Biomedical subjects
Publications and source records attributed to J E McDermott.
Treatment of symptomatic large cystic lesions of the talus has had mixed results. A technique of treatment using a cored osteochondral graft taken from the ipsilateral knee is presented. Preliminary results in ten consecutive patients show significant improvement in all patients with an average increase of 27 points in the AOFAS Hindfoot score.
Thirty-five patients undergoing a Bröstrom procedure for ankle instability were studied retrospectively as to the presence or absence of spurs and loose bodies, outcome, and mortise relationships. 100 adult volunteers had their ankles radiographically and clinically examined for spurs, loose bodies, and laxity. 100 patients' ankles with computed axial tomography were examined to define malleolar relationships. The AOFAS Hindfoot scores on the Bröstrom patients with or without spurs were not different. Patients undergoing a Bröstrom procedure had a 3.37 times incidence of spurs and/or loose bodies compared to normal adult population. The incidence of asymmetric but asymptomatic ankle laxity in normal adults was 11%. The fibula has a 38 degree range of position relative to the axis of the talus and the medial malleolus. A posterior fibular position may predispose to injury.
Thirteen patients presenting with symptomatic pathologic variations or congenital deformities of the subtalar joint are presented. These variations included: four abnormal posterior talar processes, five patients with asymmetric subtalar joint development, and four congenital complete subtalar coalitions with a secondary ball-and-socket joint. In each case these adult patients had been unaware of the variation and had been symptom free until "awakening" sprain or fracture trauma brought about symptoms. The nonoperative and operative management of these variations is reviewed.
Between 1977 and 1992, 42 patients were seen who had 51 feet operated upon for bunions in which the surgery failed. A total of 105 procedures were done on these 51 feet until the patients either achieved satisfactory correction (N = 28) or they declined (N = 14) further surgery. An analysis of these failures and review of literature revealed 12 anatomic variations and 7 secondary factors that were seen in association with surgical failure. These findings were correlated with published criteria and our experience with various bunion procedures to advance general indications and contraindications for specific bunion procedures.
Diabetes remains the world's leading cause of amputation. Like many other major health problems, prevention is the key to successful management. Patient education efforts coupled with a team approach of aggressive early management represent the optimum current strategy. Multidisciplinary physician teams consisting of orthopaedic and vascular surgeons, supported by consultation, serve as the focus for leadership and decision making. Their efforts are supported by allied health personnel, nurses, physician's assistants, and physical therapists trained in foot evaluation, pedicare, and nail trimming, assisted by competent trained shoe technicians, orthotists, or pedorthists. At each visit the patient is examined, footwear is evaluated, and ongoing education is provided. Visits are scheduled according to a risk protocol, and treatment is based on problem classification. This regimen should result in increased patient compliance and overall improved patient care.
Diabetic malperforans ulcers are extremely challenging problems, and their treatment requires a multidisciplinary approach. The wound management technique is based on the depth of ulceration; necrosis and infection should be aggressively managed. Wound healing and prevention of adjacent breakdown is best assured through casting and professional shoewear techniques. The vascular aspects of the patient's disease must be addressed. Patients failing this multidisciplinary team approach may be candidates for adjunctive management. If transcutaneous oxygen studies indicate diminished oxygen perfusion, hyperbaric oxygen might be considered. Contraindications to this modality are certain pulmonary problems, including chronic obstructive pulmonary disease and pulmonary fibrosis. Some individuals, particularly those with claustrophobia, may find small hyperbaric chambers psychologically unacceptable. Studies on tissue and platelet growth factors are encouraging. Limited clinical experience with these materials has been encouraging and future clinical applications are anticipated; however, like hyperbaric oxygen, these growth factors are only an adjunct to a comprehensive foot care program.
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The position of the first metatarsal following a crescentic osteotomy for hallux valgus is a function of the size of the saw cut and orientation of the osteotomy. This study reports the effect of these variables, recommended technique, and potential pitfalls when using the crescent osteotomy. Using molded polyurethane foam metatarsals and a precision drill press which controlled the saw cuts, the following variables were studied: (1) orientation of the saw cut to the metatarsal, (2) the saw size (diameter of the saw relative to the shaft width of the osteotomy site), and (3) the direction toward which the crescent faces (proximal/distal). Best correction can be obtained if the saw diameter is larger than the diameter of the osteotomy site (allowing a greater degree of correction before impingement), the saw tip is tilted slightly toward the sesamoids (which ensures that the metatarsal does not rotate medially with correction), and the saw is rotated laterally to cause slight declination of the toe.
A multiple-use testing shoe capable of various orthotic modifications has been developed. Its use in predicting prescription performance and patient compliance is presented. Patient compliance is enhanced by understanding gained through the testing procedure.
We compared the difference in operative time, hospitalization and recovery time in two groups of patients who underwent open or arthroscopic resection of anterior, tibiotalar, impinging spurs. The operative time was approximately the same, but the average length of hospitalization and time to recovery were shorter in the arthroscopic group. A classification system is proposed that grades the degree of spur formation and assists in predicting the length of recovery time and whether the patient is a candidate for open or arthroscopic spur resection. In this series, grade I spur patients recovered and resumed full activity at 5.0 weeks, grade II at 5.6 weeks, grade III at 6.4 weeks, and grade IV at 10.0 weeks postoperatively. Grade IV patients are not suitable candidates for an arthroscopic debridement.