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Biomedical subjects

A R Catanzariti

Publications and source records attributed to A R Catanzariti.

At least 19 recordsLinked to original sources
PubMed2001

Tenodesis for chronic lateral ankle instability.

The goal of lateral ankle stabilization is restoration and stability without any functional deficit. Obviously, only anatomic reconstruction can prevent deficits in range of motion. As a result, motion loss is unavoidable with tenodesis procedures. Unfortunately, no procedures are available for anatomic reconstruction of subtalar joint instability. Therefore, when there is objective evidence of subtalar joint instability, tenodesis procedures must be considered. The authors believe that stability is more important than range of motion when degenerative changes are present within the ankle joint. Tenodesis results are good for the short term (less than 5 years) but may deteriorate over time (after more than 9 years). Some residual pain is common following tenodesis procedures.

Ankle Joint↗
PubMed2001

Mosaicplasty for the treatment of osteochondral defects of the ankle joint.

Autogenous osteochondral transplantation is a relatively new procedure for the treatment of osteochondral lesions of the ankle joint. The procedure is reserved for larger stage III and stage IV lesions. The corresponding author has had good preliminary results with a high level of patient satisfaction. The procedure is relatively straightforward and reliable. The need for a second surgical site has not proved to be a great disadvantage of the procedure; no complications have occurred to date at the knee donor site. This procedure, which was first described for use in the knee joint, shows excellent promise for use in the ankle and warrants larger investigational studies to assess outcomes.

Ankle Joint↗
PubMed1994

Arthroscopic arthroplasty of the ankle joint.

Anterior ankle impingement syndrome is characterized by pain, edema, and limited ankle dorsiflexion. The article examines this syndrome in detail from a variety of perspectives, including indications and contraindications, physical examination, various diagnostic modalities, surgical anatomy, surgical approach, procedures for arthroscopy, and complications.

Ankle Injuries↗
PubMed1991

Medial column stabilization.

This article presented a brief review of medial column stabilizing procedures. The various types of procedures that have been advocated for different deformities have been discussed. It is important to keep in mind that fusion of any of the medial column joints should not be performed as an isolated procedure in flexible flatfoot deformity. Medial column stabilization is only a component procedure when surgically managing a flexible flatfoot. When choosing procedures to correct a flexible flatfoot, thorough preoperative evaluation is important. It is also important to realize that conservative measures should be exhausted before attempting any type of stabilization of the medial column for flexible flatfoot deformity. Specific criteria for flexible flatfoot surgery should include severe uncontrollable deformity, an inability to wear standard foot gear, and persistent pain and disability despite exhaustive conservative therapy. A medial column stabilization is also an excellent procedure for those patients who have end-stage degenerative joint disease of the medial longitudinal arch.

Arthrodesis↗
PubMedDate not supplied

Ostectomy for diabetic neuroarthropathy involving the midfoot.

Diabetic neuroarthropathy is a frequent complication of diabetes mellitus that results in instability of the foot, structural deformity, and soft-tissue breakdown secondary to increased plantar pressure. The midfoot is commonly involved in diabetic neuroarthropathy. Collapse of the medial, lateral, or both longitudinal arches may result in increased plantar pressures and subsequent midfoot ulceration. The majority of these wounds can be managed with local wound care, off-loading, and other forms of nonoperative care. Surgical intervention becomes necessary when the wound fails to heal with conservative measures. The authors performed a retrospective review of patients who underwent ostectomy for chronic or recurrent ulceration in the midfoot secondary to diabetic neuroarthropathy. The authors reviewed 27 procedures in 20 patients. There were 18 medial ulcers and 9 lateral ulcers. Wounds had resolved in 20 of 27 cases for 74% healing rate. The majority of failed procedures involved lateral column wounds (six of seven). Revisional surgery was required in five of the nine lateral column wounds for limb salvage. There was a statistically significant difference between the rate of complications by ulcer location (p = .00174). The rate of complications was significantly higher for lateral column ulcers. These results indicate that ostectomy is a reasonable option for medial column ulcers that fail nonoperative care. However, ostectomy for ulcers involving the lateral column is less predictable and failure often requires complex reconstructive soft tissue and osseous procedures for limb salvage.

Adult↗
PubMedDate not supplied

Posterior calcaneal displacement osteotomy for adult acquired flatfoot.

