Biomedical subjects
Publications and source records attributed to G Friend.
For many decades, resecting the base of the proximal phalanx was a popular method of correcting hammertoes. The long-term result of the procedure, however, is a flail, proximally retracted, "floating" toe. Correction of this challenging surgical problem can be accomplished with a V-Y advancement flap and specific releases.
The occurrence of single stress fractures after Keller arthroplasties has been documented. This paper presents a case of sequential stress fractures of metatarsals two and three after Keller arthroplasty with hemi-phalangeal implant. It is the author's view that failure to recognize and properly treat the fracture of the second metatarsal led to the additional fracture of the third metatarsal. Furthermore, the use of a nonrigid orthotic with metatarsal padding is recommended postoperatively to decrease the probability of this complication.
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A procedure is described for correction of a digital deformity that consists of both a congenitally elongated lesser toe and an acquired adductovarus of that toe. This elongated underlapping toe is often treated by arthroplasty of the distal interphalangeal joint with resection of the head of the middle phalanx. The author proposes middle phalangectomy through specifically described incisions as a better way to resolve this deformity. The procedure is not technically difficult and can be performed as an outpatient.
A procedure is described for correction of tailor's bunions. The L-osteotomy is a transpositional neck osteotomy that is inherently stable. Fixation of choice is the Orthosorb absorbable pin (Johnson & Johnson Orthopedics, Raynham, MA). A retrospective study was undertaken of 12 patients who underwent 21 osteotomies. All patients believed that the pain and deformity associated with the tailor's bunion were resolved by the surgery. One asymptomatic nonunion, and one asymptomatic malunion occurred. At final follow-up, radiographic lucency at the Orthosorb pin sites persisted in 62% of the feet.
The weekly breast cancer conference has clearly improved this community's ability to care for breast cancer patients. The range of issues has been broad. Some of the discussions are related to various aspects of surgical care, pathology issues such as specimen marking and evaluation, the use of prognostic indicators, adjuvant treatment, hormone replacement, bone marrow transplantation, post lumpectomy mammography, etc. The list is endless and expands every week. This conference format is very feasible in a community setting and has ongoing in-depth benefits. Each host hospital designates one person to regularly coordinate preparation of the host hospital's conference. This ensures timely retrieval of all related diagnostic information for review by the radiologist and pathologist. Additionally, the case history is typed and available only on the morning of the conference.