Orthopaedics and Trauma RSS feed: Current Issue. Orthopaedics and Trauma presents a unique collection of International review articles summarizing the current state of knowledge and research in orthopaedics. Each issue focuses on a specific topic, discussed in depth in a mini-symposium; other articles cover the areas of basic science, medicine, children/adults, trauma, imaging and historical review. There is also an annotation, self-assessment questions and a 'second opinion' section. In this way the entire postgraduate syllabus will be covered in a 4-year cycle.http://www.orthopaedicsandtraumajournal.co.uk/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Orthopaedics and Trauma1877-1327241February 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000102/abstract?rss=yesEditorial Board10.1016/S1877-1327(10)00010-2Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1iihttp://www.orthopaedicsandtraumajournal.co.uk/article/PIIS187713270900195X/abstract?rss=yesAbstract: The initial management of the trauma victim has evolved over many years. Changes have occurred in both pre-hospital and hospital practice and in the overall approach to patient management. The focus of patient care is now aimed at maintaining the patient's physiological state whilst obtaining an early CT scan of the head, spine and trunk to identify all injuries. However, in the critically ill patient with active bleeding the immediate surgical control of haemorrhage is essential. Recent developments in trauma management, including damage control resuscitation, more rapid imaging, improved methods of haemorrhage control and the identification of patients who would benefit from either early total care or damage control orthopaedics have all led to improved outcomes in the trauma patient.(i) Initial resuscitation of the trauma victimNicholas S. Duncan, Chris Moran10.1016/j.mporth.2009.12.003Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Mini-Symposium: Basic Science of Trauma18http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001961/abstract?rss=yesAbstract: The basic science underlying the process of bone healing has been a topic of intense research activity over the past 50 years. Increasing understanding of events on a molecular level has allowed a greater understanding of factors that might contribute to failure of these mechanisms. From this it has been possible to introduce new treatment methods as adjuncts to traditional methods, both for fresh fractures and for established non-unions. Knowledge of these topics is essential to the day to day practice of the majority of orthopaedic consultants and as such is a favourite topic of examiners in both basic surgical and specialist orthopaedic examinations. The first half of this article summarizes current understanding of the biology of bone healing, highlighting recent advances. The second part is an overview of the aetiology and management of non-union.(ii) An update on fracture healing and non-unionPaul J. Harwood, James B. Newman, Anthony L.R. Michael10.1016/j.mporth.2009.12.004Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Mini-Symposium: Basic Science of Trauma923http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001936/abstract?rss=yesAbstract: Clinical care of the injured is evolving rapidly. Understanding of the cellular and humoral interactions which link shock, coagulopathy and inflammation has expanded rapidly and provided the framework for clinical developments. Tissue hypoxia and hypoperfusion drives protein-C mediated acute coagulopathy and endothelial cell and leukocyte dysfunction. When severe, tissue damage occurs and is manifest as Adult Respiratory Distress Syndrome (ARDS)/Multisystem Organ Failure (MOF) or sepsis from relative immune-compromise.Extensive surgery can constitute a ‘second hit’ to physiological reserves, hence Damage Control Surgery (DCS) aims to control life-threatening bleeding and the lethal triad, and Damage Control Orthopaedics (DCO) utilizes temporary external fixation for the initial management of major fractures to confer the benefits of early stabilization, without the risks of major surgery.Damage Control Resuscitation (DCR) describes a seamless strategy, with surgery as a lynch pin. Haemostasis and restoration of tissue perfusion and oxygenation are enshrined as surgical goals. Supporting fluid strategies restrict initial volumes during resuscitation, then switch to haemostatic resuscitation with high ratios of blood to blood products. Rapid control of bleeding and coagulopathy appear to moderate the systemic inflammatory response, with much improved survival and swifter progress to definitive reconstruction. At present, manipulation of the systemic inflammatory response to injury is only possible by the indirect means offered by DCR.(iii) An update on the systemic response to traumaIan Pallister10.1016/j.mporth.2009.12.001Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Mini-Symposium: Basic Science of Trauma2428http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001924/abstract?rss=yesAbstract: Children differ markedly from adults in their response to trauma. They sustain predictable injuries from typical mechanisms based upon their age and activity profile. They have been shown to have different patterns of injury when sustaining single bone trauma, pelvic fractures and spinal injuries. The microscopic structure of a child's bone is different creating an environment for unique fracture types including those of the physis. The biological healing response differs and children often have the capacity for significant remodelling. Due to the unique anatomy and physiology of a child, the management of severe trauma and multiple injuries is different to that of an adult. Continuing growth and development always needs to be taken into account and will have a bearing on the management plan. The long-term outcome, from both a functional and psychological standpoint, is of great concern as these patients have potentially so much time ahead of them. It is important to be aware of all these differences to ensure that assessment, diagnosis, initial and definitive management, rehabilitation and follow up are optimal for each injured child.