct the 2-minute questionnaire: Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP. Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA. 2001;286:57-63. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip
- [Education - Basic](https://teambone.com/education-basic/)
- [Education - Clinical](https://teambone.com/education/education-clinical/) - Introduction to Orthopaedic Surgery For Rotating Medical Students Introduction Adult Trauma Basic Science Orthopaedic Tumors Pediatric Orthopaedics Hand and Upper Extremity Foot and Ankle Pediatric Trauma Spine Surgery Orthopaedic Sports Medicine Total Joint Arthroplasty
- [Recent Posters](https://teambone.com/recent-posters/) - Orthopaedic Research Society (ORS) function, 2020 meeting John Skedros and Peter Muir at 2020 ORS meeting Brody King and Hunter Marshall at 2020 ORS meeting Nathan Camp Demonstrating excellent Jenga skills at ORS function, 2020 meeting American Association of Physical Anthropology (AAPA) 2015 Meeting (St. Louis) Improving Analysis of Osteon Cross Sectional Shape - AAPA
- [Osteoporosis](https://teambone.com/osteoporosis/) - Osteoporosis Osteoporosis Survey Selected references used for osteoporosis survey Sample DXA Reports for Primary Care Providers OSTEOPOROSIS of the lumbar spine and OSTEOPENIA of the hips Women Men Sample DXA Reports for Primary Care Providers Women Men
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