The authors retrospectively reviewed 24 patients who underwent posterior calcaneal displacement osteotomy (PCDO) for posterior tibial tendon dysfunction and adult acquired flatfoot deformity from 1991 to 1996. The average follow-up was 27 months. Analysis consisted of preoperative and postoperative evaluation of radiographs, as well as postoperative subjective results. Ancillary procedures included flexor digitorum longus tendon transfer (n = 19), tendo Achilles lengthening (n = 21), tibialis anterior tendon transfer (n = 5), naviculocuneiform joint arthrodesis (n = 4), and first metatarsocunieform joint arthrodesis (n = 1). The talo-first metatarsal angle on the lateral view decreased from a preoperative average of 22.13 degrees to a postoperative average of 8.50 degrees. The talo-first metatarsal angle on the anteroposterior view decreased from an average preoperative value of 22.96 degrees to a postoperative average of 11.04 degrees. In all cases, talar head coverage at the talonavicular joint improved. Subjective results were categorized as good (n = 17), satisfactory (n = 5), and poor (n = 2). Complications included sural neuritis (n = 6), Achilles tendon rupture (n = 2), difficulty with fixation (n = 2), and undercorrection of deformity (n = 2). Patients who had higher preoperative and postoperative talo-first metatarsal angles on either the anteroposterior or lateral radiographs had significantly poorer outcomes (p = .0403, p = .002, p = .009, p = .001, respectively). In addition, those patients who had medial column fusions had statistically significant poorer subjective results (p = .015). Patients who had flexor digitorum longus (FDL) tendon transfers did significantly better than those patients who did not have FDL transfer (p = .004). The authors conclude that the posterior calcaneal displacement osteotomy is a reasonable option for management of posterior tibial tendon dysfunction in the adult acquired flatfoot.

Adult↗
PubMedDate not supplied

Predislocation syndrome: a review and retrospective analysis of eight patients.

Predislocation syndrome is defined as an either an acute, subacute, or chronic inflammatory process involving the lesser metatarsophalangealjoints. If left untreated, this process can lead to plantarplate and capsular attenuation and metatarsophalangeal joint instability. A retrospective analysis were performed on eight patients who were treated with a flexor tendon transfer for this condition. A subjective analysis and chart review were performed to determine the final outcome of these patients. All patients had a chief complaint of a painful second metatarsophalangeal joint with seven of eight patients having an associated hallux valgus deformity. Excellent results were achieved in six patients. Residual stiffness was the primary complaint of two patients following surgery, suggesting that metatarsophalangeal joint stiffness may be a potential problem after flexor digitorum longus tendon transfers. However, we concluded that the flexor digitorum longus tendon transfer remains an excellent procedure for second toe instability and late-stage predislocation syndrome. A literature review describing the epidemiology, symptom complex, physical findings, radiographic signs and therapies used to manage predislocation syndrome were also discussed.

Adult↗
PubMedDate not supplied

Low-molecular-weight heparin for deep vein thrombosis prophylaxis in foot and ankle surgery: a review.

The necessity of prophylaxis for deep vein thrombosis (DVT) in those patients who undergo foot and ankle surgery remains poorly defined. The authors explore and review the low-molecular-weight heparin (LMWH) preparations for use by foot and ankle surgeons. Recent literature has described a low incidence of DVT and pulmonary embolus (PE) following foot and ankle surgery. Nonetheless, it is paramount that foot and ankle surgeons be aware of the potential risk factors and methods of prophylaxis for DVT. Many options are available for prophylaxis. This article presents a review of DVT with particular attention given to distinguishing risk factors, prophylaxis, and LMWH preparations.

Ankle↗
PubMedDate not supplied

Elective foot and ankle surgery in the diabetic patient.

The philosophy of treating diabetic foot pathology has changed dramatically throughout the years. No longer are old, unfounded fears considered the standard of care. The authors enumerate on their indications and goals of treating this complex entity. Clinical aids, as well as patient evaluations are discussed.

Achilles Tendon↗
PubMedDate not supplied

Graft-enhanced arthrodesis.

This article reviews the various sites in the foot and ankle where the use of a bone graft to enhance arthrodesis may be indicated. Specific indications are reviewed in detail and demonstrated with clinical examples. Bone graft classification is discussed along with a comparison of autografts and allografts. The controversy surrounding the use of allogenic bone in arthrodesis sites is also thoroughly reviewed. Lastly, this article discusses factors influencing selection of fixation devices and surgical techniques that will promote osseous consolidation and enhance primary union when bone grafts are used in arthrodesis sites.

