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At least 757 records · Page 42Linked to original sources
PubMed2000

Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus.

The charts and radiographs of 99 patients with 106 intraarticular fractures of the calcaneus were retrospectively reviewed. There were 75 men and 24 women. The average age was forty-two (range, 17 to 81). Fifty-seven of the fractures were left and 49 were right. The mechanism of injury was a fall from a height in 69 patients and motor vehicle accident in 30 patients. According to Sanders classification, seventy-one cases (67%) had type II fractures, 25 cases (23.6%) had type III, and ten cases (9.4%) had type IV. All the patients had operative management through a limited sinus tarsi approach with minimal fixation of the fracture with one or several pins. One of the pins was usually applied from the talus to the calcaneus through the fracture after reduction of the posterior facet. Nine cases (8.5%) developed postoperative infection, four cases (3.8%) had superficial wound infection, four cases (3.8%) had pin tract infection and one case (0.9%) had osteomylitis. Our follow-up at an average of 29 months (range, 12 to 84 months) showed that the American Orthopedic Foot and Ankle Society, Ankle-Hindfoot Score for the all group was 77.6 (range, 31-91). Forty-one fractures (38.8%) were graded excellent, 39 fractures (36.7%) good, 14 fractures (13.2%) fair, and 12 fractures (11.3%) were failures. Although radiological degenerative changes in the subtalar joint were seen in 41 cases (38.7%), only six cases (5.6%) required subsequent subtalar fusion. The authors conclude that the operative method used in the current study which followed the principle of minimal soft tissue damage and minimal internal fixation may be a good option for management of calcaneus fractures.

Adolescent↗
PubMed1998

Oral analogue scale as an outcome measure after displaced intra-articular calcaneal fractures.

Functional outcome measures of displaced intra-articular calcaneal fractures have been documented using general health surveys (SF36) and disease-specific health surveys (Visual Analogue Scale). A simple oral analogue scale (OAS) was collected on 115 patients with 124 displaced intra-articular calcaneal fractures at 2 years or more after fractures. There was a high correlation (r = 0.72, P < 0.0001) between the verbal OAS and the written Visual Analogue Scale. We believe that the OAS may assist in follow-up outcome assessment and management in this difficult trauma patient population. Outcomes may be accomplished verbally rather than in written form.

Calcaneus↗
PubMed1999

Clinical significance of increased mobility in the sagittal plane in patients with hallux valgus.

Hallux valgus (HV) deformity is not always accompanied by pain. We compared roentgenograms of 32 feet of people with HV deformity and pain to roentgenograms of 22 feet of people with painless HV deformity. Twenty-three feet without HV deformity or pain were used as controls. Weightbearing and nonweightbearing roentgenograms of the lateral talar-first metatarsal angle showed a statistically significant difference between feet with deformity and pain compared with feet with painless HV, or compared with normal feet. Changes in the angles of HV between weightbearing and nonweight-bearing situations showed significant differences between HV feet and normal feet, whether or not they had pain. In HV patients, increased mobility in the sagittal plane may play a considerable role in the development of pain.

Female↗
PubMed2000

Effect of physical therapy on limited joint mobility in the diabetic foot. A pilot study.

Eleven patients with limited joint mobility and neuropathy were enrolled in a physical therapy program of passive joint mobilization at a rate of two sessions per week. Treatment resulted in a significant improvement in joint mobility after 10 sessions. Further improvement after 20 sessions did not reach the level of statistical significance, although near-normal joint mobility was attained. After completion of therapy, there was a progressive deterioration in joint mobility. No serious adverse effects were noted during treatment. This study provides some evidence that use of physical therapy may result in significant, although temporary, improvement in the mobility of the ankle and foot joints in diabetic patients with limited joint mobility and neuropathy. As limited joint mobility has been associated with the development of abnormally high pressures under the feet, which in turn may contribute to plantar ulceration in the susceptible neuropathic foot, the results indicate that physical therapy may be useful in the prevention of plantar ulceration in diabetic patients with limited joint mobility and neuropathy, although this must be verified by additional research.

Adult↗
PubMed2002

Evaluation and treatment of stage 0 Charcot's neuroarthropathy of the foot and ankle.

Charcot's neuroarthropathy is a relatively common disease in patients with diabetic neuropathy. If unrecognized or left untreated, Charcot's neuroarthropathy can result in a severely misshapen and unstable foot and ankle. Ulceration, soft-tissue infection, and osteomyelitis frequently ensue, and partial or complete amputation of the foot is not uncommon. A high index of suspicion and proper interpretation of clinical and diagnostic findings are essential to establish a timely and accurate diagnosis and to institute appropriate treatment. The pathogenesis of neuroarthropathy is reviewed and diagnosis and treatment of the stage 0 diabetic Charcot foot are presented.

Ankle Joint↗
PubMed2001

Articular cartilage. Anatomy, injury, and repair.

