Biomedical subjects
Publications and source records attributed to J J McGarry.
Hereditary multiple exostoses is a relatively uncommon disorder of endochondral bone characterized by the presence of multiple, cartilaginous-capped exostoses arising from the metaphyses. A rare presentation of hereditary multiple exostoses in the calcaneus of a 35-year-old man is reviewed and discussed. A brief review of the literature is provided, as well as a discussion of the patient's family history.
Hemangiomas of bone are rare lesions accounting for approximately 1% of all primary bone tumors. Intraosseous hemangiomas of the foot are especially rare, with only sparse reports in the literature. Presented here is a case study of an erosive bony lesion of the midfoot that was microscopically and histopathologically proven to be a mixed cavernous and capillary hemangioma. Eradication of the lesion during diagnostic biopsy obviated further treatment.
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Osteomyelitis and osteoarthropathy may appear clinically and radiographically similar. Many retrospective and some prospective studies have shown that magnetic resonance imaging provides valuable information about the pathologic basis of disease, specifically in the differentiation of osteomyelitis from osteoarthropathy. Although culture and biopsy of bone are the definitive diagnostic procedure, this may not always be possible. Magnetic resonance imaging can be used as an adjunct to help plan treatment protocols.
A descriptive overview of the type of internal fixation, the biomechanical principles of this fixation technique, and the methods of application are outlined. Clinical illustrations demonstrate some of the more commonly used internal fixation techniques.
Acute dysvascular limb in young adults is a rare entity. Diagnosis is often difficult because symptoms are not recognized as ischemic. The most common causes of this condition are premature atherosclerosis, thromboangiitis obliterans, microemboli, popliteal entrapment syndrome, collagen vascular disease, Takaysu's arteritis, and coagulopathy. A case study is presented to illustrate the disease process. A systematic approach to diagnosis, consisting of history and physical examination, palpation and auscultation of peripheral pulses at rest and following exercise, and noninvasive vascular examination at rest and following exercise, is recommended. Suggestion of an ischemic condition following noninvasive studies should be followed up with an arteriogram. The prognosis is dependent on the underlying etiology of the ischemia, early detection, and appropriate treatment.
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The laterally comminuted fracture-dislocation of the ankle can be associated with devastating consequences. Previously described surgical as well as nonsurgical-treatment results have been disappointing. Accurate anatomical reduction and rigid fracture stabilization of a comminuted fibula can be extremely difficult. This manuscript presents some of the more common methods of comminuted fibular fracture fixation described in the literature. A case report demonstrates successful anatomical stabilization of a comminuted fibula, utilizing a method for internal fibular fixation which has been previously employed, but has not been advocated, in the literature. Clinical and radiographic results at 12 and 20 months post-injury are promising.
A case involving a benign osteochondral tumor of the talar dome is presented. Graft considerations are reviewed and some of their specific characteristics are highlighted. Selection of a fresh-frozen cadaveric graft in this case was based on the goal of maintaining articular congruity in the ankle joint. The authors' experience demonstrated that normal joint function can be preserved with this type of graft.
Mycetoma, also known as madura foot, is a local, chronic, slowly progressive disease with the classic presentation involving tumefaction, multiple draining sinuses, and grain-filled pus. It is primarily produced by either a bacteria (actinomycetoma) or a fungal (eumycetoma) organism. Determining the causative organism is fundamental to the treatment process. All types of mycetoma infections should be treated with early surgical debridement and tissue culture. Tissue should be sent for gross, microscopic, and histopathologic evaluation. In addition to surgical management, these patients should be managed adjunctively with a prolonged course of chemotherapy. Patients with actinomycetoma are treated with an antibiotic and can expect to have a clinical cure with little chance for recurrence, whereas, patients with eumycetoma are treated with an antifungal agent and usually do poorly with a high rate of recurrence. The case presented involved an infection due to Actinomadura madurae (Nocardiaform madurae) and demonstrates successful treatment with surgical resection and prolonged doxycycline chemotherapy.
The authors present a review and case presentation of an intratendinous ganglionic cyst. This rare entity is discussed with emphasis on its pathogenesis, microscopic anatomy, and clinical occurrence to aid in the differential diagnosis with other cystic type lesions that may occur in the foot. A case report is presented to demonstrate this unusual lesion, and the surgical approach used to excise the affected peroneus brevis tendon.
The purpose of this article is to introduce a modification of the Brostrom procedure to repair chronic lateral ankle instability. This technique involves utilizing an implantable anchoring system to simplify the plication of the injured capsular and ligamentous structures of the ankle. The advantage of this surgical technique is that it provides the surgeon with a relatively rapid, simple procedure that utilizes the proven technique first described by Brostrom in 1966.
The authors present a synthetic skin substitute, Epigard, which was developed in 1973 and has been used worldwide for temporary coverage of open wounds. Epigard is a two-layer, non-medicated wound dressing which approximates the function of human skin. The article discusses the proper indications and usage of Epigard, as well as post operative wound management and definitive wound closure decisions. A case presentation involving a serious diabetic wound infection is discussed. At Doctors Hospital, Epigard has become an important adjunctive therapy in wound management by improving wound healing time and decreasing patient hospital stay.