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Biomedical subjects

Thomas S Roukis

Publications and source records attributed to Thomas S Roukis.

At least 19 recordsLinked to original sources
PubMed2006

The management of acute Charcot fracture-dislocations with the Taylor's spatial external fixation system.

The surgical repair of acute diabetic neuropathic osteoarthropathy of the midfoot remains a challenge with little guidance available in the medical literature. The authors present a review of the diabetic Charcot neuropathic osteoarthropathy process and proposed surgical intervention techniques with a special emphasis on the available data regarding the use of external fixation. A detailed, step-by-step, guide through the foot-specific Taylor spatial external fixation system is provided. Finally, the authors' preferred technique for these difficult limb salvage cases is presented in detail.

Acute Disease↗
PubMed2006

The use of Ilizarov technique and other types of external fixation for the treatment of intra-articular calcaneal fractures.

Treatment of severely comminuted calcaneal fractures with soft tissue compromise is still a controversial issue among surgeons. Complications of open reduction internal fixation have been well reported in the literature with a fairly high incidence of posttraumatic osteoarthritis of the subtalar joint, symptomatic hindfoot stiffness (especially when fixed in varus), wound dehiscence, and potential for the development of osteomyelitis caused by the extensive soft tissue trauma inherent with these injuries. For these reasons, closed treatment techniques using minimally invasive reduction procedures with application of ring-type fine-wire external fixation have recently gained popularity.

Calcaneus↗
PubMed2006

Lisfranc fracture-dislocations: current treatment and new surgical approaches.

Anatomic reduction and restoration of the acute or chronic fracture-dislocation of the tarso-metatarsal joint is essential and needs to be addressed early in the patient's treatment with internal or external fixation. Long-term results following this injury can be associated with chronic instability, posttraumatic arthrosis, and poor functional outcomes. In this article, the authors review the current treatments of internal fixation and introduce new surgical techniques for addressing the acute or chronic tarso-metatarsal injuries with the application of circular multiplane external fixation devices.

Arthrodesis↗
PubMed2006

Alternatives to ankle implant arthroplasty for posttraumatic ankle arthrosis.

Various surgical options beyond implant arthroplasty are available to treat posttraumatic ankle arthrosis. Conservative options are usually employed in combination and include the use of nonsteroidal anti-inflammatories, bracing, and orthoses, as well as injections of intra-articular corticosteroid and hyaluronic acid. If these conservative treatments fail, surgical intervention can be entertained. Alternatives to total ankle implant arthroplasty include (1) arthroscopic debridement, (2) arthrodiastasis, (3) peri-articular resurfacing using allograft or cartilage transplantation, and (4) peri-articular osteotomies to correct angular, rotational, or translational malalignment. However, ankle arthrodesis is the standard technique for end-stage ankle arthrosis. This article reviews the literature and presents an in-depth surgical technique for each procedure. The article also describes how to prevent and address the most common complications.

Ankle Injuries↗
PubMed2005

Central metatarsal head-neck osteotomies: indications and operative techniques.

The author presents the history and indications of various central metatarsal head-neck osteotomies with special emphasis on the radiographic assessment, vascular supply, and regional anatomy. The surgical techniques described include (1) minimal incision osteotomy; (2) Weil metatarsal osteotomy and various modifications; and (3) a novel "telescoping" osteotomy. Ancillary soft-tissue and osseous digital procedures as well as the prevention and management of potential complications are presented in detail.

Combined Modality Therapy↗
PubMed2005

The tailor's bunionette deformity: a field guide to surgical correction.

The author presents a detailed review of the Tailor's bunionette deformity of the fifth metatarsal with special emphasis on radiographic analysis and surgical correction. The surgical techniques discussed include (1) partial metatarsal head ostectomy; (2) metatarsal head resection; (3) minimal incision osteotomy; (4) osteotomies about the metatarsal head-neck, shaft, and base; and (5) ancillary soft tissue procedures. Techniques employed to prevent and correct potential complications are discussed in detail for each osteotomy.

