Consultation with the specialist. Eye examinations in infants and children.
Explore the source record for details and available documents.
Child↗
Biomedical subjects
J H Calhoun
Publications and source records attributed to J H Calhoun.
Displaced intra-articular calcaneus fractures treated with the Galveston plate.
From January 1992 to August 1993, 59 calcaneal fractures in 48 patients were treated. Thirty-three fractures in 31 patients were displaced intra-articular fractures and were treated with open reduction and internal fixation through an extensile lateral approach with the Galveston plate (Smith and Nephew, Richards, Memphis, TN). Complete radiographs and CT scans were available for 32 of the fractures. The CT scan classification of Sanders was used. The distribution of the fractures was: IIA, N = 17; IIB, N = 2; IIC, N = 2; IIIAB, N = 7; IIIAC, N = 2; IV, N = 2. Sixteen (50%) had calcaneocuboid joint involvement. Preoperative and postoperative radiographic measurements of Bohler's angle, Gissane's angle, talocalcaneal angle, and Achilles tendon fulcrum distance were made. Clinical follow-up on 23 fractures in 22 patients at an average of 21 months is presented. Seventy percent of the patients have no pain or only occasional pain not requiring medication. Using the Maryland Foot Score for assessment, 78% of the patients had a good or excellent result. The Galveston plate was useful for maintaining reduction of intra-articular calcaneus fractures treated operatively and provided results comparable to other reported series.
Adult↗
Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification.
Calcaneal fractures have been treated by closed methods since the time of Hippocrates. The understanding of the anatomy, injury mechanism, and classification of these fractures has advanced since surgical treatment was introduced in 1850. Despite 145 years of different treatment techniques, no consensus has been reached. Investigation into the injury patterns, anatomy, and outcomes has lead to the advances reviewed in this article.
Calcaneus↗
Fractures of the calcaneus. Part II: Treatment.
Extra-articular fracture management of the calcaneus is well accepted. Despite advancements, there is still no consensus on the treatment of intra-articular calcaneal fractures. Although the results of open reduction and internal fixation appear promising, evaluation is difficult because there is no universally accepted classification system. We believe that a consensus is developing for the evaluation, staging, and treatment of the acute calcaneus fracture and its chronic problems. Advancements in the understanding of the anatomy, injury mechanism, and classification of calcaneal fractures were presented in Part I (Foot & Ankle International, 17(4):230-235, 1996). Treatment of displaced intra-articular fractures gives superior results when anatomic reduction of the subtalar joint is achieved.
Acute Disease↗
Update on the diagnosis and management of osteomyelitis.
Osteomyelitis can be classified by duration, pathogenesis, location, extent, and host status. Bone infections are currently classified by the Waldvogel or the Cierny-Mader classification. Because the Waldvogel classification is an etiologic system and the Cierny-Mader classification is descriptive, both classifications can be simultaneously used. The Cierny-Mader classification is based on the anatomy of the bone infection and the physiology of the host. Cierny-Mader staging allows stratification of long bone osteomyelitis and the development of comprehensive treatment guidelines for each stage. Current trends in long bone osteomyelitis therapy emphasize early diagnosis and aggressive treatment. Radiographs and bone cultures are the mainstays of diagnosis. Imaging with radionuclide scans, computerized tomography, and magnetic resonance imaging are used when the diagnosis of osteomyelitis is equivocal or to help guage the extent bone and soft tissue infection. Surgical treatment involves débridement of necrotic bone and tissue, obtaining appropriate cultures, managing dead space, and, when necessary, obtaining bone stability. Medical therapy includes improving any host deficiencies, initial antibiotic selection, and antibiotic modification based on culture results. Antibiotic delivery has expanded to include effective oral agents and local therapy with antibiotics mixed in polymethylmethacrylate. Cierny-Mader staging was developed to describe long bone osteomyelitis. This staging system has to be modified to describe diabetic foot osteomyelitis and vertebral osteomyelitis. Osteomyelitis in patients with diabetes mellitus involves the bones of the feet or ankles. The vascular and neurologic status of the patient must be carefully accessed. Patients may be managed with local débridement surgery or ablative surgery plus 2 to 4 weeks of antibiotic therapy depending on whether all of the osteomyelitis is surgically removed. If the patient does not wish surgery or is not a surgical candidate, suppressive antibiotic therapy can be used. Vertebral osteomyelitis is usually hematogenous in origin. The diagnosis is made by bone cultures, histology, and radiographs. Magnetic resonance imaging and technetium scans are useful in making the diagnosis and in gauging the extent of the bone and soft tissue infection. Therapy requires parenteral antibiotic therapy and may include early surgery and stabilization. The choice of an antibiotic therapy is guided by the bone biopsy or débridement culture results.
Adolescent↗
Osteomyelitis.
The complexities of osteomyelitis make its diagnosis and treatment challenging. Current trends emphasize early diagnosis and aggressive treatment. Imaging has improved, with nuclear scans and magnetic resonance imaging, and technique modifications have enhanced the specificity of these tests. Treatment depends on thorough debridement of necrotic bone and tissue, accurate cultures and administration of culture, and sensitivity-specific antibiotics. Antibiotic delivery has expanded to include effective oral agents and local agents mixed with polymethylmethacrylate or a biodegradable substance. Success rates in treating this disease have improved with the use of a systematic approach, making outcome more predictable.
