Biomedical subjects
Andrea Cracchiolo
Publications and source records attributed to Andrea Cracchiolo.
A cotton batting compression dressing and fiberglass cast used safely in the immediate postoperative period after hindfoot or ankle surgery.
BACKGROUND: Patients undergoing surgery on the foot and ankle who require immobilization are typically placed in splints or soft compression dressings after surgery to avoid complications associated with swelling. As swelling subsides, this temporary immobilization is removed and replaced with a short-leg cast, making an additional office visit necessary, which adds to the cost as well as patient discomfort. METHODS: We apply a cast in the operating room using a special padding technique to accommodate postoperative swelling. It is supportive enough that it does not need to be replaced shortly after surgery. This cast was applied to 38 patients having surgery on the hindfoot or ankle between March, 2003, and February, 2004. RESULTS: All patients tolerated the cast during the initial 2 weeks after surgery, and there were no complications. CONCLUSION: The purpose of this study was to describe the casting technique and document its safety for use immediately after surgery on the hindfoot and ankle.
The use of a 95 degree blade plate and a posterior approach to achieve tibiotalocalcaneal arthrodesis.
UNLABELLED: Various types of internal fixation have been used to achieve arthrodesis of both the ankle and subtalar joints. We have investigated the use of a standard 95 degree angled blade plate as a method of more rigid internal fixation to achieve arthrodesis of these joints. The purpose of this retrospective study was to review our clinical and radiographic results in adults using a blade plate applied through a posterior approach to fuse the ankle and subtalar joints. METHODS: Between April 1995 and June 2000, 10 tibiotalocalcaneal arthrodeses were performed using a posterior approach and a blade plate for internal fixation. There were 10 adults (five men and five women) whose average age was 64 years (range, 42 to 80 years). The indication for the procedure was severe pain which was unresponsive to nonoperative management in patients with arthritic joints. Preoperative diagnoses included six patients with post-traumatic arthritis, two with primary degenerative arthritis, one with rheumatoid arthritis, and one with post-polio deformity. An average of 1.7 previous operations had been performed on the affected ankle. RESULTS: Clinical and radiographic follow-up was performed for all patients at an average of 37 months (range, 12 to 71 months) postoperatively. All 10 patients achieved a solid fusion. The mean time to radiographic fusion was 14.5 weeks (range, 9 to 26 weeks). The operation resulted in plantigrade feet in all patients with an average tibia-floor angle of 2.3 degrees of dorsiflexion and an average of 5 degrees of hindfoot valgus. Patients had excellent pain relief, however function did not improve as much. Complications occurred in three patients. One patient required a small split-thickness skin graft for wound healing, one experienced a transient posterior tibial nerve neuropraxia, and one developed a deep venous thrombosis in the nonoperative leg at six weeks postoperatively. Three patients required removal of the blade plate because of discomfort, which promptly cleared. CONCLUSIONS: Arthrodesis provides excellent pain relief for patients with painful arthritic deformities of the ankle and subtalar joints. Using a posterior approach, a blade plate for internal fixation and bone grafts resulted in a solid fusion for all our patients. This method is particularly effective in large patients with a mild-moderate hindfoot deformity.