Biomedical subjects
Publications and source records attributed to A Manoli.
Three photographs are presented that illustrate the rationale for the use of the long posterior flap in below-knee amputations for peripheral vascular disease and diabetes mellitus.
A case demonstrating a mechanical cause of posterior tibial tendon degeneration is reported. The possible etiologies for degeneration of the posterior tibial tendon are discussed.
The treatment of Johnson stage 2 posterior tibial tendon insufficiency remains controversial. Because the deformities remain flexible in stage 2, bony osteotomies are preferable over fusion operations. It is our contention that operative intervention should address all of the components of the pes planovalgus deformity that exists in stage 2 disease. Seventeen patients with 20 cases of stage 2 posterior tibial tendon insufficiency were treated with heel cord lengthening, flexor digitorum longus to medial cuneiform tendon transfer, lateral column lengthening, and medial displacement calcaneal osteotomy. Preoperative, postoperative, and final radiographs while standing were analyzed to determine radiographic correction of the deformities. In addition, the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale was applied to all patients before surgery and at 6-month intervals after surgery. Currently, the average follow-up is 17.5 months. The average foot rating score preoperatively was 51.4 and has improved to 82.8. Radiograph measurements have demonstrated statistically significant correction of the pes planovalgus deformity, as well as maintenance of the correction to date. It is our conclusion that this combination of surgical procedures provides correction of the symptomatology and deformity associated with stage 2 posterior tibial tendon insufficiency. The long-term result of the procedure is unknown.
Increasing use of air bags and seat belts has led to the saving of many lives. However, the orthopaedic surgeon is now left to manage increasing numbers of serious foot and ankle trauma. It is important to injury prevention programs to have an injury severity scale for these injuries. The Abbreviated Injury Scale is used widely; however, it is intended primarily to gauge possibility of death after accidents. It is not sensitive enough to give meaningful data about the foot and ankle trauma epidemic. The Trauma Committee of the American Orthopaedic Foot and Ankle Society has developed a rank order list of 91 foot and ankle injuries that commonly occur in vehicular crashes. The injuries are ranked according to severity (FASS-S). Estimated long-term impairment is also given for each injury (FASS-I). This scale is designed as a guideline to help rank importance and impairment of vehicular crash injuries. It is expected that the scale will be modified as future validity testing and other research dictates.
Explore the source record for details and available documents.
Twenty-nine feet in 28 patients who underwent subtalar distraction bone block fusion for the treatment of subtalar deformities associated with symptomatic arthrosis were evaluated. All patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score. Eighteen men and 10 women with a mean age of 44 years were evaluated. The mean follow-up was 33 months. Subtalar arthrosis was secondary to trauma in 27 of 29 feet (93%) with os calcis fractures in 19, subtalar dislocations in 5, and talus fractures in 3. Eighteen of the 28 patients (64%) returned to either full- or part-time work. The change in the mean AOFAS Ankle-Hindfoot Scale score from 25 preoperatively to 75 postoperatively was statistically significant (P < 0.0001). The radiographic analysis of the pre- and postoperative standing lateral radiographs showed an average increase of 8 mm in hindfoot height, 9 degrees in lateral talocalcaneal angle, and 11 degrees in lateral talar declination angle that were statistically significant (P < 0.0001). All patients but one (96%) were satisfied. Complications included four nonunions, two varus malunions, one metatarsal stress fracture, and one medial plantar nerve paresthesia. Each nonunion occurred in patients who smoked.
Explore the source record for details and available documents.
Subtalar joint dislocations, although not common, have been increasing in frequency over the last decade. Generally, subtalar joint dislocation can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer minimal disability, with subtalar joint stiffness as the primary complaint. This report includes four cases of suspected joint dislocation or subluxation with occult intra-articular fractures identified only by CT scan following essentially normal radiographs. Evidence seems to indicate that CT scanning in patients with suspected subtalar joint subluxation or dislocation and normal radiographs is justified.
In seven cases of Lisfranc joint injury after trauma, bunion deformity developed. This "traumatic bunion" occurs over a prolonged period of time after injury. A high index of suspicion is needed to identify the deformity as being traumatic in origin. Injury about the first metatarsophalangeal joint complex may also contribute to this deformity. When recognized, it may need to be treated with a first metatarsal-cuneiform fusion and distal soft tissue realignment.
Accurate placement of rigid fixation of the subtalar joint in arthrodesing procedures (triple, subtalar, or pantalar arthrodesis) can be difficult. We have found that the "bottom-up" method simplifies this procedure and eliminates many potential problems. A technique is described incorporating the bottom-up method utilizing the combined aiming device (Synthes, Paoli, PA).
Explore the source record for details and available documents.
The free vascularized fibula graft has been an increasingly useful tool in orthopaedic surgery. In addition to its many applications, the reported low donor site morbidity has helped make this a popular treatment modality. Isolated flexor hallucis longus flexion contracture has been reported in the literature; however, multiple ipsilateral clawtoe deformity has not been reported. We describe two cases of multiple clawtoe deformity following ipsilateral harvest of a free vascularized fibula graft.
Dislocations of the subtalar joint are rare injuries. The anatomy, pathophysiology, treatment, and prognosis of subtalar joint dislocations have been well described in the literature. The purpose of this paper is to review the current literature on subtalar joint dislocations, as well as outline those aspects of the anatomy, pathomechanics, and treatment pertinent to care of the patient with subtalar joint dislocation. In addition, complications and obstacles to reduction are described. Subtalar joint dislocations, although not common, have increased in frequency over the last decade. Generally, they can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer some disability with subtalar joint stiffness the primary complaint. Associated intra-articular fractures increase the risk of posttraumatic arthrosis.
Closed degloving injuries of the toes are rare due to their short length, protection in shoes, and general lack of adornment. When these injuries occur, neurovascular compromise can lead to a loss of viability of the toe. Prompt recognition and successful reduction are necessary to maintain normal structure and function.
Delayed treatment of a rupture of the Achilles tendon is a challenge. Operative treatment is generally recommended, with a variety of techniques being described to appose the tendinous ends and augment the repair.
Osteochondral lesions of the talar dome are a common cause of ankle disability. Management options are as numerous as the terms used to describe these lesions. The recognition of a traumatic etiology has increased our understanding and management of these disorders. Modern imaging technology has enhanced the ability to fully evaluate and accurately classify this lesion, which is fundamental for proper treatment.
Few cases of high pressure water injection injuries of the foot have been reported. These cases suggest that only minimal soft tissue destruction results and that, with conservative or limited surgical management, full recovery should be expected. This is a report of two cases of this "benign variant" of high pressure water injection injury that resulted in toe amputations.
Thirty patients who had had a total of fifty-one Mitchell procedures to correct adolescent hallux valgus deformities were examined clinically and radiographically an average of seven years (range, three to seventeen years) after the operation. The average age of the patients at the time of the operation was fifteen years (range, ten to nineteen years). The result was excellent in nineteen feet, good in sixteen, fair in six, and poor in ten. The fair and poor results were associated with recurrence of the deformity, stiffness (real or perceived), and unsightly scars. The cause of the fair and poor results was inadequate correction at the time of the operation in six feet and loss of fixation in two; the loss of fixation resulted in one recurrence and one malunion. The remaining eight patients who had a fair or poor result were not totally satisfied and had reservations about more than one of three categories (relief of discomfort, appearance, or range of motion). Seventeen feet had a plantar callosity beneath the second metatarsal head, suggesting increased load-bearing by the second metatarsal. Although sixteen callosities caused no symptoms at the most recent follow-up evaluation, the long-term implications of this altered pattern of weight-bearing are unknown.