A new modified technique for harvest of calcaneal bone graft in surgery on the foot and ankle.
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Ankle↗
Biomedical subjects
K T Mahan
Publications and source records attributed to K T Mahan.
Hydroxyapatite as a bone substitute.
A bone substitute eliminates the need for autogenous and allogeneic bone grafting, along with the complications unique to each. Coralline hydroxyapatite is a synthetic bone void filler manufactured from marine coral, which has a natural trabecular structure similar to that of cancellous bone. While initial studies have been promising, the use of coralline hydroxyapatite may be limited in the foot and ankle owing to its inherent mechanical weakness and lack of biodegradation. In this retrospective study, 20 patients who received coralline hydroxyapatite implants were reviewed to determine associated complications and host reaction to the material. The results indicate that the material is biologically inert and safe to use as a small-defect filler in low-load applications. Long-term clinical trials are needed to determine the indications for this material in the foot and ankle.
Adult↗
Bone grafting in foot and ankle surgery. A review of 300 cases.
Three hundred foot and ankle bone grafts were reviewed in three separate series of 100 consecutive grafts from two institutions. The series represent a period from 1977 to 1990 and demonstrate treatment patterns that varied over time and between institutions in indications, graft material, and perioperative management. Over 42% of the 300 grafts were for calcaneal osteotomies; most were Evans calcaneal osteotomies. Over 72% of the grafts were allogeneic bone-bank bone, which performed well in calcaneal osteotomies and for packing of defects. Upon review of the incidence of bone complications, no significant differences were observed between surgical procedures that used autogenous versus allogeneic grafts. However, four out of six failures of first metatarsal repair were with allogeneic bone. There was a significant difference in complication rates for the major indications for bone-graft surgery. Nonunions and arthrodeses resulted in higher complication rates than expected, whereas calcaneal osteotomies resulted in a lower complication rate than expected.
Ankle Joint↗
Closed rupture of the anterior tibial tendon. A case report.
Closed subcutaneous rupture of the anterior tibial tendon is a relatively uncommon injury that requires a thorough clinical examination to diagnose correctly. The authors report a case of this disorder and provide a review of the relevant literature. A method of surgical repair not previously described in the literature is also presented.
Age Factors↗
Podiatry Institute ankle fusion technique.
The authors review the ankle and pantalar fusion literature. The authors performed a retrospective review on 42 ankle and pantalar fusions, emphasizing the role of internal fixation. The Podiatry Institute technique for internal fixation of ankle fusions is described and experience with the technique is reviewed. Complications included delayed union and nonunion at the fusion site or the repaired fibular osteotomy site and tibial fractures at screw stress riser sites. Modifications to reduce these complications are discussed. Experience with internal fixation in ankle and pantalar fusions, both in this study and in current literature, has been positive.
Adult↗
Tarsal tunnel syndrome. A retrospective study.
Many etiologies of tarsal tunnel syndrome exist, but it is difficult to determine the specific etiology for a patient. Surgical success rates vary in the literature from 44% to 100%. This retrospective study reviewed 40 patients with 45 data sets. Thirty-five patients (87.5%) in the study were female; 35 patients (87.5%) were caucasian. Thirty-two feet (71.1%) showed improvement following the tarsal tunnel surgery. The Tinel's sign parameter improvement was statistically significant. The differences in the subjective parameters of burning, radiating, and sharp sensations were statistically significant, while the differences in pins and needle sensation were nearly significant. The Takakura index and its constituent parameters were all statistically significant postoperatively with the exception of muscle atrophy, which did not have sufficient data for testing.
Adult↗
Calcaneal donor bone grafts.
Autogenous bone grafting is an important part of many foot and ankle surgical procedures. Although alternative bone graft materials such as allogeneic bone are available, autogenous bone continues to be the material of choice for many procedures. The calcaneus provides a source of small amounts of autogenous corticocancellous or cancellous bone. The author describes the surgical technique for procurement of calcaneal bone grafts. Twenty-five cases are reviewed. The morbidity associated with procuring calcaneal bone grafts is favorably compared with that associated with procuring bone from other donor sites.
Adolescent↗
Characteristics of adolescent hallux abducto valgus. A retrospective review.
