Biomedical subjects

David B Thordarson

Publications and source records attributed to David B Thordarson.

25 records · Page 2Linked to original sources

PubMed2002

Failure of hallux MP preservation surgery for rheumatoid arthritis.

Eight patients underwent surgery on 15 feet for rheumatoid forefoot problems. Thirteen of the 15 feet that were operated upon had an attempt to preserve the hallux metatarsophalangeal joint while resectional arthroplasty was performed on the lesser MP joints. All of the 13 feet that had the MP joint preserved had a well-preserved joint space preoperatively and no active signs of inflammation at the time of this procedure. Eight feet underwent a distal Chevron osteotomy to realign the great toe, two feet underwent an IP fusion as only the IP joint had evidence of erosive changes, and one foot underwent a combination of a Chevron osteotomy and a proximal phalangeal osteotomy (Akin procedure). Two patients had no surgery on their first ray as it was well aligned with no evidence of erosive changes. Of the 13 feet that did not have a fusion performed, 11 had development of a valgus deformity or inflammatory erosions. The average time to failure was 24 months (range, six to 36 months). The Chevron/Akin procedure remained successful at 18 months and one of the IP fusions was successful at six years after surgery. Although patients with rheumatoid forefoot disease may on occasion have a well-preserved hallux MP joint with minimal or no deformity and no active inflammation, with severe lesser toe involvement, most of these patients will fail a surgical procedure which does not involve fusion of the hallux MP joint.

Arthritis, Rheumatoid↗

PubMed2002

Partial calcanectomy: an alternative to below knee amputation.

Twenty-two patients with non-healing wounds over the heel, with or without underlying osteomyelitis, had been unresponsive to conservative therapy. They were treated with a partial calcanectomy as an alternative to below knee amputation. Nine patients had a primary diagnosis of diabetes. Thirteen patients had osteomyelitis from various other causes. All patients had a minimum 12 months follow-up except three who were deceased. Average follow-up was 27 months (range, two to 80 months). All patients healed their wounds with no patient requiring subsequent below knee amputation. Twelve patients had delayed wound healing including all nine with diabetes. Eleven additional procedures were performed on the heels of nine patients. Of the 18 patients available for follow-up at this time (four patients had died), all were satisfied with their surgery. Twelve were using orthoses while six used athletic shoes. Pain with activity was described as none in six, mild in 10, moderate in one, and severe in one patient with RSD. Ability to walk improved in seven, did not change in 10, and decreased in one (due to unrelated problems with his diabetes). Only one patient would have chosen a below knee amputation in hindsight due to pain in his lower leg and ankle. Partial calcanectomy is a viable alternative to below knee amputation with a high satisfaction level for patients with large heel ulcers with or without osteomyelitis.

Adult↗

PubMed2002

The role of pulsatile cold compression in edema resolution following ankle fractures: a randomized clinical trial.

Twenty-four patients with displaced ankle fractures awaiting surgery were randomized to a study (n=11) or a control group (n=13). In the study group, patients had a pulsatile cold compression (PCC) device applied to their ankle, and remained at bed rest with the extremity elevated while awaiting surgery. In the control group patients remained in a posterior molded splint instead of the PCC device. Baseline circumferential measurements of the ankle were obtained, followed by measurements at 24-hour increments to evaluate edema resolution. In addition, patient satisfaction with use of the PCC device was evaluated with a scale ranging from 1 to 4. The median decrease of circumference in the study group compared to the control group was 0.5 cm vs. 0.1 cm at 24 hours (p=0.005), 0.9 cm vs. 0.4 cm at 48 hours (p<0.001), and 1.2 cm vs. 0.5 cm at 72 hours (p=0.009). The ratio of the decrease in circumference relative to the circumference of the normal ankle was significantly higher in the PCC group compared to the control group at all time points. All patients in the PCC group were satisfied with the device (median satisfaction score = 4). The PCC device was well tolerated and resulted in a significantly greater reduction of ankle circumference at 24, 48, and 72 hours after its application, compared to splinting and elevation alone. The PCC device facilitates edema resolution following ankle fractures.

Adult↗

PubMed2002

PLA screw fixation of Lisfranc injuries.

Fourteen patients with Lisfranc injuries were treated with open reduction and internal fixation with PLA absorbable screw fixation by a single surgeon. From one to four PLA screws were used in each case (average two). In four patients, K-wires were inserted and removed at six weeks following surgery for instability of the fourth and/or fifth tarsometatarsal joints. Average follow-up was 20 months (range, three to 45 months). No patient was noted to have a soft tissue reaction to the screws. No evidence of osteolysis was noted on any of the follow-up X-rays at the screw sites. No loss of reduction was noted in any follow-up X-rays compared to immediate postoperative radiographs. The use of absorbable screws in this small series was found to be safe, without reaction and obviated the need for screw removal at short-term follow-up.

Adolescent↗

PubMed2002

An anatomic comparison of venous damage resulting from 2 dorsal surgical approaches to proximal interphalangeal joint arthroplasty.

Proximal interphalangeal joint arthroplasties were performed on 40 toes of 10 fresh-frozen cadaveric feet. Twenty toes had a transverse elliptical incision of skin and extensor mechanism, and 20 had a longitudinal incision with transverse excision of extensor mechanism. Venous anatomy, including damage to the dorsal collateral veins, was noted. In the transverse-incision group, 14 (70%) of 20 toes had 1 dorsal vein transected, and 2 (10%) of 20 toes had both dorsal veins transected; in the longitudinal-incision group, no dorsal collateral veins were injured. As transverse incisions carry a high risk for damaging the dorsal collateral veins, and such damage may contribute to postoperative swelling, care should be taken to protect these veins. Longitudinal incisions are less likely to damage these venous structures.

Arthroplasty↗

PubMedDate not supplied

Fusion in posttraumatic foot and ankle reconstruction.

Despite appropriate acute treatment, many foot and ankle injuries result in posttraumatic arthritis. Arthrodesis remains the mainstay of treatment of end-stage arthritis of the foot and ankle. An understanding of the biomechanics of the foot and ankle, particularly which joints are most responsible for optimal function of the foot, can help guide reconstructive efforts. A careful history and physical examination, appropriate radiographs, and, when necessary, differential selective anesthetic blocks help limit fusion to only those joints that are causing pain. Compression fixation, when possible, remains the treatment of choice. When bone defects are present, however, neutralization fixation may be necessary to prevent a secondary deformity that could result from impaction into a bone defect.

Ankle Injuries↗

PubMedDate not supplied

Nerve and tendon lacerations about the foot and ankle.

Nerve and tendon lacerations of the foot and ankle region are relatively common. Acute nerve and tendon injuries should be repaired with appropriate techniques at the time of initial wound exploration. Primary nerve repair may help minimize the risk of painful neuroma formation; primary tendon repair can lead to better functional results than delayed repair. Most chronic nerve injuries, except those to the tibial nerve or its major divisions, are managed by resection of a painful neuroma and burying the nerve ending in a protected area. Delayed reconstruction of tendon injuries is performed when correction of the functional deficit outweighs the morbidity of surgery.

Ankle↗