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1.
Foot Ankle Int ; 22(7): 544-51, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11503978

ABSTRACT

Osteochondral Lesions of the Talar Dome (OLT) are common problems encountered in orthopedics. Although the etiology remains uncertain, a myriad of treatment options exists. The authors describe arthroscopically assisted autologous osteochondral graft (OCG) transplantation procedures in the treatment of unstable OLTs in nine patients. The patients underwent standard preoperative MRI examination to assess fragment stability (using De Smet criteria for stability). Intraoperative arthroscopy was used to correlate the preoperative MRI assessment (using Cheng/Ferkel grading). After transplantation procedures, MRI (using De Smet criteria for stability) assessed graft incorporation for stability at an average of 9.3 months after the procedure. Preoperative MRI correlated highly with arthroscopic findings of OLT instability (sensitivity = 1.0). This has been demonstrated in the current orthopedic literature. The post transplantation MRI demonstrated stable graft osteointegration by De Smet criteria in all patients. Postoperative visual analogue pain scales showed significant improvement from preoperative assessment. Postoperative AOFAS Ankle-Hindfoot scores averaged 80.2 (S.D. +/- 18.9). Our favorable early results and those of other authors using similar techniques may validate OCG transplantation as a viable alternative for treating unstable osteochondral defects in the talus that are refractive to more commonly used surgical techniques.


Subject(s)
Arthroscopy , Bone Transplantation/methods , Cartilage, Articular/transplantation , Magnetic Resonance Imaging , Osteochondritis Dissecans/surgery , Talus , Adolescent , Adult , Female , Follow-Up Studies , Humans , Male , Pain Measurement , Transplantation, Autologous , Treatment Outcome
2.
Foot Ankle Int ; 21(12): 996-1003, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11139039

ABSTRACT

The modified Broström procedure is an anatomic reconstruction of the lateral ankle ligaments. The present study evaluated twenty-two patients (mean age = 27.2 years) with chronic lateral ankle instability who underwent surgical repair of their lateral ankle ligaments using suture anchors as part of the modified Broström procedure. All surgeries were performed by the senior author (AK) on an outpatient basis. At a mean follow-up of 34.5 months (minimum of 18 months), twenty patients (91%) reported a good or excellent functional outcome as assessed by the Karlsson and Peterson ankle function scoring scale. One patient developed a superficial wound infection post-operatively that was eradicated with a course of oral antibiotics. Sixteen of the twenty-two patients were available for follow-up physical examination and stress radiographs. Fourteen of the sixteen patients had no evidence of instability on physical examination or on stress radiographs. One patient had diminished sensation in the superficial peroneal nerve distribution. Five of the sixteen patients had generalized ligamentous laxity; none of these patients had an excellent result, and they had lower "Overall Satisfaction" scores (P=0.013). We conclude that the use of suture anchors is a simple and effective adaptation of the modified Broström procedure, which results in a good or excellent outcome in the majority of patients with few complications.


Subject(s)
Ankle Joint/surgery , Joint Instability/surgery , Ligaments, Articular/surgery , Suture Techniques , Adult , Ankle Joint/diagnostic imaging , Female , Follow-Up Studies , Humans , Joint Instability/diagnostic imaging , Ligaments, Articular/physiopathology , Male , Middle Aged , Orthopedic Procedures/methods , Radiography , Range of Motion, Articular , Retrospective Studies , Treatment Outcome
3.
Foot Ankle Int ; 19(5): 304-10, 1998 May.
Article in English | MEDLINE | ID: mdl-9622421

ABSTRACT

We used decision-analysis modeling to determine the most cost-effective fixation device among Herbert screws, AO screws, and the Luhr plate for first metatarsophalangeal joint arthrodesis. The model considered patient-reported outcomes at minimum 2-year follow-up, patient charges for the entire course of care, and event and outcome incidences within each fixation group. AO screws had the lowest average cost of utility and, therefore, are the most cost-effective fixation device for first metatarsophalangeal joint arthrodesis even though utility is highest with the Luhr plate. Operating room costs and union rate most strongly influenced cost-effectiveness.