The authors review 63 surgical cases of adolescent hallux abducto valgus in 54 patients from the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine over a 7-year period. Twenty-five closing base wedge and capital osteotomies were evaluated for radiographic changes. Three quarters of a group of 65 patients with adolescent hallux abducto valgus were found to have an abnormally high metatarsus adductus angle. Patients who had a closing base wedge osteotomy had higher preoperative radiographic angles for the intermetatarsal, metatarsus adductus, hallux abductus, and proximal articular set angles as well as the tibial sesamoid position. Those patients had 4.49 degrees more intermetatarsal angle correction than the patients who had a capital osteotomy. Implications for evaluation and treatment are discussed.
Adolescent↗
Digital dissecting hematoma. A differential diagnosis.
The dissecting hematoma, a little mentioned postoperative complication following digital surgery, occurs when there is damage to the blood vessels intraoperatively. Accurate and immediate diagnosis is essential for providing early and appropriate treatment.
Diagnosis, Differential↗
Spinal morphine anesthesia and urinary retention.
Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented.
Adult↗
Bone graft reconstruction of a flail digit.
The author presents a case report with a 1-year follow-up period demonstrating successful bone graft stabilization of an iatrogenic flail second toe. The author discusses the techniques for calcaneal autogenous bone grafting for reconstruction of the iatrogenic shortened toe combined with ancillary procedures to improve the digital length pattern. After 18 months, this staged approach to stabilization of the digit and realignment of the digital length pattern appears to be successful.
Adult↗
The future of podiatric medical education. Cautious optimism.
The leadership of the Pennsylvania College of Podiatric Medicine sets forth the following treatise on the outlook for podiatric medical education into the 21st century. Despite the seemingly impossible challenges facing the profession and its students, it is their opinion that the future is bright and with dedicated effort the profession will become stronger in the years ahead.
Education, Medical↗
Surgical repair of a talar body nonunion.
Fractures of the talus are significant injuries and are usually intra-articular. The authors discuss the evaluation and management of a patient with a delayed union of a talar body fracture. Assessment of talar vascularity and joint integrity should be performed preoperatively. The role of internal fixation and continuous passive motion is discussed.
Adult↗
Juvenile hallux valgus with compensated metatarsus adductus. Case report.
The authors describe a case report of a patient with compensated metatarsus adductus and juvenile hallux valgus bilaterally. Treatment included closing base wedge abductory osteotomies of metatarsals one through five, modified McBride bunionectomy, Evans calcaneal osteotomy, and a percutaneous tendo Achillis lengthening. The patient maintained excellent correction on the right foot after 6 years. Hallux valgus recurred on the left foot after 2 years. The authors attribute this recurrence to a significant internal femoral torsion on the left leg. The significance of superstructural deformities on juvenile hallux valgus is discussed.
Age Factors↗
Recent concepts in understanding a child's pain.
The management of pain in children is a complex process that has significant differences from adult pain management. The authors describe the myth of children's lack of pain and how that myth has resulted in frequent undermedication of children's pain. The authors describe the physical and psychological aspects of pain. Assessment techniques for more accurately determining pain in children are also described. The authors conclude with a description of pharmacologic aspects of pediatric pain management.
Analgesics↗
Patient preparation in pediatric surgery.
This article has outlined the developmental concerns which make pediatric preparation for surgery a necessity. The goals, methodology, and essential elements of programming have been presented, along with a review of the supporting literature. Some of the major concerns expressed by children have been illustrated. In summary, the following are the essential points to keep in mind when planning pediatric patient care: Honesty. There is no substitute for the trust developed between an honest physician and the patient. Awareness of developmental concerns. The timing, wording, and presentation of preparation materials must be based on an accurate assessment of the child's cognitive and emotional readiness. Involvement of the patient and parent in decision making, treatments, and procedures whenever possible. Patients and families who feel in control are much more trusting and receptive to the physician's plan. Follow-up. Make certain the patient and family are aware of your continued concern for their well-being. In addition, ask what they feel helped them and their child the most, and what could have been done to be more helpful. This helps continued refinement of a program designed to meet client needs.
Adolescent↗
Evans calcaneal osteotomy for flexible pes valgus deformity. A preliminary study.
This procedure was quite successful, particularly in patients with a transverse plane dominant flexible pes valgus deformity. The modifications that have proved to be successful include the use of the oblique skin incision following the relaxed skin tension lines, the use of allogeneic bone graft, and the use of ancillary procedures, including the gastrocnemius recession and medial arch tendosuspension. The procedure is less predictable in those patients whose deformity is primarily in the frontal or sagittal plane. It is most critical that preoperative analysis be used to discover the presence of the masked metatarsus adductus prior to performing this procedure.
Adolescent↗