Biomedical subjects
Publications and source records attributed to J E Turba.
The clinical syndrome of extensor mechanism malalignment can either be primary or secondary. The distinguishing feature of extensor mechanism malalignment is passive patellar hypermobility at 30 degrees of flexion, which yields apprehension. Formal extensor mechanism reconstruction requires multiple steps, which are described along with variations.
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Twenty-nine patients (1 high school athlete, 9 college athletes, and 20 recreational or nonathletes) with Neer stage II impingement syndrome were treated by arthroscopic subacromial decompression after their injuries failed to improve with conservative therapy. Followup averaged 32.2 months, and results were rated based on subjective responses and the UCLA Shoulder Rating Scale. Of the results, 82.2% were rated as satisfactory, while 17.2% were unsatisfactory. The greatest margin of improvement was in the pain rating. Postoperatively, 65.5% of the patients returned to their previous level of activity and 56% of the collegiate athletes returned to their previous competitive level. The average time to return to college-level competitive athletics for the recreational or nonathletes was 6.6 months (average 5.4). There were no infections or neurovascular complications in the series.
Clinically, the splayfoot is characterized by valgus of the great toe with bunion formation in association with a relative varus position of the first metatarsal. On the lateral side of the foot, there is varus of the fifth toe with a relative valgus position of the fifth metatarsal and resultant bunionette formation. Radiographically, splayfoot is characterized by an intermetatarsal angle between the first and second metatarsals of greater than 12 degrees, and an intermetatarsal angle between the fourth and fifth metatarsals of greater than 8 degrees. The Giannestras splayfoot procedure consists of excision of the bunion and bunionette, adductor tenotomy, opening-wedge osteotomy of the first and fifth metatarsal bases, and realignment of the first and fifth toes. One-hundred and sixteen splayfoot operations were performed in 72 patients, with an average follow-up of 5.2 years. Results were considered excellent in 33% (39 feet), good in 45% (52 feet), fair in 14% (16 feet), and poor in 8% (9 feet). The primary cause of a fair or poor result was collapse of the bone graft at the base of the first metatarsal, causing recurrent varus and symptomatic hallux valgus.