Biomechanical Evaluation of a Cadaveric Flatfoot Model and Lateral Column Lengthening Technique.

Patients with adult acquired flatfoot have progressive worsening of bony alignment with many being unable to perform a heel rise. Following reconstruction, pathologic skeletal alignment is corrected and the ability to perform a heel rise is often restored. The purpose of this study was to evaluate the relationship between forefoot liftoff forces and skeletal alignment in a cadaveric flatfoot model by assessing the effect of sequential lengthening of the lateral column using an Evans-type calcaneal osteotomy. Bony alignment was measured in 8 cadaveric specimens with the use of a 3-dimensional digitizing system. Transection of the spring ligament, pie-crusting of the plantar fascia, and cyclic axial loading of the foot was performed to create an anatomic and functional flatfoot model. An Evans-type calcaneal osteotomy using 6, 8, 10, and 12 mm wedges was performed. Specimens were mounted to a custom jig that applies tensile loads to the Achilles, peroneus brevis, peroneus longus, and tibialis posterior tendons. Creation of a flatfoot reduced the lateral talo-first metatarsal angle (Meary's angle) by 13° (23.6° ± 2.8° vs 10.6° ± 3.8°, p < .05) and forefoot force by 7% (199.3 N ± 7.3 N vs 185.4 N ± 9 N, p < .05). Sequential lengthening of the lateral column restored skeletal alignment and force transfer to the forefoot (12 mm wedge: Meary's angle 22.7° ± 3.9°, liftoff force 206.8 N ± 7.5 N). The cadaveric flatfoot model demonstrated decreased forefoot forces that were restored with an Evans-type calcaneal osteotomy wedge. This highlights the importance of restoring skeletal alignment when correcting advanced adult acquired flatfoot.

Calliphoridae (Diptera) Associated With Rattus rattus Carcasses in the Tijuca National Park, Rio de Janeiro, Brazil.

Forensic entomology is a complementary tool for penal procedures, mainly on estimating postmortem interval. Study of cadaveric fauna in various environments is primary as source of information to support this science. This study collected information about the fauna of Calliphoridae associated to carcasses of Rattus rattus in the Tijuca National Park, RJ. Four collections were conducted, one for each season of 2015, exposing six carcasses at georeferenced points in each collection. The carcasses were placed 550 m from the boarder and equidistant by 100 m. Five decomposition stages were identified, and 10,559 individuals of Calliphoridae belonging to 10 species were collected. The most abundant species were Hemilucilia semidiaphana (Rondani) (Diptera: Calliphoridae) and Lucilia eximia (Wiedemann) (Diptera: Calliphoridae). L. eximia was the most abundant species during the Swelling and Black Putrefaction stages, succeeded in the next stages by two species of the genera Hemilucilia. H. semidiaphana was the dominant species in the last two stages, followed by Hemilucilia segmentaria (Fabricius) (Diptera: Calliphoridae). The genus Mesembrinella (Diptera: Calliphoridae) occurred mainly during the Black putrefaction stage. Mesembrinella bellardiana (Aldrich) was more abundant, with higher occurrence during the Black putrefaction and Dry decay stages. Mesembrinella peregrina (Aldrich) occurred in the two last stages with low abundance. Huascaromusca aeneiventris (Wiedemann) (Diptera: Calliphoridae) occurred during all the observed stages, mainly during the Butyric fermentation stage. Huascaromusca purpurata (Aldrich) (Diptera: Calliphoridae) occurred only during the Dry decay stage and in low abundance. A succession pattern in the carcasses colonization was observed, providing relevant information for the resolution of criminal investigations in this environment.

Integrative Medicine as an Adjunct to Orthopaedic Surgery.