Foot Deformities↗
PubMed2005

Modifications of the great toe fibular flap for diabetic forefoot and toe reconstruction.

Diabetic forefoot and toe wounds are difficult to heal in a timely fashion. Despite proper continued offloading and protective shoe-gear techniques, these wounds are frequently complicated by recurrent breakdown and adjacent toe deformities. When properly performed, pedicle flaps from the fibular border of the great toe represent viable and cost-effective means of providing early and durable soft tissue coverage and osseous reconstruction of diabetic forefoot and lesser toe wounds. Two modifications of the traditional great toe fibular flap are described: the great toe fibular adipofascio-cutaneous flap and the great toe fibular osteo-cutaneous flap, useful for providing forefoot and toe reconstruction, respectively. Understanding the surgical aspects of the treatment provides insights into overall care for these challenging wounds. Long-term outcomes studies involving these toe reconstruction techniques are needed to fully evaluate their success in preventing recurrent toe deformity and forefoot ulceration.

Cost-Benefit Analysis↗
PubMed2004

Corrective ankle osteotomies.

Corrective ankle osteotomies are periarticular osteotomies of the fibula, distal tibial metaphysis, or distal tibial metaphyseal diaphyseal junction. These osteotomies are indicated when angular, rotational, or translational malalignment is present. The author presents a review of the literature and in-depth surgical technique for each procedure, as well as a review of how to prevent and address the most common complications encountered.

Ankle Injuries↗
PubMedDate not supplied

A systematic approach to diabetic foot infections.

Foot infection is the most common reason for hospitalization and subsequent lower extremity amputation among persons with diabetes. Foot ulceration caused by diabetic neuropathy, trauma, and peripheral vascular disease can lead to a limbor life-threatening infection. The optimum treatment of these potentially devastating conditions depends on a multidisciplinary approach that addresses the related or underlying disorders and thus ensures proper wound healing and a positive outcome. In addition to antibiotic therapy, severe soft-tissue or bone infections may necessitate surgical treatment, including drainage, débridement, and vascular reconstruction. Initial (empiric) antibiotic therapy should provide coverage against staphylococci and streptococci and should be revised according culture results. Antibiotic therapy is not indicated in clinically noninfected wounds. The duration of antibiotic treatment can range from 1 week for mild infections to 6 weeks or more for residual osteomyelitis and severe deep tissue infections. Aggressive (and sometimes repeated or staged) surgical intervention and appropriate antibiotic therapy can reduce the likelihood of a major amputation and the duration of hospitalization.

Anti-Bacterial Agents↗
PubMedDate not supplied

Autologous platelet-rich plasma for wound and osseous healing: a review of the literature and commercially available products.

The application of autologous platelets that have been sequestered, concentrated, and mixed with thrombin to create growth factor-concentrated, autologous platelet-rich plasma for application to soft tissue wounds and for osseous healing has been a subject of great interest for much of the past 2 decades. Autologous platelet-rich plasma, which consists of both quantitative and qualitative components, has the greatest potency or ability to produce the desired effect. Manufacturers prepare autologous platelet-rich plasma with the ultimate goal of maximizing its benefits while minimizing potential risks. Unfortunately, the manufacturing processes for autologous platelet-rich plasma are highly variable, and the types of proprietary systems available on the market for soft tissue and osseous applications are numerous. The authors provide here an in-depth review of commercially available systems for delivery of autologous platelet-rich plasma that emphasizes the subtle yet important differences among systems. In addition, a detailed review of the literature regarding the use of autologous platelet-rich plasma in soft tissue and osseous healing is provided. Although findings are not yet conclusive, autologous platelet-rich plasma has been shown to be safe, reproducible, and effective in mimicking the natural processes of soft tissue wound and osseous healing.

Blood Platelets↗
PubMedDate not supplied

A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus.