Adult↗
An anatomic analysis of endoscopic plantar fascia release.
Eighteen fresh-frozen cadaver foot specimens underwent release of the plantar fascia via a newly described endoscopic technique. A 75% release was attempted on each specimen in order to represent a partial fascial release. Each specimen was then dissected to assess the success of the procedure. Five separate measurements were recorded evaluating the reproducibility of the procedure, adequacy of the release considering accepted etiologies for chronic heel pain, and the possibility of damage to local structures. Partial release was noted to be possible, but controlling the exact percentage of the incision was difficult. The release averaged 82% of the width of the fascia, with a range of 53% to 100%. There was no damage in any specimen to the first branch of the lateral plantar nerve, the structure considered most at risk during the procedure. Release of the deep fascia of the abductor hallucis muscle was not possible with this approach.
Cadaver↗
Injuries of the foot related to the use of lawn mowers.
We managed thirty-three patients who had open injuries of the foot related to the use of a lawn mower from 1985 through 1992. Twenty-eight of the patients were male and five were female. They ranged in age from four to seventy-three years old. The injuries were associated with the use of push lawn mowers (twenty-two patients), riding lawn mowers (nine patients), and self-propelled lawn mowers (two patients). The injuries included forty open fractures, twenty amputations, eighteen lacerations of the skin and nail beds, nine lacerations of tendons, two closed fractures, segmental loss of bone in two patients, and segmental loss of the Achilles tendon in one patient. The findings on culture of intraoperative specimens revealed a mean of 3.1 organisms (range, one to nine organisms) per patient. All of the patients were managed with at least one operative procedure (mean, 2.4 operations; range, one to five operations), and all were treated with parenteral antibiotic therapy (mean, 2.3 antibiotics; range, one to six antibiotics) except for one patient who had oral antibiotic therapy. The mechanism of injury was documented for twenty of the twenty-two patients who had been injured by a push lawn mower. Seventeen patients were injured while pulling the push lawn mower backward, and eight of those patients had been pulling the lawn mower up a slope.(ABSTRACT TRUNCATED AT 250 WORDS)
Accidents, Home↗
Ring fixators for reconstruction of traumatic disorders of the foot and ankle.
External fixation methods have an accepted place in orthopedic management of problems involving the foot and ankle. Traditionally, reconstruction and correction of deformity have been managed with extensive soft-tissue release, osteotomies, and arthrodeses. Methods of external fixation have evolved dramatically over the past decade with the introduction of the techniques of Ilizarov to the Western World. This article covers ankle arthrodesis, burn scar contracture, distal tibial deformity, and fractures.
Adult↗
Osteomyelitis.
Osteomyelitis can be difficult to treat. Current trends emphasize early diagnosis and aggressive treatment. Imaging has improved with nuclear scans and magnetic resonance imaging, and recent modifications in technique have enhanced the specificity. Treatment depends on debridement of necrotic bone and tissue, obtaining accurate cultures, and administration of culture- and sensitivity-directed antibiotics. Antibiotic delivery has expanded to include effective oral agents and local agents mixed with polymethylmethacrylate or a biodegradable substance. Success rates in treating this disease have improved with a systematic approach, making outcome more predictable.
Chronic Disease↗
A comprehensive study of pressure distribution in the ankle joint with inversion and eversion.
The understanding of load transfer characteristics is the baseline for biomechanics of the ankle joint. Changes in contact patterns of the articular cartilage from the norm may indicate pathologic conditions. Measurement of the contact in human cadaver ankles provides a direct measurement for this understanding. The force transfer characteristics of the three facets of the ankle joint were investigated. Five fresh-frozen cadaver lower extremities were tested in 12 positions under three axial loads of 490, 686, and 980 N. Fuji film served as the pressure transducer and the prints were analyzed by a computerized video digitizer. The results demonstrated that as the foot was moved into inversion or eversion with the ankle in neutral flexion or dorsiflexion, there was a decrease in total contact area and an increase in the average high pressure. In plantarflexion, the contact area was lower and the average high pressure was higher, indicating a greater force per unit area as compared with dorsiflexion and neutral flexion. In plantarflexion, however, little change was noted with inversion or eversion. In dorsiflexion, the total contact area was higher and the average high pressure slightly lower as compared with neutral flexion. With inversion, the contact area of the medial facet of the ankle increased and with eversion it increased on the lateral facet, especially in dorsiflexion. With an increase in loading, the pressure did not significantly increase but the contact area did increase. The centroid of the contact moved anteriorly to posteriorly on the talus as the joint moved from dorsiflexion to plantar-flexion.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Use of antibiotic-PMMA beads in the ischemic foot.
