Outcomes in hallux rigidus patients treated nonoperatively: a long-term follow-up study.

The purpose of this study was to analyze radiographic outcome and patient satisfaction in non-operative care of hallux rigidus. Twenty-two patients representing 24 feet were surveyed and radiographed. Average follow-up was 14.4 years (range, 12-19 years). In 75% (18/24) of the feet, the patients would "still chose not to have surgery" if they had to make the decision again. The pain remained about the same in 22 feet, improved with time in one, and became worse in one. The most common reason given for not having surgery was that the pain was not severe enough. The most common type of self-care was a shoe with an "ample toe box." More patients benefited from a stiff sole than a soft sole, but the majority of patients did not cite the sole of the shoe as being important. There was measurable loss of cartilage space radiographically over time in 16 of 24 feet, and in eight of the 16 feet, the loss of cartilage space was dramatic. The majority of hallux rigidus patients rated their pain as staying the same over a twelve-year period, despite significant deterioration of joint space noted radiographically.

Rheumatoid arthritis of the forefoot.

Severe and often debilitating involvement of the forefoot is seen frequently in patients with rheumatoid arthritis. The combination of destructive synovitis and weight bearing leads to a spectrum of disorders causing pain, deformity, and eventual loss of function. In addition, advances in total knee and total hip arthroplasty have placed added importance on preserving the ability of the foot and ankle to bear weight and allow functional ambulation. This article reviews the epidemiology, pathophysiology, clinical presentation, physical examination, and treatment of rheumatoid arthritis of the forefoot.

Quantitative analysis of cancellous bone graft available from the greater trochanter.

To quantify the amount of cancellous bone graft available from the greater trochanteric region, 20 paired iliac crest-proximal femur specimens were harvested and compared in 10 adult pelvises. A 1.3 x 1.3-cm cortical window was made in the lateral aspect of the proximal femur 2 cm distal from the tip of the greater trochanter. Cancellous bone evacuation was performed by curettage. The extent of harvest was mechanically limited by the medial wall of the trochanter and by curette impingement on the margins of the cortical window. The graft was quantitated after maximal digital compression in a 10-ml syringe and compared with cancellous graft obtained from the paired anterior iliac crest. The average compressed volume of cancellous bone harvested from the greater trochanter was 6.5 ml (range, 4.2-9.6 ml). The average iliac crest cancellous bone volume was 6.0 ml (range, 2.7-8.8 ml). Differences in graft volume between the anterior iliac crest and the trochanter were not statistically significant. The resulting defect in the proximal femur remained isolated to the trochanteric region. In this study, we demonstrate that cancellous bone is available from the greater trochanteric region in an amount similar to that available from the anterior iliac crest. We also show that it is obtainable in a reproducible manner. Our clinical experience of over 100 cases has demonstrated acceptable morbidity associated with this technique. The greater trochanteric region may be used as a secondary source of autogenous cancellous bone graft when specific procedures demand more bone graft than available from the iliac crest alone, or in patients who have had previous iliac crest graft harvest.

The unusual accidental death of a pregnant woman by sexual foreplay.

This is the case of a young pregnant black woman who died during foreplay when her male partner with his hands accidentally forced air from her vaginal cavity into her uterine cavity, causing air embolization in the veins on the surface of her heart and her brain. Her premature infant was removed by cesarean section by emergency-room personnel after she died. The infant survived for 12 days before being declared brain dead.

The pathology and medicolegal aspects of sexual activity.

The pathology of injury and its complications related to sexual activities has changed remarkably when compared with that of the past, which usually involved assaults or murders of female victims of varying ages, with moderate to serve beatings that may have accidentally resulted in the victim's death. Serial murderers, serial rapists, and molesters of both boys and girls have become much more prevalent in the last two decades in the United States. Unorthodox sexual behavior, such as "fisting," has increased in frequency, as has sexual violence related to cults, such as satanism. All of these present many challenges to medicolegal investigators. This report describes general and specific pathological sexual activities and injuries, some characteristics and methods of the perpetrators, and some specific cases as examples.

Anorectal trauma. Medicolegal and forensic aspects.

A review of both deliberate and accidental anorectal trauma is presented. The mechanisms and types of injuries as well as the complications are discussed. Injuries resulting from sexual assaults are discussed in detail.

Investigation of cremations and severely burned bodies.

Among the most difficult cases for law enforcement and medicolegal investigators to investigate are those in which victims have been deliberately burned to cover up a crime, or those in which cremation has resulted from an accident or suicide. This difficulty arises from the fact that the bodies may be destroyed or fragmented. The major objective in these investigations are twofold: The first task is to identify the body using every means available, including the aid of such experts as forensic pathologists, forensic anthropologists, dentists, toxicologists, and serologists as well as fire investigators, who can contribute to the investigation by providing information about the course of the fire.