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Ultrastructure of collapsed metatarsophalangeal silicone elastomer implant.

The use of silicone elastomer implants in podiatric surgical practice is presently a well accepted treatment modality. However, there are instances of failure, and the present study describes a total collapse and fragmentation of a metatarsophalangeal joint prosthesis. Defects are demonstrated by scanning electron microscopy, while physical and chemical reasons for the occurrence as stated in the current literature are reviewed.

Biomechanical Phenomena↗

An alternative fixation technique when performing hallux interphalangeal joint fusions.

Fusion of the hallux interphalangeal joint has classically been performed by means of cancellous bone screws or crossed Kirschner wires. Although these techniques may be suitable for uncomplicated fusions, they may not be amenable to those cases requiring simultaneous total first metatarsophalangeal joint implant arthroplasty; therefore, a new technique is discussed that utilizes the Micks' external fixator.

Arthrodesis↗

[The surgical management of the forefoot in rheumatoid arthritis. A review of 150 cases (author's transl)].

The authors have performed 150 surgical procedures in 95 patients. In most of the cases, the procedure was a resection - realignment of the metatarsal heads. The results were assessed in 80 patients and were found to be satisfactory as regards pain and functional ability. Good results persisted as regards pain which remained absent in 90% of cases but the functional results tended to worsen with time. Good results being present in only 70% after a 10 year follow up. In 34 cases a prosthetic implant (Swanson type) was used. The results were deceptive.

Adolescent↗

Osteoarthritis in some developing countries.

Only a few studies on osteoarthritis (OA) have been performed in developing countries. They all concern African populations. OA occurs less frequently in developing populations. Whether this is due to genetic or environmental factors or to selective forces like an excessive mortality at younger ages, is difficult to decide. Development of criteria for clinical degenerative joint disease is recommended. Furthermore studies are proposed on the geographical distribution of specific joint OA, the concept of generalized OA, the pattern of joint involvement, the natural history of degenerative joint disease, and the role of occupation, sports, and environmental factors.

Adult↗

Pseudorheumatoid nodules in an adult.

The finding of soft tissue lesions that present as rheumatoid nodules in a patient with no history or symptoms of rheumatoid arthritis or rheumatic fever sets the stage for a variety of differential diagnoses. One of the diagnoses that must be considered is the pseudorheumatoid nodule, which is rarely found in the adult. This article deals with one such case. A review of the literature is discussed along with a description of the remaining diagnoses from which it is distinguished. In this particular case, the patient presented lesions typifying those of rheumatoid nodules with the absence of any constitutional symptoms. Follow-up to date shows no signs of rheumatoid arthritis, although the literature does suggest the possibility that these lesions may be the precursor of the disease.

Adult↗

Pigmented villonodular tenosynovitis: a case report.

A case of pigmented villonodular tenosynovitis is described. The characteristics and clinical course are discussed and compared as to natural history, histopathology, pathophysiology, etiology, differential diagnosis, and treatment. The etiological factors of this entity are generally uncertain; however, this case may well be associated with a specific incident of trauma, eg., a puncture wound sustained from stepping on a nail.

Adolescent↗

Complications with the use of bioabsorbable pins in the foot.

The authors present a brief history and overview of the usage of bioabsorbable pins in Podiatric Surgery. A retrospective study of 49 patients who had been implanted with Biofix pins is presented. The number of patients who displayed reactions to the pin sufficient to require subsequent surgical intervention was found to be 10.2%. Three specific cases are presented in detail. All of the patients who displayed reactions were over 40 years of age and the majority were between 55 and 60 years of age. A discussion of these facts is presented with the authors' views on why bioabsorbable pin reactions may be expected to occur in older age groups.

Adult↗

Criteria for generalized and focal osteoarthritis.

STUDY OBJECTIVE: to identify homogeneous, distinct subgroups of osteoarthritis patients based on distribution of osteoarthritis lesions. PATIENTS-METHODS STUDY DESIGN: cross-sectional, prospective, multicenter. Patients with osteoarthritis of the hip, knee, fingers, or spine. DATA COLLECTED: clinical and radiologic features at 41 joint sites. METHODS: multivariate statistical analysis including a) k-mean clustering analysis followed by ascending hierarchical classification b) and a tree-structured discriminant method to confirm and to characterize the subgroups obtained using the clustering method. RESULTS: The 1021 patients were first classified into five categories with an error rate (obtained by cross-validation) of 7.6%. The tree obtained by segmentation took into account manifestations of osteoarthritis at the hands, knees and spine. Irrespective of the reason for seeking medical advice, patients with bilateral involvement of the fingers or with involvement of the spine and both femorotibial joints were classified as having generalized osteoarthritis; in contrast, focal osteoarthritis was defined as the absence of involvement of the fingers and of either the spine or the knees. CONCLUSION: The statistical analysis provided a classification system that would be easy to use in everyday clinical practice. Prospective studies are needed to evaluate the potential clinical relevance of this system.

Cluster Analysis↗

Delayed diagnosis of tuberculosis presenting as small joint arthritis--a case report.

Small joint arthritis is an uncommon manifestation of tuberculosis. We report a case of tuberculosis presenting as arthritis of the midtarsal joints with concomitant spinal involvement. This case illustrates the difficulties in diagnosing tuberculous arthritis as it has an insidious onset, paucity of constitutional symptoms, unremarkable early physical findings and frequent absence of associated pulmonary involvement. A high index of suspicion in high-risk individuals with chronic monoarthritis, is required to avoid delayed diagnosis.

Adult↗

Hallux tenotomy-capsulotomy.

The deformity of the hallux that is described in this article is most probably more common than we realize and is often seen in patients with mycotic nails and subungual exostosis. This pathology is easily corrected with a tenotomy-capsulotomy at the level of the distal interphalangeal joint. This procedure, when accomplished as described, does not affect the function of the hallux at the level of the metatarsophalangeal joint.

Foot Deformities↗

Composite metacarpophalangeal joint reconstruction in great toe-to-hand free tissue transfers.

he recommended technique of skeletal fixation of great toe-to-hand free tissue transfers for thumb reconstruction is related to the length of the first ray present. When the entire first metacarpal is intact, fusion of the disarticulated great toe proximal phalanx to the metacarpal head has been described. Another possibility in this selected situation with cartilage present on the metacarpal head is to reconstruct a new metacarpophalangeal (MP) joint from a cuff of collateral ligaments and plantar plate on the proximal phalanx, anchored to the metacarpal head. In a series of 45 great toe-to-thumb transfers, eight were done with a composite MP joint reconstruction technique. A description of this technique and clinical results are presented. Based on the results in these patients, this technique should be considered as an alternative to joint fusion when the entire first metacarpal is intact.

Adult↗