Thirty-six patients with 44 ischemic foot infections were managed with antibiotic-polymethylmethacrylate (PMMA) beads. Most of these patients received gentamicin-impregnated PMMA beads but tobramycin and vancomycin-impregnated PMMA beads were used on three patients. Angiopathy occurred in 35 patients secondary to diabetes and secondary to renal disease in 2; 1 patient had both diabetes and renal disease. The most common bacteria was Staphylococcus aureus (82%), although other organisms and multiple bacteria were present. In spite of the variability of the bacteria, PMMA beads were helpful in managing foot infections in this difficult patient population.
Anti-Bacterial Agents↗
The Ilizarov technique in ankle fusion.
Failed ankle arthrodesis represents a significant challenge to the orthopaedist today. The complexity of this problem is further increased when associated with additional complications, such as osteomyelitis, leg length discrepancy, or concomitant foot deformity. In many instances, the only viable salvage alternative is amputation. The authors report 21 cases of complex distal tibial pathology or failed ankle arthrodesis treated with the Ilizarov external fixator. Of the 20 cases available for follow-up evaluation, 16 (80%) achieved good results with solid ankle arthrodesis and resolution of associated pathology. The Ilizarov fixator may be a viable clinical tool in these difficult cases in which amputation is the alternative.
Adolescent↗
Sporotrichosis presenting as arthritis and subcutaneous nodules.
Arthritis is a rare manifestation of systemic sporotrichosis. A patient who had sporotrichal arthritis of both wrists and elbows is described. Predisposing factors included alcoholism, rose gardening, and antecedent trauma. The onset of the arthritis was insidious, and the diagnosis was made 2 1/2 years after his first symptoms were noted. Treatment with surgical debridement and a 23-week course of ketoconazole was unsuccessful. A review of the literature suggests that some combination of intravenous or intraarticular amphotericin B and potassium iodide, ketoconazole, or surgery is necessary for effective treatment.
Arthritis, Infectious↗
Treatment of infected pilon nonunions with small pin fixators.
Six consecutive patients with infected intra-articular fractures of the distal tibia were studied. They were treated with resection of all infected or necrotic bone, systemic antibiotics, and instrumentation with a small pin fixator (Ilizarov external fixator). The fixator was used to perform an ankle arthrodesis and to fill the defect created by bone resection with distraction osteogenesis. In all cases, the infections were eradicated, and a solid arthrodesis was attained. The patients required from zero to two revision procedures (average 1.3), and their time in the fixator varied from 3 to 13 months (average 8 months). All of the patients experienced at least minor complications during treatment (superficial pin tract infections). At final follow-up, no patient demonstrated shortening of more than 1.5 cm. One patient has an internal rotation deformity of 15 degrees; a second has a varus deformity of 10 degrees and occasionally uses lateral support (a cane) secondary to unsteadiness on uneven ground; and one patient uses aspirin occasionally for subtalar pain. All are pleased with their results and would undergo the same procedure again without reservation.
Adult↗
The Ilizarov fixator and polymethylmethacrylate-antibiotic beads for the treatment of infected deformities.
Eighteen of the 124 patients enrolled in the gentamicin methylmethacrylate bead (GMB; Septopal) study had infected deformities that were treated with the Ilizarov external fixator. Nine of these patients (Group 1) were treated with an initial debridement and intravenous antibiotics for four weeks. Nine patients (Group 2) were treated with GMB and, five days after operation, intravenous antibiotics. The two groups were similar. Group 1 included eight men and one woman (average age, 31.8 years) and Group 2, seven men and two woman (average age, 37.4 years). Both groups had multiple deformities, including nonunions, segmental defects, angulation, and shortness. The end results were identical. Eight patients in each group had their infection successfully arrested (88.9%), and eight patients in each group had their deformity successfully treated. The use of GMB with the Ilizarov fixator was as effective as long-term parenteral antibiotics with the Ilizarov fixator for the treatment of infected deformities.
Adult↗
The treatment of infected nonunions with gentamicin-polymethylmethacrylate antibiotic beads.
Fifty-two patients enrolled in the Septopal study of infected nonunions were prospectively examined in a randomized, controlled, closed study. Patients were divided into two groups. Group 1 consisted of 24 patients treated with debridement and intravenous antibiotics for four weeks. Group 2 consisted of 28 patients treated with debridement, gentamicin-polymethylmethacrylate (Septopal) beads, and perioperative broad-spectrum parenteral antibiotics. Both groups were treated with similar methods for reconstruction of the nonunions. The demographics of the two groups were similar. The average patient age in Group 1 was 38.4 years, and in Group 2, 37.1 years. Group 1 included 21 men and three women and Group 2, 23 men and five women. The nonunions in both groups ranged from simple hypertrophic nonunions to atrophic unions to segmental defects. The end results were good in both groups. Twenty patients in Group 1 and 25 patients in Group 2 had their infections successfully arrested (83.3% and 89.3%, respectively). Nonunions were successfully healed in the two groups, with similar results (Group 1, 83.3%; Group 2, 85.7%). Infected nonunions responded equally well to either systemic treatment with long-term intravenous antibiotics or local treatment with gentamicin-polymethylmethacrylate beads.
Adult↗