The entry level residency curriculum. Proposal for discussion.

The author discusses the curriculum proposed for the PGY-1 residency program. The author briefly describes the activities resulting from the March 1992 residency forum that have led to a national survey of residency program directors to ascertain opinions about the critical elements of the PGY-1 residency. The elements proposed as part of the PGY-1 curriculum, including specific training experiences for 13 clinical rotations, are presented. Results of the survey will be used as a basis for discussion at a second residency forum to be held in December 1992.

Compression: is it necessary for bone healing?

The authors present a review of bone healing. A literary search on the subject reveals a variety of experiments performed on healing bone using different techniques. The review of this literature establishes that compression in bone healing is not absolutely necessary. It also relates that bone healing without any fixation is not desired. Therefore, the goal of this paper is to enlighten the surgeon that controlled, semirigid, semicompressed fixation with active range of motion is the ideal criteria for bone healing, and decreases the chance of cast disease.

Gonococcal arthritis case report.

In the case reported, the diagnosis of gonococcal arthritis unfolded over the course of 1 week and was not fully conclusive until presumptive therapy was initiated. Although the clinical, microbiologic, and immunologic characteristics of gonococcal arthritis can be differentiated from other types of bacterial arthritides, not all textbook symptoms are present at one time in one particular case. There also are subtle signs that are involved. In this case study, there was little definitive evidence that stood out to confirm the diagnosis. It was the interdependence of a complete history, serologic and radiographic studies, clinical presentation, and demographic considerations that led to an accurate diagnosis and timely treatment of gonococcal arthritis.

Cutaneous horns: review of literature and case report.

Cutaneous horns, although rarely seen in the podiatric practice, must be considered in one's differential diagnosis when treating keratinous skin lesions. These lesions have been described as both malignant and premalignant, and an adequate amount of tissue at the base of the lesion must be obtained for proper biopsy. The authors discuss a case in which an unusual surgical technique is used in the treatment of a cutaneous horn.

A quantitative method of determining the pneumatic ankle tourniquet setting.

Pneumatic ankle tourniquets are currently used in podiatry for maintaining hemostasis during foot surgery. The literature is limited concerning the safest pressure to use with this device. This study was undertaken to develop a simple and reliable method of deriving a proper pressure setting that would be safe and efficacious. Using a Doppler stethoscope, the minimum effective tourniquet pressure was established on 54 limbs from 35 patients undergoing foot surgery at our institution. The average pressure needed to obtain a "bloodless field" was 218.6 +/- 34.6 mm. Hg. However, in the younger, normotensive patients the average pressure utilized was 203.9 +/- 22.3 mm. Hg. The lower pressures used were felt to be safer and better tolerated by the patients. The authors concluded that the minimum effective pressure should be determined for each patient preoperatively and the routine use of a maximum safe pressure of 250 mm. Hg should be discouraged.

Surgical treatment of Freiberg's infraction with the use of total joint replacement arthroplasty.

Freiberg's infraction is an osteochondrosis of the second metatarsal head, although it may be seen less often in the other metatarsals. It usually occurs in the second decade of life and is more commonly seen in females. The etiology is generally of a traumatic nature and symptoms include painful, limited range of motion of the joint. If untreated, destructive joint changes may lead to a painful degenerative arthritis requiring surgical intervention. The authors discuss joint replacement with a Swanson Silastic flexible hinged toe implant.

Hallux varus--surgical correction and review of the literature.

Acquired hallux varus may follow correction of hallux abducto valgus by the modified McBride procedure. The authors discuss correction of both acquired and congenital hallux varus and show pre- and postoperative illustrations of both types.

Gangrene in the diabetic foot: its implications and consequences.

Diabetic problems of the feet are not uncommon. Occasionally, these difficulties progress to the point where surgical intervention is required. A case was presented which involved a deep abscess of the foot that compromised the circulation to the toe. Ultimately, open toe amputation was necessary. The etiologic factors causing diabetic complications were presented and the importance of each was stressed. The preoperative considerations for surgical amputation and debridement were defined, as well as the possibility for successful healing.