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At least 613 records · Page 34Linked to original sources

Anatomic variations in the first ray: Part I. Anatomic aspects related to bunion surgery.

Dissection and roentgenographic findings in 35 nonoperative cadaveric and freshly amputated feet were correlated with disorders of the first day--specifically the sesamoids. There are four noteworthy factors associated with first ray pathology. The most significant are axial rotation of the first metatarsal bone and degenerative changes at the first metatarsophalangeal joint. Significant anatomic variations can be correlated with failed bunion surgery.

Adolescent↗

Long-term experience with total joint prosthetic replacement for the arthritic great toe.

A report on the use of 130 double-stemmed flexible hinge silicone elastomer implants as total joint replacements for the metatarsophalangeal (MTP) joint of the great toe in 98 patients since 1971. Of the total number of patients involved, 11 were men and 87 were women; the average age per joint was 57 years. The report is based on a minimum follow-up of 12 months, an average follow-up of 9.4 years, and a maximum follow-up of 16 years. Seven patients (10 joints) were lost to follow-up. In the 57 patients with osteoarthritis, 81 joints were replaced; in the 30 patients with rheumatoid arthritis, 37 joints were replaced. Five patients were revised from a failed excisional hemiarthroplasty, and four patients (with five joints involved) were revised from a failed silicone implant hemiarthroplasty. Two patients had a surgically arthrodesed MTP joint taken down and revised to a total joint arthroplasty. The results were graded excellent, good, fair, or poor based on relief of pain and cosmesis. The overall results were good. On the basis of these findings, the author concludes that there is a place for total joint prosthetic replacement with this device in the surgical reconstruction of the painful, destroyed MTP joint of the great toe.

Arthritis, Rheumatoid↗

Athletic injuries of the first metatarsophalangeal joint.

Turf-toe injuries can occur in many athletic endeavors. This article describes the different injuries that occur to the first metatarsophalangeal joint that may be termed "turf toe." These injuries may result in significant morbidity. Thus proper diagnosis is paramount for instituting appropriate treatment to facilitate an athlete's prompt return to the playing field. Two case studies are presented to illustrate injuries of the first metatarsophalangeal joint in the athletic population.

Adolescent↗

Natural course of joint destruction and fluctuation of serum C1q levels in patients with rheumatoid arthritis.

Using the number of joints with erosion in a total of 68 joints throughout the body, we studied a population of patients with rheumatoid arthritis whose disease duration was 10-15 years. Three groups, each showing a Poisson distribution, were found: the subset with least erosive disease (LES), the subset with more erosive disease (MES), and the subset with mutilating disease (MUD). The mean number of joints with erosion was 10.9 in LES, 32.2 in MES, and 53.5 in MUD. In LES, erosive articular changes were primarily limited to the peripheral smaller joints. In MES, the larger axial joints were also involved. Almost all joints were extensively damaged in MUD. During the early period of disease, differences between the 3 groups were highly significant in the rapidity of carpal bone destruction, as assessed by the yearly reduction of carpal height ratio (P less than 0.001), and in the serum C1q level (P less than 0.001).

Adult↗

Stress fractures of the sesamoid bones of the first metatarsophalangeal joint in athletes.

Over a period of 11 years 15 cases of stress fractures of the sesamoid bones of the first metatarsophalangeal (MTP) joint were treated in athletes. The mean age of the patients was 22.3 years, and there were 9 males and 6 females in the series. All patients were athletes, who began to suffer from the symptoms during training without any trauma. Eight fractures were located in the medial, six in the lateral sesamoid bone, and in one case both sesamoids were affected. The diagnosis was performed on the basis of the history, symptoms, clinical examination, and radiological, or isotope scanning findings. Ten of the patients were treated conservatively by prescribing an avoidance of excessive physical activity and better training shoes. In five cases surgical excision of the fragmented painful sesamoid bone was performed. There were no complications in the series and the athletes could start gradually training 6-8 weeks after the operation. The histology showed fibrotic non-union at the fracture site and supported the diagnosis of stress fracture. Three of the conservatively treated athletes had mild symptoms in intensive training, others had a good end result.

Adolescent↗

Total replacement of the metatarsophalangeal joint in the horse. A single pilot study.

In this paper the successful replacement of an equine metatarsophalangeal joint by a human total condylar knee prosthesis is reported. In the period of observation following implantation of the endoprosthesis the experimental animal showed almost no lameness when exercised at walk, bearing weight on the operated limb. Flexion and extension of the joint were markedly reduced. The clinical and histological observations clearly support further investigation into the equine metatarsophalangeal joint replacement by an endoprosthesis.

Animals↗

Keller's arthroplasty: is distraction useful? A prospective trial.

There are many operations for hallux valgus and hallux rigidus, but Keller's operation remains one of the most popular, particularly for the older patient. A prospective trial was carried out to compare the results of Keller's operation modified by Kirschner-wire distraction with those of the standard operation. The results suggest that there is no advantage in using temporary Kirschner-wire distraction; indeed, degenerative changes in the interphalangeal joint and a subjectively worse result may result from its use.

Adult↗

Resection arthroplasty of the rheumatoid forefoot.

After discussing the term of resection arthroplasty of the rheumatoid forefoot, the problem of indications and contraindications for surgery is dealt with. Experience obtained by operations is presented together with the recommended operative technique.

Arthritis, Rheumatoid↗

Stress fracture of the lateral metatarsals following double-stem silicone implant arthroplasty of the hallux metatarsophalangeal joint.

Stress fractures of the lateral metatarsal bones occur frequently and are most commonly seen following repetitive trauma. However, such fractures rarely occur after reconstructive operations involving the hallux metatarsophalangeal joint. The authors report four patients who developed a lateral metatarsal stress fracture during the first year following use of a double-stem silicone implant to reconstruct the hallux and, in addition in the case of one patient, the second metatarsophalangeal joint. An analysis of all these patients established the incidence of this complication to be 3%. The etiology of these fractures appears to be an overloading of the lateral metatarsals secondary to some shortening of the hallux metatarsal or in reestablishing motion to the hallux metatarsophalangeal joint. All fractures healed without complication and did not result in further forefoot symptoms or deformities. However, this complication should be suspected when lateral metatarsalgia develops following silicone implant arthroplasty because roentgenograms initially may be normal.

Adolescent↗