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Biomedical subjects

A K Walling

Publications and source records attributed to A K Walling.

17 recordsLinked to original sources
PubMed2000

Subtalar arthrodesis for complications of intra-articular calcaneal fractures.

Eighty six subtalar arthrodeses performed between 1985 and 1996 for complications associated with intra-articular calcaneal fractures were retrospectively evaluated. Patients were divided into three Groups: (I) 59 patients with calcaneal malunions (II) 13 patients with failed open reduction and internal fixation, and (III) eight patients undergoing open reductions and primary fusion for highly comminuted fractures. In each scenario, internal fixation was achieved with cancellous lag screws. Bone graft material consisted of either autogenous iliac crest graft, local graft obtained from the lateral wall exostectomy of the malunion, or freeze-dried cancellous allograft. Fusions in Groups II and III were performed in situ. Fusions in Group I were performed either in situ or utilizing a variety of reconstructive procedures depending upon the type of malunion encountered. Eighty three of the 86 fusion attempts were successful following the initial operations for a union rate of 96%. Fusion rates were similar regardless of the graft material used. Complications included four varus malunions, four cases of osteomyelitis, and two cases of reflex sympathetic dystrophy. A statistically significant shorter hospital stay was found for patients not undergoing iliac crest bone graft procedures. Eighty patients with at least two year follow up achieved a mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of 75.0. Scores were similar for all three groups and for the various types of reconstructive procedures used. No correlation was found between postoperative talar declination angle and the AOFAS ankle-hindfoot score. Worker's compensation patients tended to have a poorer clinical outcome.

Adult↗
PubMed1999

Subtalar repositional arthrodesis for adult acquired flatfoot.

Arthrodesis of the subtalar joint is well recognized treatment option for moderate or severe flatfoot associated with adult acquired flatfoot secondary to posterior tibial tendon dysfunction. The success of the subtalar arthrodesis is dependent on restoration of normal bony relationships in the hindfoot and midfoot. For this reason, a distinction is made between a repositional arthrodesis and the traditional in situ type of arthrodesis. An in vitro study of the adult acquired flatfoot identifies an anteroposterior subluxation of the subtalar articulation that can be corrected durably and reliably through a repositional talocalcaneal arthrodesis. Intraoperative reduction techniques are useful in obtaining reduction of the peritalar subluxation. There are certain clinical features that help identify patients with flatfoot deformities who are good candidates for subtalar fusion. As the pathoanatomy of the flatfoot deformity is better elucidated, treatment techniques are modified to better address the key elements of the deformity. A repositional subtalar arthrodesis was shown to produce excellent correction in a moderate to severe in vitro flatfoot example in the authors' clinical series.

Adult↗
PubMed1999

Triple arthrodesis.

Twenty-five adult patients with 32 fused hind-feet were evaluated at an average of 4.3 years after triple arthrodesis. All patients had Stage 3 or 4 deformity secondary to adult acquired flatfoot. All operations were performed using a standardized technique using rigid internal fixation. Postoperative American Orthopaedic Foot and Ankle Society hindfoot scores improved an average of 36 points. There was one nonunion and two residual varus malunions in patients who underwent additional procedures to obtain satisfactory position and fusion. All but one patient were satisfied with the result of their procedures and would have surgery again. With careful attention given to positioning, a triple arthrodesis is an acceptable treatment for late stage deformities in patients with adult acquired flatfoot.

Achilles Tendon↗
PubMed1995

Subungual exostosis: a simple technique of excision.

Subungual or Dupuytren's exostosis is a benign lesion of the distal phalanx that is prone to recurrence if incompletely excised. We report on a series of five patients treated with our simple excision technique. Despite sacrifice of a portion of the nail bed, the cosmetic appearance of the nail was excellent in four patients and good in one patient. There were no recurrences.

Adolescent↗
PubMed1994

Soft-tissue and bone tumors about the foot and ankle.

The development of primary and malignant tumors of the soft tissues and bones of the foot and ankle are uncommon. A potential for misdiagnosis and increased morbidity exists for those patients who do indeed have a malignancy. This article illustrates the proper steps in staging lesions and the appropriate techniques for biopsy. This will help physicians to avoid undertreating malignant lesions, and, conversely, overtreating benign lesions.

Ankle↗
PubMed1990

Fractures of the calcaneal apophysis.

Eleven patients with 12 open or closed fractures of the calcaneal apophysis were reviewed. The patterns of fracture varied, although all could be classified by a scheme similar to that used for physeal injuries in the long bones. Open injuries involved young children and were associated with subsequent maldevelopment of the posterior (nonarticular) portion of the calcaneus due to growth mechanism damage. The other susceptible age group, adolescence, had two patients with slipped calcaneal apophysis (type 1 injury), similar to slipped capital femoral epiphysis, and three patients with a splitting fracture through the apophysis and physis into the main part of the calcaneus (type 4 injury). Microscopic physeal injury was also observed in the calcaneus of a fatally injured boy.

