Structural and functional reconstruction after resection of aneurysmal bone cyst of the fifth metatarsal: a case study.

We report a case of a primary benign bone tumor (aneurysmal bone cyst [ABC]) involving the distal portion of the fifth metatarsal, identified in an adolescent. The tumor, histologically identified as an ABC with reparative giant cell reaction, became symptomatic. Treatment included resection, followed by reconstruction of the fifth metatarsal using grafts of autologous bone with preservation of function in the metatarsophalangeal joint. The basis for selecting this form of treatment is discussed, as well as the natural history of ABC and giant cell reparative granuloma. Restoration of form and function is illustrated by this case study with a 23-month follow-up.

Ankle joint evaluation--an overview of arthroscopic technique.

Arthroscopy is useful in diagnosing and treating ankle pathology. It is comparatively atraumatic, which makes early postoperative ambulation possible and eliminates the problems resulting from casting and immobility. Familiarity with arthroscopic instruments and technique is essential and close attention to details is mandatory to avoid damage to the joint and other complications.

Plantar fibromatosis: surgical considerations with case histories.

Plantar fibromatosis characteristically is found in the central and medial bands of plantar fascia, although it has been reported in other areas of the foot and, through continued growth and extension, has become adherent to tendons and overlying structures. Clinically, the lesion is somewhat uncommon, usually accompanied with minimal pain and benign in nature. However, it must be distinguished from other possibly malignant lesions that may also localize in the foot. The treatment of choice is surgical extirpation of the mass. Unfortunately, the outer limits of the lesion are difficult to define, and incomplete excision often results in return of the lesion postoperatively. Therefore, a complete fasciectomy of the involved fascia is the procedure of choice in order to reduce markedly the possibility of recurrence of the fibromatosis lesion.

The angled great toe implant (Swanson design/Weil modification) in the surgical reconstruction of the first metatarsophalangeal joint.

This article deals with implant arthroplasty using the angled great toe implant. Specific terminology is defined. Emphasis is on implant design, criteria for patient selection, and the operative procedure. Postoperative care and complications are briefly touched on.

The use of the Papineau bone-grafting technique in salvage of the infected total joint implant.

The development of osteomyelitis after first metatarsophalangeal total implant-arthroplasty can be a complication encountered by any foot surgeon. The postoperative course is often long with a guarded to poor prognosis. The authors present a salvage procedure for this surgical complication utilizing aggressive surgical debridement followed by an autogenous bone graft. The technique, as described by Papineau, was developed to shorten hospitalization time and reduce deformity. A case presentation is given to illustrate the successful use of this procedure in the treatment of postoperative osteomyelitis of the foot without systemic antibiotics.

Diagnosing osteomyelitis: evaluation and significance of multiple tracer bone imaging.

The use of various radioactive compounds in the diagnosis of osteomyelitis has been the topic of discussion by numerous authors. A great number of bone imaging agents have been experimented with and clinically applied with varying results. It is the intention of this article to detail and compare the use of two such agents: technetium-99m phosphonate, a phosphorus compound radioactively labeled with an isotope of technetium, and gallium citrate 67, a radioactive isotope of gallium. Both of these materials have specific indications and limitations. However, used in the proper setting, either singularly or in conjunction, they give the clinician precise information about pathologic processes. It is the clinician's careful interpretation of both positive and negative test results that enables him to make proper diagnosis and thus institute appropriate therapy.

A clinical evaluation of the total first metatarsophalangeal joint prosthesis: the use of footprints in assessing foot contact.

The use of footprints in evaluating surgical results is most significant to the physician. This clinical investigation consisted of patients whose surgical correction of severe hallux valgus included the use of the Swanson-total great toe hinged prosthesis. The resulting failure of weightbearing by the great toe pulp postoperatively were found to be associated with excessive weightbearing by the lesser metatarsal heads, evidenced by discrete keratomas, a relative lesser metatarsalgia, and footprinting analysis. In conclusion, we believe that there is a definite relationship between the lack of weightbearing under the first ray and the instability of the first metatarsophalangeal musculoligamentous structures. This was found to be influenced by metatarsal protusion and first metatarsophalangeal joint range of motion. The possibility also exists that the intrinsic property of silicone played a role in failure of great toe weight-bearing. It is our belief that the Swanson-total is truly and mainly a joint spacer that relieves pain associated with first metatarsophalangeal joint arthrosis. The possibility exists that when using the Swanson-total with a short first metatarsal protrusion it may be necessary to perform shortening osteotomies on the appropriate lesser metatarsals. This redesigning of the metatarsal parabola could restore a normal forefoot weight-bearing pattern and minimize postoperative complications. Further research on this matter is in the planning stages.

Early confirmation of stress fractures in joggers.

Four joggers had early confirmation of clinically suspected stress fractures by radionuclide bone scans. The radioactive bone scan was abnormal as early as six weeks prior to the appearance of conventional roentgenographic changes. The stress fractures involved the bones of the lower extremities and included the femur, tibia, and calcaneus. Radioactive bone scanning also correctly identified stress fractures with bilateral involvement and referred pain. In joggers, when a stress fracture is clinically suspected and the conventional radiographs are negative, a radioactive bone scan is indicated for early confirmation and institution of appropriate treatment.