Articular cartilage plays a vital role in joint morphology. An understanding of articular cartilage anatomy and physiology will enable the physician to more fully appreciate its function and necessity. Articular cartilage is made up of four basic biological layers or zones. Each zone possesses attributes necessary to make articular cartilage as a whole strong, durable, and more able to withstand shear and axial forces through a joint. Cartilage metabolism is relatively slow in comparison with other tissues; hence, it is much more difficult for defects in cartilage to heal spontaneously. There are many ways in which articular cartilage can incur damage. Mechanical injury, be it acute or insidious, causes cartilage to fissure and fracture. This results in painful and inflamed joints along with disruption of the cartilage. Metabolic diseases also can produce joint destruction, inflammation, and pain. The resultant defects fail to heal spontaneously because of slow metabolism of cartilage. These chondral defects eventually may penetrate subchondral bone. Disruption of the layers of cartilage eventually will cause collapse and loss of integrity of the entire joint apparatus as a whole. More than 250 years ago, Hunter stated, "Ulcerated cartilage is a troublesome thing--once [it is] destroyed it is not repaired." Articular cartilage defects are very difficult to repair effectively. Cartilage defects can heal spontaneously, if the defect extends to subchondral bone. The reparative substance, fibrocartilage, is less durable and much less smooth. There are many techniques and procedures in which chondral or osteochondral defects can be filled. Promoting subchondral bleeding is the method most commonly used clinically. This allows pleuripotent cells to fill the defect with eventual fibrocartilage. Implants are gaining favor as a method of inducing a more pure, hyaline-like cartilage into cartilage defects. Gene therapy and tissue engineering are at the forefront of cartilage research today. Cartilage injury and repair remains today a very difficult topic of study. Understanding the anatomy of articular cartilage, the pathomechanics of injury, and methods available for cartilage repair, will help the physician more adequately approach treatment options.

Animals↗
PubMedDate not supplied

Results of the surgical treatment of Lisfranc fracture-dislocations.

The authors present a series of 25 patients with Lisfranc fracture-dislocation who were treated by reduction (open or closed) and stabilization with Kirschner wiring. Minimum follow-up was two years. The dislocations were divided based on the Quenu and Kuss classification system. Nonsurgical reduction was possible in 17 patients. Neither the type of dislocation nor the type of reduction influenced the results in progression in our series. Nonetheless, long-term functional results were better when the quality of the reduction was excellent.

Adolescent↗
PubMed1976

Dysplasia epiphysealis hemimelica. A case report.

Experience with a 9-year-old girl with Dysplasia Epiphysealis Hemimelica in the right lower extremity demonstrates that avoidance of confusion leading to medical--legal problems and promotion of effective management would have been possible by early recognition of the condition.

Ankle Joint↗
PubMed1985

Genetic aspects of the spondyloarthropathies.

Family studies and investigation of the HLA associations have in recent years added to our understanding of the spondyloarthropathies. In regard to ankylosing spondylitis it is likely that B27 itself is the major susceptibility gene but that additional genes may play a secondary role. Heterogeneity of the B27 antigen has been demonstrated but has not yet been shown to be relevant to disease susceptibility. Haplotypes including Cw6 are related to susceptibility to psoriasis and psoriatic arthritis and although the risk for the arthropathy is increased in B27-positive individuals, there is some uncertainty regarding the association with other B locus antigens and further work is needed. There is also uncertainty as to whether B27-associated disorders occur randomly within families, or whether particular disorders cluster in certain families and further evidence in this field would be of considerable interest. Genetic studies, as here outlined, have not as yet had a major impact in clinical medicine but it is anticipated that a deeper understanding of the mechanisms of HLA-linked susceptibility genes and in particular of how they interact with environmental agents, will improve our ability to treat and possibly prevent the relevant diseases.

Adult↗
PubMed1989

Posterior subtalar joint arthrography. A useful tool in the diagnosis of hindfoot disorders.

Obscure hindfoot disorders are often classified under the heading of sinus tarsi syndrome (STS). The diagnosis of STS is based upon subjective symptoms: tenderness over the lateral aperture of the sinus tarsi and hindfoot instability. Arthrography of the posterior subtalar joint is an objective parameter, identifying peri- or intraarticular pathology as the cause of symptoms. In 27 patients with STS, the pathologic arthrographic findings include less-marked microrecesses in the sinus tarsi region, ganglions at the anterior aspect of the subtalar joint, retraction of the joint recesses, a smooth and rounded appearance of the capsule, and a frozen subtalar joint. Through analysis of these films, the appropriate therapeutic approach can be outlined; infiltrations into the sinus tarsi itself, intraarticular corticosteroid injections, or subtalar arthrodesis for resistant cases are the procedures of choice. In the authors' experience, surgical curettage of the sinus tarsi has no place in the treatment of STS.

Adolescent↗
PubMedDate not supplied

Skeletal and tendon lesions of male broiler-breeders reared on elevated slats.

Eighty 25-week-old male broiler-breeder chickens were placed in pens with elevated slats for 16 weeks. A similar group of birds was housed on floor pens for comparison. The coxofemoral, stifle, and tibiotarsal joints and their supporting tendons and ligaments were examined grossly. Rearing heavy broiler-breeders on elevated slats did not result in grossly apparent arthritis, tendonitis, or tendon failure. Body weights and shank lengths and diameters were not markedly different. Microscopically, the broiler-breeders reared on slats had a lymphocytic synovitis with synovial cell hyperplasia involving the gastrocnemius and digital flexor tendons. The incidence and severity of the lesion increased with time.

Animals↗
PubMed1983

Lisfranc's fracture-dislocations: etiology, radiology, and results of treatment. A review of 20 cases.

Tarsometatarsal fracture-dislocation is an uncommon but severe lesion. Since this diagnosis is over-looked in about 20% of cases, accurate radiographic examination is imperative. In the presence of suggestive clinical signs and negative standard roentgenograms, stress-films in eversion-pronation and inversion-supination are obtained under general anaesthesia. A review of 20 cases shows that plaster cast immobilization without reduction is unsatisfactory, often resulting in Südeck's atrophy and subsequent painful degenerative arthritis. Secondary fusion may be necessary to relieve symptoms. The treatment of choice is anatomic reduction and transfixation with Kirschner wires. The major complication is arterial damage with necrosis of the forefoot. Amputation may be necessary.

Adolescent↗