Biomedical subjects

Andre Stark

Publications and source records attributed to Andre Stark.

3 recordsLinked to original sources

PubMed2005

Arthrodesis compared to Mayo resection of the first metatarsophalangeal joint in total rheumatoid forefoot reconstruction.

BACKGROUND: Painful forefoot deformity from rheumatoid arthritis can be treated with resection of the lesser metatarsal heads combined with either resection or arthrodesis of the first metatarsophalangeal (MTP) joint. METHODS: In a prospective, randomized study we compared arthrodesis of first MTP joint with Mayo resection as part of total forefoot reconstruction in patients with painful forefoot deformity from rheumatoid arthritis. The lesser metatarsal heads were resected and extensor tenotomy was done in all patients. Thirty-one patients were randomized to either the arthrodesis or resection group. RESULTS: After a mean followup of 36 (26 to 52) months, the median subjective satisfaction score was 96 points out of 100 in the resection group and 92 points in the arthrodesis group. Significant improvements in pain, handicap, and activity according to Foot Function Index (FFI) were found in both groups (p <0.001 except for handicap in resection group and activity in fusion group were p=0.02). There were no statistically significant differences between the groups in these measures, nor in the patients' willingness to have the procedure again. There were no recurrences of prominences or tenderness under the forefoot in either group and no recurrence of severe hallux valgus in the resection group. The arthrodeses healed in 93%. There was no higher risk for clinically relevant IP joint symptoms after arthrodesis. The operating time was significantly longer in the arthrodesis group but this was not linked to a higher wound infection rate. CONCLUSION: These results indicate that Mayo resection may still be a good choice for the first MTP joint in total forefoot reconstruction in patients with rheumatoid arthritis.

Adult↗

PubMed2005

Spontaneous correction of angular fracture deformity in the rat.

BACKGROUND: The different parts of long bone are known to participate in the spontaneous correction of fracture deformity. However, the relative contribution of growth plate, epiphysis and diaphysis of bone during the correction process is not clear. ANIMALS AND METHODS: We used a rat model of tibial fracture fixed with a semi-rigid intramedullary pin in anterior angulation, and evaluated the magnitude, temporal course and pertinent sites of spontaneous deformity correction by means of radiography and bone mineral uptake. RESULTS: Over a 12-week period, the mean angular deformity was corrected from 27 degrees to 11 degrees. The major portion of the correction (14 degrees of 16 degrees) occurred within 3 weeks, concomitantly with fracture healing. The angle of the proximal growth plate changed 8 degrees over the study period. The first 3 weeks were characterized by intense bone formation on the concave side of the fracture. From weeks 3-8, signs of resorption predominated on the corresponding convex side. On the concave side, the front of new bone formation in the proximal diaphysis moved in the opposite direction to that at the fracture level, so that both sites contributed to deformity correction. INTERPRETATION: We found that different sites of a diaphyseal bone fractured in angulation respond quite differently, but still in an orchestrated way to promote correction by modeling. Notably, most of the spontaneous correction occurred during the reparative phase, the major contributor being the diaphysis, not the growth plate. Compared to other reports on angulated fracture using rigid fixation and limb immobilization, our data suggest that semi-rigid fixation and early weight bearing is more efficient in enhancing not only healing, but also deformity correction.

Animals↗

PubMed2002

Broken wings--common with the Hardinger plug.

We used the Hardinger occluder plug in 51 consecutive total hip arthroplasties. In 34 hips, 1 or more of the 12 polyethylene wings fractured and could be washed out from the canal. As many as 7 wings were loose in 2 arthroplasties. Although numerous wings were broken, no failure occurred in occlusion. The placement of loose wings in the femoral canal was studied by cementing a Charnley prosthesis in a saw-bone prepared with loose wings. The model was cut into slices. We found that the plastic wings could come into contact with both the bone and prosthesis.

Hip Prosthesis↗