Biomedical subjects
Publications and source records attributed to M J Coughlin.
Twenty patients (30 feet) with symptomatic bunionettes refractory to conservative care underwent longitudinal diaphyseal osteotomy, lateral condylectomy, and distal metatarsophalangeal realignment. At an average of 31 months followup, 93% (28 feet) noted good or excellent results. This technique was found to be useful and predictable in correcting the bunionette deformity.
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Explore the source record for details and available documents.
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An excellent means of salvaging a deformity of the hallux, metatarsophalangeal joint arthrodesis should be technically simple and yield predictable results. The author reviews the literature on this procedure and presents the particular technique he has developed.
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This article discusses the causes of subluxation and dislocation of the second metatarsophalangeal joint. Determination of the pathology and magnitude of the deformity is reviewed and methods for conservative care are included. Surgical procedures presented include soft-tissue release and repair and excisional arthroplasty with consideration given to hammertoe repair.
The crossover second toe deformity occurs when the lateral collateral ligament and joint capsule of the second metatarsophalangeal joint deteriorate. The second toe initially deviates in a medial direction but with time deviates dorsally and crosses up and over the great toe. A total of 17 patients (22 toes) were evaluated and 11 patients (15 toes) underwent surgical correction. A 90 degree satisfactory rate was noted at 42 months follow-up.
While the surgeon may tend to use one procedure in the repair of a hallux valgus deformity, versatility is most important when treating the juvenile bunion. Using a distal soft-tissue repair when subluxation is solely at the metatarsophalangeal joint is an acceptable approach. A metatarsal or cuneiform osteotomy is necessary if the intermetatarsal angle is abnormally large. It is important not to stretch the indications for a bunion technique in order to correct the hallux valgus deformity. If a more severe deformity is present, a more aggressive technique must be used to correct the abnormality. That varying success rates are reported with different techniques testifies to the fact that the juvenile bunion is not suited for a standard hallux valgus repair. The surgical technique used to repair a specific juvenile bunion depends upon the anatomic and physiologic abnormalities present in each patient.
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Arthrodesis of the first metatarsophalangeal joint was performed in eleven patients (sixteen feet) after a Keller procedure had failed. Multiple intramedullary threaded Steinmann pins were used to fix the bone at the site of the arthrodesis, and a successful arthrodesis was achieved in each patient. Interposition of a graft of bone from the iliac crest was done in four feet with an excessively short hallux. Lateral metatarsalgia that was due to intractable keratoses on the plantar part of the foot was relieved in eleven (92 per cent) of the twelve feet that had it preoperatively. Cock-up deformity of the hallux was also improved. Residual stiffness of the interphalangeal joints, which was a major preoperative problem, was not improved. Arthrodesis of the first metatarsophalangeal joint is a useful procedure to salvage a failed result of the Keller procedure.
Treatment of olecranon fractures by prolonged immobilization often results in limited elbow motion. With the use of a compression screw apparatus, anatomical reduction was obtainable, and only a short period of immobilization was needed. In a series of eleven fractures there were no non-unions and an average decrease in elbow range of motion of only 8 degrees.
In a two-year follow-up on sixteen total shoulder arthroplasties done with the semiconstrained Stanmore prosthesis, we found that patients with rheumatoid arthritis or osteoarthritis of the glenohumeral joint noted a greater relief of pain, were more satisfied with their surgery, used fewer analgesics, and had a greater increase in range of motion than patients with traumatic arthritis. Patients with irreparable rotator-cuff injury demonstrated the poorest range of motion postoperatively. Younger patients gained significantly more motion than older patients. All patients continued to have difficulty with lifting heavy loads. Complications consisted of one patient with a chronically dislocating prosthesis, one patient with a deep wound infection, and one with a postoperative wound dehiscence. The average follow-up was 31.4 months, ranging from twenty-four to fifty-three months.
Twenty patients with hallux rigidus were evaluated following cheilectomy. The surgical procedure involved resection of proliferative bone at the metatarsophalangeal joint to allow at least 45 degrees of passive dorsiflexion. The follow-up ranged from 7 months to 156 months. Postoperatively, there was minimal progression of the degenrative process. Subjectively, there was uniform patient satisfaction with the procedure.