Top 10 Articles From the JAAOS

What's Relevant, Popular in Orthopaedics

Jeffrey S. Fischgrund, MD; David C. Smith

Disclosures

November 23, 2011

JAAOS Top 10 Articles for 2011

Introduction

Having to choose the Top 10 articles that have appeared this year in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is a daunting task: We have an embarrassment of riches! As the flagship publication of the academy, JAAOS adheres to a rigorous standard of quality. Our readers remind us regularly how highly they regard JAAOS. They also let us know that they expect this level of excellence to be maintained.

These readers have given us guidance in developing the list below, the first 5 of which represent the most-read articles so far this year. All of these articles provide practical clinical advice as well as expert insight from their authors; it is this sort of hands-on, useful information that our readers rely on for in their daily practice.

1. "Acute Compartment Syndrome of the Upper Extremity" by Prasarn and Ouellette, in the January issue, is an extremely useful update on a potentially devastating entity. Acute compartment syndrome can be difficult to diagnose in some patient populations, but identifying this entity and treating it emergently are essential to gaining the best possible outcome. The authors concisely review the pertinent facts of anatomy, etiology, pathophysiology, and clinical evaluation before guiding the reader through management modalities richly illustrated with intraoperative photographs, detailed figures, and a treatment algorithm.

Patellar Fractures

2. "Patellar Fractures in Adults," by Melvin and Mehta, in the April issue, is another example of a problem-solving review. The authors emphasize that nonsurgical management can provide excellent results in certain minimally displaced fractures, but that surgery is needed, particularly in the presence of an incompetent extensor mechanism. Half a dozen treatment methods are described for managing the variety of fractures that may present.

3. In the June issue, "Four Common Types of Bursitis: Diagnosis and Management," by Aaron and coauthors, highlights a type of article that JAAOS presents several times a year -- one on a topic of general interest not directly related to a specific area of orthopaedic expertise but nevertheless one that most, if not all, of our readers will eventually encounter. Bursitis is a common cause of musculoskeletal pain that must be distinguished from many other potentially confusing painful disorders. Aaron and colleagues offer the clinical presentation, diagnostic criteria, and management strategies regarding prepatellar, olecranon, trochanteric, and retrocalcaneal bursitis. The authors note that nonsurgical management is a mainstay for all four, but refractory cases may require surgical intervention.

Acetabular Fracture

4. "The Modified Stoppa Approach for Acetabular Fracture" by Archdeacon and coauthors, published in March, is a surgical techniques article that provides detailed anatomic illustrations, as well as an accompanying video demonstration, regarding the internal fixation of pelvic and acetabular fractures via a modification of the Stoppa approach, originally developed for the repair of inguinal hernias. This approach provides improved exposure of the quadrilateral surface and posterior column as well as minimal dissection of the inguinal canal, femoral nerve, and external iliac vessels. The authors provide a valuable list of both pearls and pitfalls to be relied on or avoided while performing a modified Stoppa approach.

5. "Management of Distal Clavicle Fractures" by Banerjee and coauthors, published in our July issue, also rated high on the list of most-read articles. As with other articles well regarded by Academy members and JAAOS readers, this article discusses a relatively common injury whose management can depend on specific patient factors. Both nonsurgical and surgical management provide similar results, the authors report. The decision whether to operate must be based on the amount of fracture displacement as well as individual patient demands. No single surgical technique has proven to be superior to others.

Rheumatologic Conditions in Children

6. "Rheumatologic Conditions in Children Who May Present to the Orthopaedic Surgeon" by Marilynn Punaro, also in our March issue, discusses disorders that can be frustratingly difficult to diagnose and treat. Juvenile idiopathic arthritis is a heterogeneous group of diseases, and laboratory evaluation and imaging are of limited value in screening for rheumatic diseases. Diagnosis comes down to pattern recognition based on history and the physical examination. The author provides numerous useful tables and discussion points to assist in making a correct diagnosis.

7. "Metastatic Disease in the Thoracic and Lumbar Spine: Evaluation and Management" by Rose and Buchowski, in the January issue, is an excellent example of JAAOS' regular, updated reviews of oncologic issues that may confront the practicing orthopaedic surgeon. Spinal metastases are found in most patients who die of cancer, and a rational treatment plan can indeed improve quality of life, preserve neurologic function, and prolong survival. The authors recommend surgery in patients with progressive disease or inadequate pain relief based on the NOMS (neurologic, oncologic, mechanical, and systemic indications) algorithm of Bilsky and Smith.

Ligament Injuries of the Thumb

8. Another article this year that goes into great detail regarding surgical techniques is "Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint," by Tang, in the May issue. Chronic attritional attenuation (gamekeeper's thumb) and acute injury (skier's thumb) of the ulnar collateral ligament are painful injuries that can lead to instability and disability -- as can the less common but no less harmful reverse gatekeeper's thumb, which is injury to the radial collateral ligament. Tang provides in-depth techniques for managing both acute and chronic ulnar and radial collateral ligament injuries and notes that, although decreased motion of the metacarpophalangeal joint is a common complication of such surgeries, given the nature of these injuries, joint stability is much more important than mobility.

9, 10. Pediatric disorders were discussed frequently this year in JAAOS as new information and updates have come to the fore in childhood and adolescent orthopaedics during the past few years. The review article by Punaro on rheumatologic conditions in children and adolescents is one example. "Cervical Spine Trauma in Children and Adults: Perioperative Considerations," by Vanderhave and coauthors, in the June issue, and "Surgical Management of the Problematic Hip in Adolescent and Young Adult Patients," by Schoenecker and coauthors, in May, also provide current information from the literature on the perisurgical considerations and surgical management of 2 challenging scenarios.

Although cervical spine fractures and dislocations are less common in children than in adults, childhood injuries are more likely to be associated with neurologic injury. Vanderhave and coauthors particularly emphasize airway management and direct laryngoscopy for intubation, noting that any potentially problematic effect of doing so on an unstable cervical spine may be overestimated. They also discuss the critical importance of spinal cord monitoring during subacute management, noting that perfusion to the spinal cord is critical and may require the use of intravenous fluids, colloids, blood products, and vasopressors.

Schoenecker and coauthors, like Archdeacon and coauthors as well as Tang, provide detailed surgical techniques on managing pathologic hip conditions in the adolescent and young adult, particularly the Bernese periacetabular osteotomy, the authors’ redirectional procedure of choice in managing symptomatic hip instability secondary to primary acetabular deficiency. Schoenecker and coauthors also note that the recent, successful innovation of the transtrochanteric surgical hip dislocation approach offers the potential for comprehensive correction of deformity and labral chondral disease secondary to Legg-Calvé-Perthes disease and slipped capital femoral epiphysis.

Conclusion

Each year, the JAAOS publishes worthy material in addition to review articles -- our Orthopaedic Advances articles, for example, which present concise updates of techniques or devices not yet widely reported in the literature, and On the Horizon From the ORS, our quarterly column of informative articles highlighting topics from the frontiers of basic science as submitted by members of the Orthopaedic Research Society. It is, however, our carefully researched and written review articles on topics of interest to the generalist as well as the specialist, and to the resident as well as the experienced surgeon that form the core of JAAOS. The 10 articles discussed here could easily have been augmented by 10 more, and then by 10 more after those. We are most proud of the high level of educational and informative material that JAAOS provides its readers and all of the members of the American Academy of Orthopaedic Surgeons. 

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