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Biomedical subjects

A Cracchiolo

Publications and source records attributed to A Cracchiolo.

At least 55 records · Page 3Linked to original sources
PubMed1989

Treatment of major wound necrosis following total knee arthroplasty.

Following total knee arthoplasty, seven patients developed significant wound necrosis and dehiscence, requiring wound coverage with soft tissue flaps. Three patients had rheumatoid arthritis, three had degenerative arthritis, and one had osteosarcoma of the distal femur. Five different prostheses were used and the wound problems were discovered on average 21 days after arthroplasty. The average wound size was 6.0 cm2. Five were infected, four with Staphylococcus epidermidis and one with Staphylococcus aureus. All patients were treated with antibiotics and local debridement for an average of 10 days prior to the flap procedure. Medical gastrocnemius muscle flaps were used in two patients, unipedicle flaps transposed from the lateral thigh in three, and bipedicle flaps shifted from the medial thigh in two. Flaps were done an average of 56 days after arthroplasty, and knee rehabilitation was delayed an average of 76 days after arthroplasty. Patients were followed an average of 48 months after the flap procedure. Six patients had mild or no knee pain and one who remained infected had moderate constant pain. Three of the patients had greater than 90 degrees of knee motion and one had 75 degrees of motion. The remaining three had only 35 degrees of motion, due in part to significant preoperative contractures, infection, local radiation, and chemotherapy. Late infection developed in two patients at 20 and 45 months following the flap procedure. There was one excellent, three good, two fair, and one poor result using the Hospital for Special Surgery knee rating system at final follow-up examination.

Adolescent↗
PubMed1989

Magnetic resonance imaging of the hindfoot.

This article demonstrates normal anatomy of the foot and ankle as visualized with magnetic resonance imaging (MRI) in the sagittal, axial, and coronal planes. Additionally, selected cases chosen from our experience with more than 100 clinical scans are shown to highlight the primary areas in which we have found MRI to be clinically useful: bone marrow abnormalities, especially osteomyelitis and osteonecrosis, soft tissue injuries and masses, and cases in which metallic fixators make CT evaluation problematic.

Adult↗
PubMed1989

Stress fracture of the lateral metatarsals following double-stem silicone implant arthroplasty of the hallux metatarsophalangeal joint.

Stress fractures of the lateral metatarsal bones occur frequently and are most commonly seen following repetitive trauma. However, such fractures rarely occur after reconstructive operations involving the hallux metatarsophalangeal joint. The authors report four patients who developed a lateral metatarsal stress fracture during the first year following use of a double-stem silicone implant to reconstruct the hallux and, in addition in the case of one patient, the second metatarsophalangeal joint. An analysis of all these patients established the incidence of this complication to be 3%. The etiology of these fractures appears to be an overloading of the lateral metatarsals secondary to some shortening of the hallux metatarsal or in reestablishing motion to the hallux metatarsophalangeal joint. All fractures healed without complication and did not result in further forefoot symptoms or deformities. However, this complication should be suspected when lateral metatarsalgia develops following silicone implant arthroplasty because roentgenograms initially may be normal.

Adolescent↗
PubMed1988

Silicone implant arthroplasty for second metatarsophalangeal joint disorders with and without hallux valgus deformities.

Subluxation or dislocation of the second metatarsophalangeal joint (MTPJ) is usually associated with a hammertoe deformity and, frequently, with a significant hallux valgus deformity. Although the joint itself may be painful, there is also pain in the hammertoe deformity, especially when the patient is wearing closed shoes. A painful intractable plantar keratosis is usually present. We reviewed all of our patients with second MTPJ subluxation or dislocation, in whom a double-stem silicone implant had been used to relocate the joint. In 31 feet of 28 patients, 32 implants were used. All but six feet with advanced degenerative joint disease secondary to Freiberg's infraction had severe associated forefoot pathology that necessitated surgical correction. Several feet had previous bunion operations as well as operations on the second toe. In addition to the second toe, we performed hallux valgus corrections in 23 feet, seven of which were revision procedures. At an average follow-up time of 37 months, good results were seen in 20 feet (63%), good results with reservations in eight feet (25%), and failure in four feet (12%). Transfer metatarsalgia was the most frequent complication. The implants remained stable, and in only one was there a suspected fracture. More optimum results might have been achieved had there been better correction of the hallux valgus deformities, more frequent correction of the hammertoe deformity, and less resection of the second metatarsal head. These patients with pathology usually involving both the first and second MTPJ are difficult to treat, therefore. Their results are less predictable and not as favorable as those achieved for patients with isolated similar deformities.

Adult↗
PubMed1987

Ischemic necrosis of the femoral head. Correlation of magnetic resonance imaging and histologic sections.