Subject(s)
Arthrodesis/economics , Arthrodesis/instrumentation , Foot Diseases/surgery , Internal Fixators/economics , Metatarsophalangeal Joint/surgery , Cost-Benefit Analysis , Decision Trees , Female , Foot Diseases/economics , Humans , Internal Fixators/adverse effects , Male , Patient Satisfaction
4.
Foot Ankle Int ; 19(2): 65-72, 1998 Feb.
Article in English | MEDLINE | ID: mdl-9498577

ABSTRACT

During a 10-year period, 47 patients underwent surgical management for tarsal tunnel syndrome (TTS). Of these, 34 (36 feet) were available for complete retrospective analysis by record review, questionnaire, and physical examination. An additional 10 patients were evaluated by record review alone. The mean age was 38 years (range, 12-65 years). Overall, average follow-up was 35 months (range, 15-102 months). All patients had nonsurgical care for an average of 16 months before surgery (range, 1-72 months). The symptom triad of pain, paresthesias, and numbness was the most common clinical presentation. All had a positive Tinel's sign and nerve compression test (NCT) at the tarsal tunnel. Electrodiagnostic studies were abnormal in 38 feet (81%). Two-point discrimination was diminished significantly by an average of 6.7 mm. At a follow-up examination two-point discrimination improved by an average of 3.8 mm (P < 0.001). Eighteen feet continued to have a positive Tinel's sign and had a residual NCT. Subjectively, patients were satisfied with the surgical outcome in 72% of the cases. Postoperative improvement in the median Symptom Severity Score and the Functional Foot Score reflected this satisfaction. The perioperative complication rate was 30%. We conclude that the diagnosis of TTS is made primarily on history and clinical evaluation with electrodiagnostic studies supporting the diagnosis in 81%. Surgical treatment is warranted after nonsurgical management has failed. Division of the deep portion of the abductor hallucis fascia is important to ensure a complete release.


Subject(s)
Tarsal Tunnel Syndrome , Adolescent , Adult , Aged , Child , Follow-Up Studies , Humans , Middle Aged , Patient Satisfaction , Postoperative Complications , Retrospective Studies , Tarsal Tunnel Syndrome/diagnosis , Tarsal Tunnel Syndrome/physiopathology , Tarsal Tunnel Syndrome/surgery
6.
Foot Ankle Int ; 19(12): 792-802, 1998 Dec.
Article in English | MEDLINE | ID: mdl-9872465

ABSTRACT

Ruptures of the anterior tibialis tendon are a rare clinical entity. Case reports in the literature reveal a total of 28 cases. Unfortunately, because of the limited discourse in the orthopaedic literature, there are few guidelines regarding the treatment for these injuries. This study analyzes the treatment of 16 anterior tibialis tendon ruptures. Eight patients in this group had operative treatment of their ruptures, and eight patients had nonsurgical treatment of their ruptures. The average follow-up for the operative and nonoperative patients were 6.68 years and 3.86 years, respectively. The Foot and Ankle Outcome questionnaire provided by the American Academy of Orthopaedic Surgeons and an outcome-based foot score described by Kitaoka et al. were used as the methods of analysis. Our outcome results show no statistically significant difference between operative and nonoperative treatment in anterior tibialis tendon ruptures. The lack of statistical difference between operative and nonoperative groups may be a reflection of the age bimodality present in this study. Elderly low demand patients were treated nonsurgically and young active patients were treated operatively. Therefore, despite a lack of statistical difference present in the outcome of both groups, we still maintain the need to repair/reconstruct anterior tibialis tendon ruptures in young active patients with high functional demands. The deficits present in the nonoperative group, we believe, would not be well tolerated in a young high functional demand patient. Nonsurgical management is an appropriate alternative in low demand elderly patients.


