This paper reviews the mechanisms of injury and the types of fractures that most commonly affect the human skeleton, presents descriptive protocols for cranial and postcranial fractures adapted from clinical and forensic medicine, and summarizes anatomically the injuries most likely to be found in archaeological skeletons along with their most common causes and complications. Mechanisms of injury are categorized as direct and indirect trauma, stress, and fracture that occurs secondary to pathology. These are considered to be the proximate, or most direct, causes of injury and they are influenced by intrinsic biological factors such as age and sex, and extrinsic environmental factors, both physical and sociocultural, that may be thought of as the ultimate, or remote, causes of injury. Interpersonal conflict may be one of those causes but the skeletal evidence itself is rarely conclusive and must therefore be evaluated in its individual, populational, sociocultural, and physical context. A cautionary tale regarding parry fractures is presented as an illustration. Yrbk Phys Anthropol 40:139–170, 1997. © 1997 Wiley-Liss, Inc.

Trauma analysis in paleopathology

Osteoarthritis (OA) is a major healthcare burden, with increasing incidence. Pain is the predominant clinical feature, yet therapy is ineffective for many patients. While there are considerable insights into the mechanisms underlying tissue remodelling, there is poor understanding of the link between disease pathology and pain. This is in part owing to the lack of animal models that combine both osteoarthritic tissue remodelling and pain. Here, we provide an analysis of pain related behaviours in two models of OA in the rat: partial medial meniscectomy and iodoacetate injection. Histological studies demonstrated that in both models, progressive osteoarthritic joint pathology developed over the course of the next 28 days. In the ipsilateral hind limb in both models, changes in the percentage bodyweight borne were small, whereas marked mechanical hyperalgesia and tactile allodynia were seen. The responses in the iodoacetate treated animals were generally more robust, and these animals were tested for pharmacological reversal of pain related behaviour. Morphine was able to attenuate hyperalgesia 3, 14 and 28 days after OA induction, and reversed allodynia at days 14 and 28, providing evidence that this behaviour was pain related. Diclofenac and paracetamol were effective 3 days after arthritic induction only, coinciding with a measurable swelling of the knee. Gabapentin varied in its ability to reverse both hyperalgesia and allodynia. The iodoacetate model provides a basis for studies on the mechanisms of pain in OA, and for development of novel therapeutic analgesics.

Pain related behaviour in two models of osteoarthritis in the rat knee.

Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 38% of the general population CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS The clinical presentation and risk factors associated with CTS are discussed in this paper Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging

https://openorthopaedicsjournal.com/contents/volumes/V6/TOORTHJ-6-69/TOORTHJ-6-69.pdf

Carpal Tunnel Syndrome: A Review of the Recent Literature

Background: Following repairs of large-to-massive tears of the rotator cuff, the rates of tendon retears are high and often involve tissue deficiency. Animal studies of the Restore Orthobiologic Implant, a collagen-based material derived from the small intestine mucosa of pigs, have indicated that it might be used to help overcome such problems. We carried out a study to determine whether patients who received this xenograft to augment a rotator cuff repair exhibited greater shoulder strength, shoulder function, and/or resistance to retearing.

Methods: We compared data from a group of patients who had undergone conventional rotator cuff repair with xenograft augmentation (the xenograft group) with data from a group in whom a repair had been done by the same surgeon without augmentation (the controls). The groups were matched for gender, mean age, and mean size of the rotator cuff tear. All subjects completed a pain and function questionnaire and were given a systematic clinical shoulder examination preoperatively and at three, six, and twenty-four months postoperatively. The twenty-four-month visit included magnetic resonance imaging to determine whether a retear had occurred.

Results: Four patients who had received a xenograft had a severe postoperative reaction requiring surgical treatment. At two years after the surgery, six of the ten tendons repaired with a xenograft and seven of the twelve control tendons had retorn, as documented by magnetic resonance imaging. The patients with a xenograft had significantly less lift-off strength, as measured with a dynamometer, and significantly less strength in internal rotation and adduction than the controls at two years after the surgery (all p < 0.05). Also, the xenograft group had significantly more impingement in external rotation, a slower rate of resolution of pain during activities, more difficulty with hand-behind-the-back activities, and less sports participation (all p < 0.05).

Conclusions: Two years after surgical repair of a large rotator cuff defect supplemented with a xenograft, patients had several persisting deficits and no recognizable benefit as compared with the results in a control group. In view of these findings, together with the unsatisfactorily high proportion of patients with a severe inflammatory reaction to the xenograft, we do not recommend use of the Restore Orthobiologic Implant in its present form.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Restore orthobiologic implant: not recommended for augmentation of rotator cuff repairs.

Early OA primarily affects articular cartilage and involves the entire joint, including the subchondral bone, synovial membrane, menisci and periarticular structures. The aim of this review is to highlight the molecular basis and histopathological features of early OA. Selective review of literature. Risk factors for developing early OA include, but are not limited to, a genetic predisposition, mechanical factors such as axial malalignment, and aging. In early OA, the articular cartilage surface is progressively becoming discontinuous, showing fibrillation and vertical fissures that extend not deeper than into the mid-zone of the articular cartilage, reflective of OARSI grades 1.0–3.0. Early changes in the subchondral bone comprise a progressive increase in subchondral plate and subarticular spongiosa thickness. Early OA affects not only the articular cartilage and the subchondral bone but also other structures of the joint, such as the menisci, the synovial membrane, the joint capsule, ligaments, muscles and the infrapatellar fat pad. Genetic markers or marker combinations may become useful in the future to identify early OA and patients at risk. The high socioeconomic impact of OA suggests that a better insight into the mechanisms of early OA may be a key to develop more targeted reconstructive therapies at this first stage of the disease. Systematic review, Level II.

Biological aspects of early osteoarthritis

Diagnosis in Orthopaedics Infection Rheumatic Disorders Crystal deposition disorders Osteoarthritis and related disorders Osteonecrosis and osteochondritis Metabolic and endocrine disorders Genetic disorders Dysplasias and malfunctions Tumours Neuromuscular disorders Peripheral nerve injuries Orthopaedic operations The shoulder The elbow The wrist The hand The neck The back The hip The knee The ankle and foot The management of acute injuries Principles of fractures Injuries of the upper limb Injuries of the spine Injuries of the pelvis Injuries of the lower limb Overuse injuries

https://morthoj.org/2010v4n3/Apleys_System.pdf

Apley's System of Orthopaedics and Fractures

The Ankle and Foot

Osteoarthritis and Related Disorders

Part 1 - General Orthopaedics - Diagnosis Infection Rheumatic disorders Crystal deposition disorders Osteonecrosis and osteochondritis disorders Metabolic and endocrine disorders Genetic disorders, dysplasias and malformations Tumours Neuromuscular disorders Peripheral nerve lesions Orthopaedic procedures and appliances Part 2 - Regional Orthopaedics - The shoulder The elbow The wrist The hand The neck The back The hip The knee The ankle and foot Part 3 - Fractures and Joint Injuries - The management of acute injuries Fracture pathology and diagnosis Principles of fracture treatment Complications of fractures Stress fractures and pathological fractures Injuries to joints Injuries of the upper limb Injuries of the spine, thorax and pelvis Injuries of the lower limb Index.

Louis Solomon

Papers

Apley's System of Orthopaedics and Fractures

The Ankle and Foot

Osteoarthritis and Related Disorders

Concise System of Orthopaedics and Fractures

Apley's Concise System of Orthopaedics and Fractures