Magnetic resonance (MR) images were correlated with matched histologic sections of a resected ischemic necrotic femoral head and neck. Preoperative radiographs had revealed Stage 3 ischemic necrosis. Preoperative MR images disclosed foci of abnormally low signal intensity alternating with normal-appearing foci of high signal intensity. Surgical resection of the femoral head and neck was followed by MR imaging and pathologic sectioning, fixation, and staining, enabling the individual sections to be compared with the postoperative MR slices. A subchondral focus of diminished signal intensity was shown to represent saponified fat and consisted of a transudate of proteinaceous material with probable calcifications. The subjacent region of normal, high signal intensity represented "mummified" fat. The next lower stratum of diminished signal intensity was composed of fibrous and vascular tissues and histiocytic infiltrates that had extensively or completely replaced the fatty marrow.

Adult↗
PubMed1986

Bilateral hip and knee arthroplasty.

Twenty-six severely deformed patients with prosthetic arthroplasty of both hips and both knees because of rheumatoid arthritis (16), juvenile rheumatoid arthritis (6), ankylosing spondylitis (2), osteoarthritis (1), and inflammatory arthritis, cause unknown (1), were followed for a mean of 6.8 years. Severe pain was the primary indication for surgery, and consistent and substantial pain relief was achieved. Most patients also had limited ambulatory and functional improvement. Computer analysis showed that this improvement was related only to preoperative walking and function and a combined hip and knee flexion of at least 190 degrees. All other parameters had no correlation with walking and function improvement. Of the 104 arthroplasties (52 hips and 52 knees), six implants (4 hips and 2 knees) in two patients failed and another seven implants (2 hips and 5 knees) in five patients were revised. Of the remaining 91 implants, 89 were clinically stable, and only two hip implants in two patients appeared destined for revision. However, when radiographic review was included, nine acetabular components, three THA femoral components, and five tibial components in 12 patients had some evidence of impending aseptic loosening, despite low patient activity levels.

Adult↗
PubMed1986

The effect of early weight-bearing in total knee arthroplasty.

Patients undergoing bilateral simultaneous total knee arthroplasty experienced early supported-weight-bearing on both knees. They were compared with two similar groups of patients whose postoperative weight-bearing on the operated extremity was markedly restricted. The clinical results and incidence of complications were similar in the three groups. There were no significant differences in the incidence of radiolucent lines at follow-up examination two to five years later. Bilateral simultaneous total knee arthroplasty is an effective and safe method of managing patients with arthritic knees where both require replacement. Early supported bilateral weight-bearing does not appear to have any deleterious effects on the bone-cement interface that can be detected on clinical or radiographic analysis. However, all patients should not be considered for bilateral prosthetic knee arthroplasty simply because they have arthritic changes in both knees and the procedure is efficacious. Frequently, only one knee is significantly painful or deformed, and its correction may relieve the opposite knee for an extended period. Bilateral operations are indicated when the pain and deformity of an unoperated knee will significantly retard the reconstructed knee, as in severe flexion contractures or malalignment.

Early Ambulation↗
PubMed1985

A method of evaluating the results of forefoot surgery.

Clinical evaluation of the foot is complicated because of the large number of structures, most of which are difficult to record or measure. A standardized system of evaluation is needed to assess the ever-increasing methods of treating foot abnormalities. An evaluation form for recording clinical information on forefoot operations has been designed and can be specifically used for computerized data retrieval. In designing the form, an attempt has been made to standardize methods of clinical examination (mainly on the forefoot) and enable accurate comparisons of data from similar studies in the literature. Two hundred thirty-two specific items are included in the form. More data are available on the forefoot because this part of the foot can be more readily evaluated clinically. Also, it is usually the area of the more extreme pathologic changes and largest number of procedures. Specific entries cover details of the history, physical signs, diagnosis, pain assessment, shoes, walking, function, general and surgical treatment, and complications. The form is applicable to computer methods or data retrieval.

Electronic Data Processing↗
PubMed1984

Foot abnormalities in rheumatoid arthritis.

By anticipating the deformities that can occur in the rheumatoid foot and by carefully and compulsively looking for them, we can more effectively deal with the pathologic conditions. Although we usually equate conservative care with nonoperative treatment, and shoe corrections are certainly important, early operative intervention may be essential. Procedures we must use early if indicated are as follows: decompression of the posterior tibialis tendon and other medical structures in the tarsal tunnel, excision of intermetatarsal bursae, and talonavicular arthrodesis. Furthermore, relating forefoot to hindfoot deformities is important. A valgus hindfoot should be corrected before laterally dislocated MTP joints. A great deal can now be accomplished in treating the remaining weight-bearing joints of the lower extremity. The possibility of combining some of these procedures while hips or knees are undergoing surgery also exists. For example, it may certainly be reasonable when performing a knee arthroplasty to consider a hindfoot arthrodesis or a forefoot arthroplasty on the opposite side.