Patients often seek nontraditional forms of treatment, including alternative/complementary medical options, such as chiropractic care and acupuncture, to meet their personal needs. In the United States, interest has grown in methods to reduce pain and improve function through Ayurvedic medicine, which uses plant-based supplements, such as turmeric. Traditional allopathic medicine attempts to provide patients with evidence-based therapeutic regimens for their musculoskeletal conditions. Integrative medicine often is used to prevent and manage the sequelae associated with injuries and illnesses; however, competitive athletes and military personnel use complementary medicine for performance enhancement. Thus, physicians should be aware of the evolving field of integrative medicine, including the reported benefits as well as any potential drawbacks, to facilitate an educated discussion with their patients.

Effect of graft shape in lateral column lengthening on tarsal bone position and subtalar and talonavicular contact pressure in a cadaveric flatfoot model.

BACKGROUND: Lateral column lengthening (LCL) has been used for correction of flatfoot deformity. The purpose of this study was to determine the effect of LCL graft shape on tarsal bone position and talonavicular and subtalar joint pressure. METHODS: A flatfoot model was created in 6 cadaveric specimens. Corrective LCL was performed using a rectangular graft or a trapezoidal graft with the broad surface oriented dorsally, laterally, or plantarly. Bony surface markers were digitized to calculate angular parameters used in the evaluation of flatfoot deformity. Contact pressure and area in the subtalar and talonavicular joints were also recorded. All measurements were carried out under multiple axial loads in the intact and flatfoot conditions, and following LCL with each graft shape. RESULTS: Flatfoot creation resulted in significant changes in arch collapse and forefoot abduction. LCL with a rectangular graft best corrected these parameters, while a laterally oriented trapezoidal graft provided some correction. Talonavicular contact pressure was unchanged after flatfoot creation, and was significantly less than intact after LCL. Subtalar contact pressure decreased in some conditions after flatfoot creation, and decreased further after LCL. CONCLUSION: LCL with a rectangular graft best restored tarsal bone orientation in a cadaveric flatfoot model. The decreases in talonavicular pressure likely represent redistribution of force from the medial to lateral foot. CLINICAL RELEVANCE: When performing LCL for flatfoot deformity, increased bone graft volume medially better restores tarsal bone position. One way of achieving this is through the use of a rectangular graft as opposed to a trapezoidal graft.

Do patients with income-based insurance have access to total joint arthroplasty?

The Patient Protection and Affordable Care Act (PPACA) is expected to increase health care availability through Medicaid expansion. The objective of this study was to evaluate potential effects of the PPACA by examining access to total hip arthroplasty in Southern California. 39 orthopaedic surgeons were called to schedule a hip arthroplasty. Insurances used included a Preferred Provider Organization (PPO), Medicare, and three income-based insurances. There was a significant difference in acceptance rate when comparing PPO and Medicare patients with income-based insurances (P < 0.001). This study showed that in Southern California, patients with income-based insurances are limited in the number of surgeons from whom they can receive care. Thus, although the PPACA will increase the number of insured patients, it may not similarly increase access to providers.

Special report: highlights of the Twenty-Fourth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, Denver, Colorado, June 26-28, 2008.

The Twenty-Fourth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) was held 26-28 June 2008 at the Denver Marriott City Center in Denver, Colorado. There were 442 registrants in attendance, including 81 individuals from 21 countries outside the United States. There were 176 abstracts submitted, and 46 (26%) abstracts were accepted for podium presentation.

Partial Hawkins sign in fractures of the talus: a report of three cases.

OBJECTIVE: We introduce the concept of the partial Hawkins sign in three cases of talar neck fracture that are associated with incomplete avascular necrosis. Our objective is to call attention to the intraosseous blood supply of the talar body, which can be interrupted by fractures to produce patterns of incomplete avascular necrosis. CONCLUSION: We conclude that the Hawkins sign does not always have to be complete. Fractures of the talus occasionally can lead to partial avascular necrosis because of the disruption of end arteries within the body of the talus, even without subluxation or dislocation. Early recognition of the partial Hawkins sign should lead to MRI evaluation that can more readily define the involvement of the talar body and assist the treating physician in recommending when the patient can bear weight.