Forty-four patients (47 feet) underwent surgical intervention for symptomatic hallux rigidus between February 1998 and April 1999. Each foot was initially graded according to a four-stage hybrid hallux rigidus radiographic grading system. A subjective evaluation based on a modified American Orthopaedic Foot and Ankle Surgery clinical rating system was performed. An objective physical examination was performed. Angular and linear measurements were obtained from standard weightbearing radiographs. The extent of articular derangement for the first metatarsal head, base of the proximal phalanx, and tibial and fibular sesamoids were graded according to the American Orthopaedic Foot and Ankle Society intraoperative grading system. Finally, a means of quantifying the percentage of first metatarsal head articular derangement was performed. Significant differences were identified between joints radiographically classified as grade II, which had lower nonweightbearing, relaxed hanging position (p = .041); nonweightbearing assisted dorsiflexion (p = .000); actual nonweightbearing dorsal range of motion (p = .002); and actual plantar range of motion (p = .009) than those classified as grade I. The angle of deviation of the second metatarsophalangeal joint revealed a significant increase in degree of medial angulation as the grade increased (p = .000). None of the remaining radiographic measurements were significant. A correlation between the hybrid radiographic grading system and percentage of actual intraoperative articular derangement was shown to exist.

Adolescent↗
PubMedDate not supplied

A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis.

Forty-seven patients (50 feet) underwent surgical intervention for symptomatic hallux rigidus between February 1998 and April 1999. Thirty-eight patients (41 feet) returned at 1 year for follow-up evaluation. Each foot was graded according to a four-stage hybrid radiographic grading system. At 1-year follow-up, 10 patients were classified as grade I, 17 as grade II, 12 as grade III, and 2 as grade IV. Subjective evaluation was based on a modified American Orthopaedic Foot and Ankle Surgery hallux metatarsophalangeal-interphalangeal 100-point scale. A pre- and postoperative objective physical examination and radiographic analysis were performed. Statistically significant differences between preoperative and postoperative values were found to exist for each portion of the subjective evaluation (p = .000); nonweightbearing dorsiflexion (p = .001); simulated weightbearing dorsiflexion (p = .003); metatarsal protrusion distance and angle of deviation of the second metatarsophalangeal joint (p = .000); and talar-first metatarsal angle (p = .015). For this specific patient population, the short-term results of surgical intervention for hallux rigidus provided subjective patient improvement and satisfaction, as well as a statistically significant but functionally minimal increase in first metatarsophalangeal joint dorsal range of motion. Additionally, in the 19 patients who underwent a periarticular decompression osteotomy, the intended correlation of plantar transposition of the capital fragment and offsetting the longitudinal shortening of the first metatarsal did not exist.

Adolescent↗
PubMedDate not supplied

Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and a comparison of results to fasciotomy.

A review of the history, mechanism of action, and application of extracorporeal shock wave therapy for chronic plantar fasciitis is presented. The results of 40 feet treated with this modality are reviewed after a mean follow-up time of 8.4 months. All procedures were performed under intravenous sedation and local infiltrative anesthesia. An electrohydraulic shock wave with a mean of 20.6 kV combined with a mean of 2,506 pulses was used. The results of a similar demographic class of patients having undergone a percutaneous plantar fasciotomy at our institution were compared to the results of this cohort of shock wave patients. Eighty-two percent of the patients treated with extracorporeal shock wave therapy were successfully treated as compared to 83% with a percutaneous plantar fasciotomy. The mean score on the 11-point visual analog scale for satisfied patients was 7.9 preoperatively and 2.95 within 7 days postoperatively. After 3 months, the mean visual analog score was 4.2 or 50% of the preoperative value after a mean of 8.4 months following treatment. Eighty-three percent of the patients treated stated that shock wave therapy improved their symptoms. There were no complications encountered in any patient in this study. Extracorporeal shock wave therapy is an effective treatment, which significantly reduces the symptoms associated with chronic plantar fasciitis and compares favorably to the results achieved with surgical intervention in the form of a percutaneous plantar fasciotomy.

Adult↗