Ankle Joint↗
PubMed1982

Office practice: footwear and orthotic therapy.

The evaluation of a patient with a foot disorder should include a careful history and examination of the foot. A more extensive evaluation may be indicated as many systemic diseases may initially involve the foot. The patient's shoes are most important and frequently correlate well with the foot pathology. Appropriate radiographs which should including weightbearing views are essential, and selected laboratory studies may be indicated. Although it may be practical to divide the foot into the components of forefoot, midfoot, and hindfoot; these three areas are functionally connected. A deformity in one area usually affects the other areas of the foot. Office procedures should include practical care of the nails and hyperkeratotic lesions which are easy to trim. Shoes must be of appropriate size to fit the forefoot and heel. The shoe may require modification or orthotic devices to accommodate existing pathology.

Adult↗
PubMed1982

Metal concentration in synovial fluids of patients with prosthetic knee arthroplasty.

Significant levels of the major components of metal prostheses in total knee arthroplasty were measured in the synovial fluids from patients with these implants. Cobalt (Co), Chromium (Cr), and Nickel (Ni) concentrations were determined by atomic absorption spectrophotometry on 26 synovial fluid samples from 18 patients with hinged (metal-on-metal) prostheses and eight patients with nonhinged (metal-on-polyethylene) prostheses. Concentrations of Co, Cr, and Ni were significantly higher in synovial fluids from hinged knees, as were Ni concentrations in fluids from nonhinged knees. Of the three metals, Ni showed some evidence of increases solubility. The metal debris did not appear to provoke a leukocyte response, insofar as surprisingly low numbers of neutrophils were present in these fluids, all of which were obtained from nonseptic knees. However, significant numbers of lymphocytes and large mononuclear cells were present in the fluids.

Arthritis, Rheumatoid↗
PubMed1981

The arthritic great toe metatarsophalangeal joint: a review of flexible silicone implant arthroplasty from two medical centers.

A review of 159 feet with double-stem silicone implants in the hallux metatarsophalangeal (MTP) joint was conducted in two medical centers. The majority of patients had a diagnosis of rheumatoid arthritis. Follow-up evaluations ranging between 18 months and six years indicate that pain relief was present in all cases with most having complete relief of pain. Hallux valgus was corrected in most and a functional range of motion as well as good muscle strength was restored. The stability provided by the procedure has improved the postoperative alignment of the lateral MTP joints from which the metatarsal heads had been excised. Operative technique must be precise and tissues must be handled and prepared for the implant with care.

Arthritis↗
PubMed1981

The great toe.

Explore the source record for details and available documents.

Foot↗
PubMed1980

Wooden foreign bodies in the foot.

Wooden foreign body injuries are difficult to diagnose and treat. Three patients who had a common wooden toothpick in the foot are presented. Two patients could recall a puncture injury and one patient could not. Roentgenography and numerous visits to several physicians did not detect the wood, which was only found during careful surgical exploration. Removal of the foreign body is required to treat the inflammatory reaction it produces.

Adult↗
PubMed1980

Results with the constrained total knee prosthesis in treating severely disabled patients and patients with failed total knee replacements.

Fifty-fix constrained total knee replacements (forty Guepar and sixteen Herbert prostheses) were performed in forty-nine severely disabled arthritic patients and they were followed for two to four years. Seventeen of these knees were operated on to salvage a failed prosthesis. Good relief of pain was achieved in 64 per cent of the knees but there was less improvement in walking and function. The over-all range of motion increased because of a reduction in preoperative flexion contractures. The results in the salvage group were less successful than in those patients who underwent a primary operation. Between six months and one year postoperatively, pain had developed in 17 per cent of the fifty-six knees, 9 per cent had walking difficulties, and 7 per cent lost function. Patellofemoral pain accounted for the unfavorable pain ratings in over half of the knees. Zonal roentgenographic analysis of each knee indicated high incidences of radiolucent lines at the cement-bone interface (75 per cent), cement-metal lucencies (68 per cent), and cement deficiencies (73 per cent). Forty-three per cent of the knees showed excessive posterior placement of the prosthesis of more than five millimeters, resulting in flexion contractures of as much as 5 degrees. Complications requiring reoperation developed in nine knees (16 per cent). There was one case of loosening and three knees had deep infections. Chronic postoperative effusions were present in 48 per cent of the knees. The use of either a cemented metal-on-metal hinged knee replacement or a metal-on-polyethylene hinge type of prosthesis was found to result in a relatively high incidence of failures and complications, and did not solve the problem of treating patients with a failed knee prosthesis.

Adult↗