Biomedical subjects
Publications and source records attributed to M D Roven.
Indications and contraindications for tenotomy, tenectomy, and capsulotomy have been cited and surgical procedures outlined. The importance of possible supplemental surgery and biomechanical follow-up have also been stressed.
A summary of the phalangeal set procedure has been given with indications, significance of the correction, contraindications, biomechanical factors, operative procedure, and the acceptance in many podiatric and orthopedic surgery circles. This is an ambulatory procedure for toe deformities which allows for release of toe contractures, reduction of superimposition of phalanges, increased joint space, and correction of malalignment.
A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated. This method has proved less traumatic than previous procedures, permitting immediate ambulation with little postoperative pain or edema. In a series of cases, I have compared this method with control studies on the same patient in which intramedullary metatarsal decompression was performed on one foot and a neck osteotomy on the opposite foot. Results with intramedullary metatarsal decompression have been comparable but have fewer postoperative sequelae. Exuberant bone callus formation dorsally and at the osteotomy site, lateral displacement of bone segments, frequency of transfer lesions, delayed healing or nonunion of the osteotomy site, and the possibility of synostosis when two adjacent bones were osteotomized are all decreased. A short review of the rationale, selection of cases, and criteria for orthotics is presented. The concept and simplified method of treatment applied in a series of cases is described.
The importance of correction of the high proximal articular set angle with a subluxed joint in hallux abducto valgus for long-term correction is cited. I have shown that if the laterally deviated facet is not corrected, pronatory forces continue to act on the first ray. When force is applied to a still laterally tilted first metatarsophalangeal joint, further side-slipping of the joint will occur even though modification of the Silver, McBride, or osteotomy procedures of the first metatarsal have been performed successfully. A review of the standard procedures for the correction of a high proximal set angle alone usually did not correct the high intermetatarsal angle usually associated with this problem. Combination procedures sometimes created complications. These include dorsal dislocation of the distal fragment in correction of the sagittal plane deformity causing metatarsalgia, limited dorsal range of motion, and damage to the sesamoids or sesamoid grooves on the plantar aspect of the first metatarsal. Angulational transpositional derotation and hallux set (ATDH) is offered to correct four deformities using one or two 1-cm incisions together with "stab" incisions. This method overcomes the many disadvantages of previous procedures and can be used in the presence of biomechanical pronatory forces to reduce the proximal articular set and intermetatarsal angles; to derotate the hallux; to neutralize the forces that pull the proximal phalanx off the first metatarsal head; and if necessary, to correct the sagittal plane deformity of the first metatarsal so that weight bearing is not disturbed.(ABSTRACT TRUNCATED AT 250 WORDS)
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