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Biomedical subjects

A Manoli

Publications and source records attributed to A Manoli.

At least 19 recordsLinked to original sources

Occult fractures following subtalar joint injuries.

Subtalar joint dislocations, although not common, have been increasing in frequency over the last decade. Generally, subtalar joint dislocation can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer minimal disability, with subtalar joint stiffness as the primary complaint. This report includes four cases of suspected joint dislocation or subluxation with occult intra-articular fractures identified only by CT scan following essentially normal radiographs. Evidence seems to indicate that CT scanning in patients with suspected subtalar joint subluxation or dislocation and normal radiographs is justified.

Adult

The traumatic bunion.

In seven cases of Lisfranc joint injury after trauma, bunion deformity developed. This "traumatic bunion" occurs over a prolonged period of time after injury. A high index of suspicion is needed to identify the deformity as being traumatic in origin. Injury about the first metatarsophalangeal joint complex may also contribute to this deformity. When recognized, it may need to be treated with a first metatarsal-cuneiform fusion and distal soft tissue realignment.

Adult

Aiming guide for accurate placement of subtalar joint screws.

Accurate placement of rigid fixation of the subtalar joint in arthrodesing procedures (triple, subtalar, or pantalar arthrodesis) can be difficult. We have found that the "bottom-up" method simplifies this procedure and eliminates many potential problems. A technique is described incorporating the bottom-up method utilizing the combined aiming device (Synthes, Paoli, PA).

Arthrodesis

Clawtoe deformity following vascularized fibula graft.

The free vascularized fibula graft has been an increasingly useful tool in orthopaedic surgery. In addition to its many applications, the reported low donor site morbidity has helped make this a popular treatment modality. Isolated flexor hallucis longus flexion contracture has been reported in the literature; however, multiple ipsilateral clawtoe deformity has not been reported. We describe two cases of multiple clawtoe deformity following ipsilateral harvest of a free vascularized fibula graft.

Adult

Subtalar joint dislocations.

Dislocations of the subtalar joint are rare injuries. The anatomy, pathophysiology, treatment, and prognosis of subtalar joint dislocations have been well described in the literature. The purpose of this paper is to review the current literature on subtalar joint dislocations, as well as outline those aspects of the anatomy, pathomechanics, and treatment pertinent to care of the patient with subtalar joint dislocation. In addition, complications and obstacles to reduction are described. Subtalar joint dislocations, although not common, have increased in frequency over the last decade. Generally, they can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer some disability with subtalar joint stiffness the primary complaint. Associated intra-articular fractures increase the risk of posttraumatic arthrosis.

Biomechanical Phenomena

Closed degloving injury of the fifth toe.

Closed degloving injuries of the toes are rare due to their short length, protection in shoes, and general lack of adornment. When these injuries occur, neurovascular compromise can lead to a loss of viability of the toe. Prompt recognition and successful reduction are necessary to maintain normal structure and function.

Adult

Neglected rupture of the Achilles tendon.

Delayed treatment of a rupture of the Achilles tendon is a challenge. Operative treatment is generally recommended, with a variety of techniques being described to appose the tendinous ends and augment the repair.

Achilles Tendon

Osteochondral lesions of the talar dome.

Osteochondral lesions of the talar dome are a common cause of ankle disability. Management options are as numerous as the terms used to describe these lesions. The recognition of a traumatic etiology has increased our understanding and management of these disorders. Modern imaging technology has enhanced the ability to fully evaluate and accurately classify this lesion, which is fundamental for proper treatment.

Fractures, Closed

High pressure water injection injuries of the foot: a report of two cases.

Few cases of high pressure water injection injuries of the foot have been reported. These cases suggest that only minimal soft tissue destruction results and that, with conservative or limited surgical management, full recovery should be expected. This is a report of two cases of this "benign variant" of high pressure water injection injury that resulted in toe amputations.

Accidents, Occupational

The Mitchell procedure for the treatment of adolescent hallux valgus. A long-term study.

Thirty patients who had had a total of fifty-one Mitchell procedures to correct adolescent hallux valgus deformities were examined clinically and radiographically an average of seven years (range, three to seventeen years) after the operation. The average age of the patients at the time of the operation was fifteen years (range, ten to nineteen years). The result was excellent in nineteen feet, good in sixteen, fair in six, and poor in ten. The fair and poor results were associated with recurrence of the deformity, stiffness (real or perceived), and unsightly scars. The cause of the fair and poor results was inadequate correction at the time of the operation in six feet and loss of fixation in two; the loss of fixation resulted in one recurrence and one malunion. The remaining eight patients who had a fair or poor result were not totally satisfied and had reservations about more than one of three categories (relief of discomfort, appearance, or range of motion). Seventeen feet had a plantar callosity beneath the second metatarsal head, suggesting increased load-bearing by the second metatarsal. Although sixteen callosities caused no symptoms at the most recent follow-up evaluation, the long-term implications of this altered pattern of weight-bearing are unknown.

Adolescent

Compartment syndromes of the foot after calcaneal fractures.