Subject(s)
Foot , Tendon Injuries/therapy , Tendons/surgery , Adult , Age Factors , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Rupture , Tendon Injuries/diagnosis , Tendon Injuries/etiology , Tendon Injuries/surgery , Treatment Outcome
7.
J Pediatr Orthop ; 11(6): 712-6, 1991.
Article in English | MEDLINE | ID: mdl-1960192

ABSTRACT

We retrospectively reviewed 51 patients aged 3-11 years with femoral shaft fractures selected for treatment with early spica cast immobilization. Shortening greater than 20 mm was the most common complication, occurring in 22 (43%) of the 51 patients. Factors associated with unacceptable shortening were shortening at the time of spica cast application greater than 10 mm, shortening greater than 20 mm at initial examination, and increasing age. Achieving less than 1 cm shortening at the time of cast application and close follow-up during the first 2 weeks after cast application are advised in order to achieve an acceptable final outcome.


Subject(s)
Casts, Surgical , Femoral Fractures/therapy , Child , Child, Preschool , Female , Femoral Fractures/complications , Femoral Fractures/diagnostic imaging , Humans , Leg Length Inequality/etiology , Male , Radiography , Retrospective Studies , Wound Healing
8.
Clin Sports Med ; 7(1): 61-74, 1988 Jan.
Article in English | MEDLINE | ID: mdl-3044623

ABSTRACT

Numerous therapeutic options are available in treating the painful bunion. The procedure that accomplishes the desired results and correction must be carefully matched with the underlying pathologic deformity. For the majority of patients, in the author's hands, the Silver Triad (eminence resection, lateral release, and medial plication) combined with the Z-1st metatarsal osteotomy is the ideal procedure.


Subject(s)
Hallux Valgus/surgery , Osteotomy/methods , Adolescent , Adult , Child , Consumer Behavior , Female , Follow-Up Studies , Hallux Valgus/diagnosis , Hallux Valgus/diagnostic imaging , Humans , Male , Middle Aged , Physical Examination , Postoperative Complications , Radiography
9.
Radiology ; 154(3): 661-4, 1985 Mar.
Article in English | MEDLINE | ID: mdl-3969469

ABSTRACT

Greater trochanteric advancement (GTA) is an orthopedic procedure designed to correct the biomechanical consequences of overgrowth of the greater trochanter by moving the greater trochanter and its attached muscles laterally and distally. Thirty-one children with trochanteric overgrowth who had secondary pelvic instability (Trendelenburg sign) were studied and underwent a total of 33 GTA procedures. The clinical and radiologic prerequisites for successful surgery are presented. In addition, the radiographic methods of measuring the lateral position of the trochanter, the articulotrochanteric distance, and the amount of trochanteric overgrowth are discussed. Measurements made on preoperative and postoperative radiographs revealed that surgery achieved a mean displacement laterally of 12.1 mm and distally 21 mm. Clinically, there were few complications (two children with mild myositis, one with broken hardware, one with delayed union of trochanter). Pelvic instability had disappeared in the 25 of the 30 patients who could be evaluated.


Subject(s)
Bone Diseases, Developmental/surgery , Femur/surgery , Adolescent , Adult , Bone Diseases, Developmental/diagnostic imaging , Bone Diseases, Developmental/etiology , Bone Screws , Child , Female , Femur/diagnostic imaging , Hip Dislocation, Congenital/complications , Hip Dislocation, Congenital/diagnostic imaging , Hip Dislocation, Congenital/surgery , Humans , Legg-Calve-Perthes Disease/complications , Legg-Calve-Perthes Disease/diagnostic imaging , Legg-Calve-Perthes Disease/surgery , Male , Radiography
10.
J Pediatr Orthop ; 5(2): 151-4, 1985.
Article in English | MEDLINE | ID: mdl-3921565

ABSTRACT

The combined use of radionuclide scintigraphy and computed tomography is recommended for evaluating children with laboratory and clinical data suggestive of flat bone osteomyelitis despite normal conventional radiographs. In addition, computed tomography may be helpful in the presence of abnormal radiographs in determining the exact location of the focus of osteomyelitis and the most suitable route for appropriate drainage or to obtain culture material.


Subject(s)
Bone and Bones/diagnostic imaging , Osteomyelitis/diagnostic imaging , Technetium Compounds , Tomography, X-Ray Computed , Adolescent , Child , Diphosphonates , Female , Gallium Radioisotopes , Humans , Male , Radionuclide Imaging , Technetium , Whole-Body Counting
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