Biomedical subjects
Publications and source records attributed to D H Elleby.
The authors introduce the long plantar wing distal metaphyseal osteotomy of the first metatarsal through a medial plantar approach. This procedure for mild-to-moderate hallux valgus is capable of correcting an increased proximal articular set angle and first intermetatarsal angle concomitantly. The biomechanical, surgical, and clinical rationale for this procedure are discussed.
Narcotic analgesics may be used safely in most patients. Common adverse effects may be managed successfully with naloxone. PCA is a newer approach to the management of postoperative pain. The authors' survey results indicate that most podiatric physicians would benefit from the understanding of the considerations in the patient subgroups with renal or hepatic dysfunction that required postoperative pain control.
A detailed discussion of the often underestimated dilemma of digital fractures and dislocations is presented. Illustrations accentuate the important concepts. An aggressive attitude should be adopted to avoid mismanagement and prolonged convalescence. Should the need arise, surgical intervention is emphasized.
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The success of applying split-thickness porcine xenografts to nail beds after nail avulsion with matrix chemocauterization depends on the adherence of the graft to the underlying tissue. When this was obtained, the authors found that porcine xenografts contribute markedly toward reducing postoperative pain and drainage. Further investigation is being undertaken to determine whether total healing time following chemomatrixectomy has been reduced by utilizing xenografts.
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A case report of epidermal inclusion cyst formation is presented as it occurred in a young male patient. The mass is noteworthy because of its location, rapid growth and bizarre size. Treatment consisted of surgical excision without recurrence.
There are many procedures in vogue today for the surgical correction of pathologic pes plano valgus deformity. The Silver opening wedge calcaneal osteotomy is utilized to correct excessive heel valgus and attempts to realign the heel under the weight-bearing surface of the tibia. It has no effect on the position or function of the subtalar joint. Midtarsal joint stress is decreased and the foot retains its ability to adapt to uneven terrain. The procedure is rarely used alone and is most frequently combined with heel cord lengthening or gastrocnemius tendon recession. In this presentation, the authors review the indications, contraindications, fundamentals of bone grafting, surgical technique, postoperative care and possible complications of the Silver calcaneal osteotomy. Preliminary results based on 10 cases during the past 3 years have been favorable.
The Evans calcaneal osteotomy is used to correct the flexible flatfoot deformity. The procedure restores functional integrity to the medial longitudinal arch and reestablishes the locking mechanism of the midtarsal joint complex. A preliminary analysis of 36 cases (50 feet) performed at Atlanta Hospital and Medical Center during the past 3 years has yielded favorable results.