(iv) The response of children to traumaSimon P. Kelley10.1016/j.mporth.2009.11.003Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Mini-Symposium: Basic Science of Trauma2941http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001730/abstract?rss=yesAbstract: Hip fractures are amongst the most common injuries presenting to orthopaedic surgeons. Elderly females with osteoporosis are most at risk and comprise the majority of patients presenting with this injury. Younger patients and those exposed to high energy trauma account for a smaller group. In elderly patients hip fracture frequently results in loss of independence and is associated with a 1 year mortality rate of around 30%. With increased life expectancy the incidence of hip fractures is predicted to rise, which has resource implications for healthcare services. Intracapsular fractures comprise approximately 50% of hip fractures and are the focus of this review.(v) The management of intracapsular fracture of the femoral neckJohn Keating, Joseph Aderinto10.1016/j.mporth.2009.11.001Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Mini-Symposium: Basic Science of Trauma4252http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709000918/abstract?rss=yesAbstract: Anterior knee pain is a common symptom in orthopaedic practice. Various conditions can affect the anterior knee, and treatment outcome depends on adequate diagnosis, but this is sometimes very difficult to establish. Nowadays, modern diagnostic and imaging procedures (CT, MRI, scintigraphy, arthroscopy) can make diagnosis more accurate and precise. Furthermore, improved surgical techniques and technologies in the treatment of cartilage, tendon, internal knee derangements, make outcomes in some diagnostic categories more favorable than previously. In this article, we describe our experience of the diagnosis and treatment of patellofemoral disorders, extensor tendon overuse, synovial plicae, bursal, bone and meniscal pathology - the predominant causes of anterior knee pain.Anterior knee painMarko Bumbaširevic, Aleksandar Lešic, Vesna Bumbaširevic10.1016/j.mporth.2009.06.005Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Knee5362http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001729/abstract?rss=yesAbstract: Patients with thoracic back pain are proportionately far more likely to have serious spinal pathology than in patients with cervical or lumbar back pain. Thoracic back pain should therefore always be thought of as a ‘red-flag’. The symptom of thoracic back pain may be the first presenting feature of spinal infection, thoracic disc prolapse or neoplasm. It is vital that any practicing orthopaedic surgeon is able to make a thorough assessment of this patient group. As in all medical conditions, a good idea of the diagnosis can usually be obtained with a detailed history and examination. In the case of spinal disease further investigations are of vital importance in order to confirm the diagnosis and to demonstrate neural as well as vertebral involvement. Management will vary depending on the aetiology and presentation.This article will outline a safe and thorough approach to the diagnostic pathways and management of these patients.The assessment of thoracic painAntony Louis Rex Michael, James Newman, Abhay Seetharam Rao10.1016/j.mporth.2009.10.005Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Spine6373http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001468/abstract?rss=yesAbstract: The most common anterolateral approaches to the cervical spine are the low and high presternocleidomastoid approaches, which allow exposure of all levels of the cervical spine, from the base of the skull to the upper thoracic vertebrae. Proper positioning of the patient is a key point to gain good operative exposure and to prevent the potential complications of excessive pressure on neural or vascular structures. This is an important aspect of cervical spinal surgery, because of the depth and relative inaccessibility of the structures, the required accuracy for the determination of level and the inherent risks of the positions themselves. We describe the common anterolateral approaches to the cervical spine, complications, and some tips and tricks to avoid them.Anterolateral approaches to the cervical spine: tips and tricksLuca Denaro, Umile Giuseppe Longo, Nicola Maffulli, Vincenzo Denaro10.1016/j.mporth.2009.09.002Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1Surgical Approaches7479http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000035/abstract?rss=yesCME questions based on the Mini-Symposium on “The Basic Science of Trauma”10.1016/j.mporth.2010.01.002Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1CME Section8081http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001444/abstract?rss=yesAnswers to CME questions based on the Mini-Symposium on “Revision Hip Surgery”10.1016/j.mporth.2009.08.015Orthopaedics and Trauma 24, 1 (2010)2010-02-01Orthopaedics and Trauma2010-02-01241S1877-1327(10)X0002-1CME Section8282