Approximately 10% of calcaneal fractures develop compartment syndromes of the foot, and of these, one half develop clawing of the lesser toes and other foot deformities, including stiffness and neurovascular dysfunction. Tense swelling and severe pain are the hallmarks of an impending compartment syndrome. The diagnosis is confirmed by multistick invasive catheterization, particularly of the calcaneal compartment in the hindfoot. Immediate fasciotomy is recommended to prevent the development of ischemic contracture. It is recommended that open reduction and internal fixation of a calcaneal fracture is performed on a delayed basis, after the fasciotomy wounds are closed.

Calcaneus

Scarred muscle excision for the treatment of established ischemic contracture of the lower extremity.

Nine patients with rigid equinocavovarus contractures of the foot and ankle after ischemic episodes of the leg were treated from 1986 to 1989. The ischemic contractures occurred after tibial and fibular fractures in six cases, and after a trimalleolar ankle fracture, an electrical burn, and cardiac bypass surgery in one case each. Previous tendon and nerve releases had failed. The scarred portion of the various involved muscles of the deep posterior compartment were widely excised along with the respective tendons. A variety of additional foot procedures were generally necessary to obtain a plantigrade foot. Night splinting to maintain a plantigrade foot was prescribed for all patients.

Adolescent

Acute foot compartment syndromes.

Twelve cases of compartment syndrome of the foot in 10 patients were retrospectively reviewed. All were high-energy injuries sustained in a fall from a height (six), crush (three), or motor vehicle accident (three). Bone injuries of the foot included five calcaneal fractures, three multiple metatarsal and/or phalangeal fractures, and two Lisfranc fracture-dislocations with multiple metatarsal neck fractures. The most consistent physical finding was tense swelling of the foot. The diagnosis was confirmed with compartmental pressure measurements in all cases. Decompressive fasciotomies were adequately performed by the medial approach of Henry or a combined approach with medial and dorsal incisions. An additional lateral incision was used in two instances.

Adult

Traumatic boutonnière deformity as a cause of acute hammer toe: a case report.

Traumatic boutonnière deformity, well-described when occurring in the fingers, can occur in a lesser toe. The deformity mimics that of a hammer toe, but the onset is acute, and develops immediately after trauma. Open repair of the central slip rupture and recentralization of the displaced lateral bands of the extensor mechanism with temporary pinning of the toe can give an excellent result.

Acute Disease

Fracture of the entire posterior process of the talus: a case report.

A 31-year-old man sustained a displaced fracture of the entire posterior process of the talus. Despite anatomic reduction and internal fixation, limitation of ankle and subtalar joint motion persisted at follow-up, 32 months after the injury. Great toe dorsiflexon was also limited, presumably from flexor hallucis longus tethering behind the ankle joint. The fracture healed without evidence of avascular necrosis of either the talar body or the posterior fragment.

Adult

Fasciotomy of the foot: an anatomical study with special reference to release of the calcaneal compartment.

Three patients with calcaneal fractures developed clawing of the lesser toes as a late sequela. Believing that this complication may be the result of contractures from an occult compartment syndrome of the foot, an investigation of the anatomical compartments of the foot was performed. The various compartments of 17 unembalmed adult lower limb specimens were injected with dyed gelatin in a controlled fashion. After freezing, the feet were sectioned either transversely or sagittally. The distribution of the dyed gelatin was then studied. Nine compartments were identified. These were the (1) medial, (2) superficial, (3) lateral, (4) adductor, (5-8) four interossei, and (9) calcaneal. The contents of each compartment was then studied as was the compartment's location in the foot and its position relative to other compartments. We identified a new, separate compartment which lies deep to the superficial compartment in the hindfoot area only. This compartment contains the quadratus plantae muscle. We have named it the "calcaneal" compartment to emphasize its hindfoot location. In addition, a communication was demonstrated between the calcaneal compartment and the deep posterior compartment of the leg through the retinaculum behind the medial malleolus, following the neurovascular and tendinous structures. Claw toe deformity following calcaneus fracture appears to be due to late contracture of the quadratus plantae muscle in the calcaneal compartment. A surgical technique for release of all of the foot compartments is described.

Adult

Compartment syndromes of the foot: current concepts.

The foot has been mentioned as a site for the development of a compartment syndrome for approximately 9 years. Despite this, very little information exists in the literature containing specifics on the nature of the disorder. Very recent work has shown that crush injuries, forefoot and midfoot fractures and dislocations, and calcaneal fractures are prone to the development of foot compartment syndromes (FCS). The classical clinical signs of pain with passive stretch of the involved muscles, and dysfunction of the nerves that pass through the involved compartments are less helpful in the diagnosis of the syndrome in the foot than elsewhere. Tense swelling of the foot may be of some help in arousing suspicion that a FCS has developed, but the diagnosis is best made by invasive catheterization of the foot compartments. Since recent work has discovered that at least nine foot compartments exist, multi-stick catheterization is recommended. Fasciotomy should be performed when the pressures are significantly elevated, to prevent the development of late contractures. A communication exists between a newly-found compartment of the foot, the calcaneal compartment, and the deep posterior compartment of the leg. A combined pattern of FCS and deep posterior compartment syndromes of the leg exists, and should be remembered by the clinician treating injuries of the foot or leg. Also, a foot injury alone may cause a deep posterior compartment syndrome in the leg. Claw-toe deformity seems to be the primary late sequela of FCS. Local procedures may be of only temporary benefit.

Compartment Syndromes