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Biomedical subjects

L A Lavery

Publications and source records attributed to L A Lavery.

97 records · Page 6Linked to original sources
PubMedDate not supplied

The interpositional arthroplasty procedure in treatment of degenerative arthritis of the second metatarsophalangeal joint.

A description of subjective and objective results in patients that received an interpositional arthroplasty procedure of the second metatarsophalangeal joint is presented. The authors evaluated nine patients using an observational, descriptive design. An independent examiner administered a subjective questionnaire at the same time a physical examination was performed. The average follow-up period was 35.5 months, with a range of 7 to 142 months. All patients showed an improvement in postoperative pain and activity. All but one of the patients rated their results as good or excellent. Additionally, the patient population demonstrated limited motion of the second metatarsophalangeal joint without pain or crepitus postoperatively. The subjective and objective results from this small case series were consistently good.

Adolescent↗
PubMedDate not supplied

Infected puncture wounds in adults with diabetes: risk factors for osteomyelitis.

The purpose of this study was to investigate factors that contribute to the development of osteomyelitis of the foot after a puncture wound in patients with diabetes. Forty-five male and 21 female adults with diabetes that were admitted to the hospital for a foot infection precipitated by a puncture were included in the study. Twenty-two (33%) patients had osteomyelitis (O) based on either a positive bone culture or pathology report. Forty-four patients had soft tissue infections (ST). Age and duration of diabetes were similar in both groups. Patients with osteomyelitis received medical treatment later than patients with soft tissue infections. A significant difference was identified when comparing the time interval from the time of the injury until patients were hospitalized and until they had the puncture wound surgically debrided, and when comparing the interval from when patients first received initial professional medical evaluation until they were hospitalized and until they had the puncture wound surgically debrided. Patients with punctures involving the forefoot (FF) and patients that wore shoes (S) at the time of the injury were more likely to develop osteomyelitis than patients that had rearfoot (RF) injuries O: FF = 20, 90%, RF = 2, 10%, ST: FF = 30, 70%, RF = 13, 30%, p < 0.05) and patients that were barefoot (B) at the time of injury (O: S = 15, 88%, B = 2, 12%, ST: S = 21, 57%, B = 16, 43%, p < 0.05). Osteomyelitis is a common complication in patients with diabetes with a foot infection following a puncture wound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Risk of complications of first metatarsal head osteotomies with biodegradable pin fixation: Biofix versus Orthosorb.

Bioabsorbable materials for fracture repair have recently become available in the United States. These products have been especially attractive to surgeons that perform elective foot surgeries because an additional surgery is not required to remove internal fixation, and exposed pins and their complications can be avoided. The aim of this study was to compare complications in distal first metatarsal head osteotomies fixed with Biofix, polyglycolide pins and Orthosorb, polydioxanon pins. The authors identified nine patients with 11 distal first metatarsal osteotomies repaired with Biofix and 28 patients with 34 osteotomies repaired with Orthosorb from surgery logs for a 2-year period. The authors abstracted medical records and radiographs to identify sterile sinus formation, non-unions, malunions, and osteolytic lesions. The age and gender of patients in the Orthosorb and Biofix groups were similar. Six osteotomies in five patients in the Biofix group demonstrated bone resorption and osteolytic changes involving the osteotomy. Two of these patients also had a dorsally subluxed malunion of the first metatarsal head. There was one dorsally subluxed malunion in the Orthosorb group. No sterile sinus tracts were identified in either group. Complications were more common in distal first metatarsal osteotomies fixed with Biofix compared with Orthosorb (Biofix 55%, Orthosorb 3%, p < 0.001, odds ratio: 39.6, confidence interval (CI) = 3.9-401.6). Complications in the Biofix group were significantly more common in patients 50 years of age and older (p < 0.05).

Adult↗
PubMedDate not supplied

Mechanical characteristics of poly-L-lactic acid absorbable screws and stainless steel screws in basilar osteotomies of the first metatarsal.

The purpose of this study is to evaluate the structural characteristics of 3.5-mm. stainless steel cortical screws and poly-L-lactic acid (PLA) absorbable screws in oblique closing base wedge osteotomies of the first metatarsal. Six pairs of frozen first metatarsal bones were excised from the specimen group. An oblique base wedge osteotomy was performed and fixated with either a 3.5-mm. stainless steel or PLA screw. Specimens were loaded to failure with the Bionix Material Testing System at a constant rate of 0.166 mm./sec. A Student's t test for paired samples with a 95% confidence interval was used to measure differences in ultimate load, ultimate displacement, and structural stiffness. The following results (mean +/- standard deviation) were obtained: Structural stiffness, PLA 12.35 +/- 3.82 N/mm. and stainless steel 10.13 +/- 5.74 N/mm.: ultimate displacement, PLA 7.39 +/- 3.23 mm. and stainless steel 10.89 +/- 7.91 mm.; ultimate load, PLA 57.95 +/- 1.01 N and stainless steel 51.49 +/- 5.22 N. In this fracture model, there were no statistically significant differences in the structural characteristics of PLA 3.5-mm. screws and stainless steel screws in oblique closing base wedge osteotomies of the first metatarsal.

Absorption↗
PubMedDate not supplied

Bacterial pathogens in infected puncture wounds in adults with diabetes.

Infections resulting from puncture wounds to the foot in diabetics appear not to have been previously reported in the medical literature. The purpose of this report is to describe bacterial pathogens identified from bone and soft tissue infections precipitated by a puncture injury in patients with diabetes. In a 7-year retrospective study, the authors evaluated 22 patients with osteomyelitis and 44 patients with soft tissue infections. Medical records and operative culture and sensitivity reports were reviewed. Staphylococcus aureus (68%), Streptococcus species (44%), and Enterococcus species (27%) were the most common pathogens identified. Pseudomonas was more common in cases of osteomyelitis (36%) than in soft tissue infections (18%) (p < 0.001). Pseudomonas was more common in patients that had worn tennis shoes at the time of the puncture injury compared to patients that were barefoot or who wore some other type of footwear (p < 0.001). Seventy-four percent of patients had polymicrobial infections. Anaerobes were identified in only seven patients (11%). This study suggests that polymicrobial infections with few anaerobes are common in infected puncture wounds in diabetics. Pseudomonas is more common in bone infections and is associated with wearing tennis shoes at the time of injury.

Adult↗
PubMedDate not supplied

Defining loss of protective sensation in the diabetic foot.

Although the importance of distal symmetric sensorimotor polyneuropathy as a risk factor for diabetic foot ulceration has been known for decades, attempts to identify the elusive point that defines loss of protective sensation have been futile. This manuscript will review the epidemiology and pathogenesis of peripheral neuropathy, discuss commonly used screening tools, and review recently reported data that more sharply define loss of protective sensation on the long spectrum of neuropathy.

Diabetic Foot↗