Arthroplasties using compressed ivalon sponge ("intra-medic sponge") long-term follow-up studies in 109 cases.
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Joint implants in the foot have contributed much to reducing deformity and pain. They can act as spacers to improve cosmetic appearance; they can increase or decrease motion in joints, while adding stability; and they can replace arthritic or diseased joints and reduce their associated symptoms. They cannot produce normal function of the foot. There is a great need to know more about the long-range effects of implanted joints on foot function and the associated compensations that invariably occur. This knowledge will lead to improved criteria for the existing implants and new designs and materials for the implants yet to come.
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Synostosing ankylosis of lower limb joints was investigated radiologically and clinically in approximately 2000 patients with ankylosing spondylitis. Ankylosis was found in 8 hip joints and in 4 of the joints of the foot skeleton. Most commonly the initial picture of these diseases is that of an arthritis (sometimes specifically misinterpreted as such) years and decades before the manifestation of ankylosing spondylitis appears. The ossifying potential of the disease can apparently manifest itself early in limited areas. The radiological morphology with destruction and reconstruction is found mainly as the well known vertebral changes. Immobilization can at the most be regarded as a favourable factor in a predominantly immunological-inflammatory patho-mechanism. Additional local abnormalities of the vascular or enzymatic systems of the joints can be assumed.
Thumb reconstruction is a complex subject and the method selected for each patient deserves individual consideration. The method of free toe-to-hand transfer for thumb replacement should be chosen only when the surgeon is familiar with all alternative methods of thumb reconstruction and feels that this technique represents the most reasonable method available. For the surgeon a clear understanding of the anatomic similarities and differences between the normal thumb and great toe are mandatory. In well selected adults and children the failure rate for free toe-to-hand transfer should be very small. The advantages of a single staged thumb replacement from tissue of similar character and quality without local tissue sacrifice are tremendous. With improvement in techniques, experience and case selectiion, much free tissue transfers will actively compete with well established methods of thumb reconstruction. Surely the free toe-to-hand transfer for thumb replacement of today is a forerunner of thumb and hand transplantation of tomorrow.
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The authors introduce a new method of correction for overlapping fifth digits. With the advent of newer types of precision power surgical instrumentation, performance of an exacting wedge osteotomy is possible on small bones. Combining an abductory wedge osteotomy with previously described soft tissue revisions can now realign a common deformity--the overlapping fifth toe.