Adolescent↗
PubMed1985

Infiltrating angiolipoma of the hand and wrist.

Three cases of angiolipomas involving the wrist and hand are reported that emphasize the pathologic differences between infiltrating and noninfiltrating types. Although not previously reported in the hand, infiltrating angiolipomas are biologically aggressive and usually invade local tissues. Proper treatment requires wide excision, but the proximity to important neurovascular structures limits adequate surgical margin in the hand. Compromising surgical resection to preserve function should be undertaken only with the understanding that recurrence is more likely.

Adult↗
PubMed1984

Abductor digiti minimi muscle flap after tumor resection in the hand.

Extensive resection of aggressive nonmalignant tumors in the hand not only produces large tissue defects but also leaves important vital structures unprotected. The following case of a 25-year-old woman illustrates the successful use of an abductor digiti minimi muscle flap to provide adequate protective coverage.

Adult↗
PubMed1982

Injuries to the knee ligaments with fractures of the femur.

Evaluation of twenty-four consecutive patients with fracture of the femoral shaft showed injuries of the ligaments of the ipsilateral knee in eight (33 per cent) of them. The history was always one of violent injury, but the examiner had to suspect that this combination of injuries had occurred simultaneously before a careful local physical examination elicited diagnostic signs. Then, pin stabilization of the distal part of the femur with stress radiographs of the knee yielded an early diagnosis. Late recognition of the combined injuries usually could be documented by radiographs of the femur and the knee in traction.

Adolescent↗
PubMedDate not supplied

Anatomy of the os trigonum.

Three anatomic specimens of os trigonum from skeletally immature patients demonstrated anatomic continuity of the cartilage containing the ossicle with the body of the talus, with a synchondrosis being present between the two ossifying regions. The os trigonum may be considered a developmental analogue of a secondary ossification center similar to the posterior calcaneal apophysis (although there are obvious histologic differences). The chondro-osseous border of the synchondrosis may be injured either as a chronic stress fracture or, less frequently, as an acute fracture, comparable to the injury patterns involving the accessory navicular.

Adolescent↗
PubMedDate not supplied

Subungual (Dupuytren's) exostosis.

Dupuytren's subungual exostosis is an uncommon osteochondral lesion affecting the distal phalanx of adolescents. Lack of awareness of this unusual lesion causes many to be initially misdiagnosed. Accurate diagnosis based on clinical findings and radiographs and appropriate treatment methods are outlined. We report retrospectively on the cases of six children treated for subungual exostosis over a 3-year period. Diagnosis was made based on clinical findings of a painful subungual or periungual mass associated with an exostosis on radiographs. Complete excision of the lesion, including the overlying nailbed, was curative in the five patients who opted for surgical treatment. Two of our patients had been previously treated with an incomplete excision and had a recurrence within 3 months of the original procedure. Failure to recognize and treat this condition appropriately may lead to morbidity due to overtreatment or recurrence. We hope this report will improve awareness of subungual exostosis and the appropriate operative treatment method.

Adolescent↗
PubMedDate not supplied

Ki-1+ large-cell anaplastic lymphoma after Ewing sarcoma.

PURPOSE: A large cell anaplastic lymphoma that developed after treatment of a Ewing sarcoma (ES) is described. PATIENT: An 11-year-old girl with a pelvic ES developed a large cell, Ki-1+, anaplastic lymphoma in the same anatomic location 10 months after multimodal therapy. RESULTS: ES recurred in the primary site 16 months after allogeneic marrow transplantation and 3.5 years after initial diagnosis, but the patient remains in remission from her lymphoma. CONCLUSION: The occurrence of lymphoma and ES in a short time interval in the same patient is very unusual. Whether etiologic factors other than chemoradiotherapy, including genetic disposition, play a role remains to be elucidated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Soft tissue sarcoma with complex membranous and microtubular inclusions.

Cytoplasmic inclusions of great complexity are encountered in an undifferentiated sarcoma of a 67-year-old woman. The tumor arising in adipose tissue between muscles of the parspinous musculature contains inclusions in most tumor cells represented by four different morphologic types. Two are intracisternal, designated microtubular reticular structure (TRS) and tubular confronting cisternae (TCC). Two others are cytoplasmic and consist of crystalline microtubular arrays and of confronting cisternal complexes of smooth endoplasmic reticulum (SER). This latter is uniquely complex and not found in previous descriptions. Tumors of mesenchymal origin and experimental virus-induced tumors are known to contain short segments of confronting cisternae and TRS. Tubuloreticular structures and TCC are well documented in cases of lupus, in human immunodeficiency virus infections, in T-cell leukemia, and in experimental viral hepatitis in chimpanzees. The patient presented has none of the coincidental pathologic condition associated with occurrence of TRS and TCC. The morphology of the inclusions and their relationships are illustrated although their biological significance remains obscure.

Adipose Tissue↗