This study reviews the arthritis clinic population of Rancho Los Amigos and a private practice limited to foot and ankle to determine the number of ankle fusions performed for collagen diseases. Rheumatoid arthritis was found to be the most common disease with ankle involvement severe enough to require fusion. From 8020 clinic visits in a 2-year period there were 61 total hip replacements, 56 total knee replacements, and no total ankle replacements. Three ankle fusions were performed. In a private practice out of 90 patients seen for ankles painful enough to require fusion, 6 were in rheumatoid arthritics. A successful ankle fusion was compatible with good function of the lower limb. Motion lost through fusion could be restored with a rocker-bottom shoe. Significant complications occurred with ankle fusion.

Aged↗

PubMedDate not supplied

Microbiology of deep tissue in diabetic gangrene.

Information on the incidence and nature of the causative organisms in the infected tissues of patients with diabetic gangrene is scanty. Studies in which material for culture was obtained from the presenting lesion reveal multiple organisms in host isolates. No data are available regarding the bacterial flora of the deep infected tissue itself, uncontaminated by surface organisms. In this investigation 58 specimens from 52 patients were obtained utilizing aerobic and anaerobic culture techniques. In the surgical theater, material was obtained from the infected deep tissues using careful aseptic dissection techniques. All patients had been on antibiotic therapy from 2 to 10 days before the study. An average of 2.3 organisms per specimen was found. The predominant organisms were Proteus sp., Enterococcus, Staphylococcus aureus, and other enterobacteriacae in that order. Anaerobes were isolated in 27 per cent of cases, but never as the only organism. Prior antibiotic therapy did not eradicate infection in infected diabetic gangrene.

Bacteria↗

PubMedDate not supplied

Neurocirculatory disorders of the foot.

There is a simple rationale for care of the dysvascular neuropathic foot. Either prevention or correction of deformities, or both, is of primary importance in the insensitive or poorly healing foot. Control of edema is necessary to achieve maximum healing potential. There are tools at hand to allow the orthopedic surgeon to judge arterial supply in addition to his clinical judgment. Interest in defensive footwear, appreciation of interface forces, and the application of standard operative techniques to this ever-present population can result in significant improvement in patient care.

Amputation, Surgical↗

PubMedDate not supplied

Transcutaneous Doppler ultrasound in the prediction of healing and the selection of surgical level for dysvascular lesions of the toes and forefoot.

Dysvascular lesions of the toes and forefoot are divided into 5 grades and matched with appropriate treatment programs. Patients with diabetes mellitus and arterosclerosis obliterans make up the greatest number presenting with such problems. Transcutaneous Doppler ultrasound has been added to clinical criteria as an aid in the prediction of healing. Systolic blood pressures are taken at the thigh, knee, calf, ankle, foot and toes using transcutaneous Doppler ultrasound as a sensitive stethoscope. Systolic blood pressure taken at the antecubital fossa is divided into the lower extremity pressures to obtain an ischemic index. Healing can be predicted with 90% or better accuracy where the ischemic index is above 0.35 in the arteriosclerotic foot and above 0.45 in the diabetic foot.

Amputation, Surgical↗

PubMedDate not supplied

Disorders of the forefoot.

Explore the source record for details and available documents.

Foot Diseases↗

PubMedDate not supplied

Amputations of the foot and ankle. Current status.

Doppler assessment of ankle and foot systolic pressure is a practical aid in the evaluation of neurocirculatory problems. If the ratio of ankle pressure to arm pressure is over 0.45, more than 90 per cent of operative procedures will heal. Intraoperative testing of blood supply aids in determining level of amputation. Healing results in 80 per cent of cases if bleeding occurs in the skin within three minutes after release of tourniquet. With vigorous debridement of infected soft tissue and bone, the remaining tissue will often heal in local foot operations. A high percentage of patients with neuro-circulation disorders become bilateral amputees. Partial foot and Syme level amputations allow these patients to remain prosthetic users. Function tests show the Syme amputee to be superior in stride length, velocity, cadence and oxygen uptake when compared with the below-knee and above-knee amputees. The criteria of McKittrick must be followed carefully to ensure healing of transmetartarsal amputations.

Amputation, Surgical↗