Ankle Joint↗
PubMedDate not supplied

The modified Lapidus arthrodesis: a retrospective analysis.

The authors present a review of 47 modified Lapidus arthrodesis procedures performed between 1985 and 1995. There were 29 females and 10 males. Eight patients underwent bilateral procedures. The average follow-up was 6.3 years (range, 1.5-10.6 years). The patients were evaluated preoperatively and postoperatively using standard weightbearing radiographs, clinical examination, and chart review. The average preoperative intermetatarsal angle was 13.8 degrees degrees, and the average postoperative intermetatarsal angle measured 2.1 degrees degrees, with a mean improvement of 10.8 degrees. The average effective shortening of the first metatarsal was 4.7 mm in those patients without bone graft. In patients whom bone graft was utilized, an average effective increase in first metatarsal length of 2.6 mm was identified. Complications included delayed union (n = 2), nonunion (n = 3), postoperative development of hyperkeratosis beneath the second metatarsal head (n = 4), elevation of the first ray (n = 3), and hallux varus (n = 2). There were no recurrences of hallux abducto valgus at follow-up. The average return to preoperative activity level was 13 weeks. Forty-two of the 47 procedures healed uneventfully. Of the remaining five feet, two required the use of a bone growth stimulator, and three required revisional surgery with autogenous bone graft to promote arthrodesis and restore alignment. In conclusion, the modified Lapidus arthrodesis is both a predictable and durable procedure for the correction of hallux abducto valgus.

Adolescent↗
PubMedDate not supplied

Soft-tissue reconstruction for recalcitrant diabetic foot wounds.

Thirty-three consecutive patients with plantar soft-tissue defects were managed by a single surgeon (EDN) with reconstruction by a medial plantar artery (MPA)-based flap. Foot defects resulted from a combination of abnormal weightbearing distribution and neuropathy secondary to diabetes mellitus in all patients. A retrospective study of diabetic patients from 1984 to 1997 with foot defects reconstructed with a MPA-based flap were reviewed. Thirty-three patients (age 55 +/- 9) with an average tissue deficit of 13 +/- 9 cm2 had MPA reconstruction of the heel (n = 8), midfoot (n = 23), and forefoot (n = 2). The mean follow-up was 19 months (range, 3 months-5 years). There were four minor complications, including marginal flap necrosis or localized infection, although all healed uneventfully. There were six major complications resulting in loss of the flap and proximal amputation. Out of seven patients, there were 12 rerotations of the previously rotated flap. Various techniques for reconstruction of plantar foot defects have been described in the literature. Utilizing glabrous skin for reconstruction of these defects is appealing for its unique shear and pressure-resisting properties. Surgical management of diabetic foot defects with the medial plantar artery flap is an effective means of soft tissue reconstruction.

Adult↗
PubMedDate not supplied

Modified lapidus arthrodesis for adolescent hallux abducto valgus.

The Lapidus arthrodesis was originally described for the surgical correction of hallux valgus associated with metatasus primus adductus. It was popularized on the adult patient with moderate to severe hallux valgus deformity. However, the authors present a retrospective review of 23 adolescents between the ages of 13 and 20 who underwent the procedures. Characteristics of adolescent hallux valgus include a smaller dorsal medial eminence, less valgus rotation of the hallux, and certain mechanical influences. These influences may include a generalized increase in motion at the first metatarsocuneiform joint. The modified Lapidus arthrodesis eliminates motion at the first metatarsocuneiform joint and therefore directly addresses an etiology of the deformity. Both preoperative and postoperative radiographs were evaluated for reduction in the 1-2 intermetatarsal angle. Patients were evaluated through either chart review or telephone interview for present activity level, comfortable footgear, and overall satisfaction of the procedure. Twenty-seven out of 30 feet (90%) had either a good or excellent result with only three complications and two recurrences over a mean follow-up of 61 months.

Adolescent↗
PubMedDate not supplied

Prophylactic foot surgery in the diabetic patient.

The preoperative and perioperative evaluation of diabetic foot pathologies has been discussed. The effects of vascular and neuropathic alterations in such cases can be devastating. Only through understanding of the underlying mechanisms that contribute to the diabetic foot can progressive, appropriate care be rendered.

Amputation, Surgical↗