Focus on total ankle arthroplasty.
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Ankle Joint↗
Biomedical subjects
James K DeOrio
Publications and source records attributed to James K DeOrio.
Morbidity associated with anterior iliac crest bone grafting in foot and ankle surgery.
BACKGROUND: Substitutes for bone graft have been advocated to avoid the potential morbidity associated with harvest of autogenous iliac crest graft. However, no current commercially available graft equals autogenous bone's osteoinductive and osteoconductive qualities. We reviewed our patients' morbidity after harvest of anterior iliac crest bone grafts for procedures involving the foot and ankle. METHODS: A computerized analysis of patient records was undertaken to identify all patients who had a harvest of unicortical iliac crest bone graft during a 12-year period. Patients were contacted either by telephone or by mailed questionnaire, inquiring about the postoperative morbidity of the procedure. Medical records were reviewed for any related complications. RESULTS: Of the 169 patients identified, 134 could be contacted. Follow-up ranged from 1 to 13 years. Not all patients answered every question. At latest follow up, 120 (90%)-patients reported no pain at the bone graft site. Eleven patients complained of persistent residual numbness lateral to the harvest site on the pelvis. Of these 120 patients, 32 (27%) reported that pain at the graft site was greater than the pain at the operative site during the initial postoperative period. No patients had extra hospital days as a result of the bone graft harvest. No deep infections occurred, although 12 (6.7%) of 180 patients had a postoperative hematoma or seroma. Overall, 116 (90%) of 129 patients were satisfied or very satisfied with their bone graft harvest. CONCLUSIONS: Harvesting of autogenous iliac crest bone graft provides the optimal bone graft material, yields minimal morbidity, and is an acceptable choice in supplementing surgical procedures on the foot and ankle.
Ankle↗
Removal of the second toe for severe hammertoe deformity in elderly patients.
BACKGROUND: Our hypothesis was that amputation of an isolated, painful second hammertoe is beneficial and has less morbidity than forefoot reconstruction when other associated deformities are not clinically painful. The objective was to evaluate the clinical outcomes of elderly patients undergoing amputation of painful second hammertoes instead of advanced reconstructive procedures. METHODS: We retrospectively reviewed all cases of removal of the second toe through the MTP joint for painful hammertoe deformities from May, 1998 to May 2004. Amputation for ischemic disease was excluded from the study. No patient had a concurrent hallux valgus reconstruction. The study group included 12 patients (17 amputations). A clinical questionnaire was used to determine patient satisfaction and postoperative changes in forefoot alignment. RESULTS: Ten patients were satisfied with the results, and the other two were satisfied with reservations. The activity level improved for nine patients. Eight patients noted continued valgus drift of the great toe. Nine patients would have the procedure again, and 11 thought that it met their expectations and would recommend it. No important complications were noted. CONCLUSIONS: Amputation of the second toe in elderly patients is acceptable for complaints of pain related solely to the hammertoe. The morbidity associated with more advanced reconstruction is avoided, while eliminating pain and improving shoe-wear and function. Patient satisfaction was high, and complications were minimal. Drift of the great toe into valgus did not appear to be a clinical problem.
Aged↗
Extending the width of an operating table using armboards.
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Body Size↗
Autologous bone from hip or knee replacement in simultaneous foot or ankle arthrodeses.
Simultaneous operations on the lower extremities may potentially benefit some patients. However, the only literature discussing simultaneous operations has been limited to bilateral simultaneous total hip or knee replacements. The cases of 10 patients who had combined joint arthroplasty (8 knee, 2 hip) and foot and ankle arthrodesis (6 subtalar, 4 ankle) were reviewed retrospectively. Combining the procedures allowed the patient to have autologous bone brought from the joint replacement site to the foot or ankle to assist in filling defects in the arthrodesis. The fusion rate of 100% and the good results of hip or knee replacement demonstrate that successful treatment is possible when both conditions are treated simultaneously.
Aged↗
Accuracy of haptic assessment of patellar symmetry in total knee arthroplasty.
Resection resulting in asymmetrically thick patellar arthroplasty in knee arthroplasty may lead to increased compression forces, wear, fracture, or loss of quadriceps power. Assessing the cut patella between the thumb and forefinger (haptic assessment) represents a convenient way to recognize asymmetry. In 2 test series, 8 orthopedic surgeons evaluated 24 precut solid foam patellae of varying asymmetric thickness by feeling the patella between thumb and forefinger, without visualization. Of 384 responses, in 73.2% asymmetry was underestimated, 10.4% assessments were exact, and in 16.4% asymmetry was overestimated. Specifically, 35.9% were correct within 1 mm, 60.7% within 2 mm, 81% within 3 mm, and 91.4% within 4 mm. The thickest half of the patella was correctly identified in 90.6% of responses. Haptic assessment of patellar symmetry is a useful technique in knee arthroplasty.
Arthroplasty, Replacement, Knee↗
Metatarsal neck osteotomy with proximal interphalangeal joint resection fixed with a single temporary pin.
BACKGROUND: Screws have been recommended for fixation of the site of the metatarsal osteotomy. METHODS: A report is presented on one surgeon's experience with a temporary, single Kirschner wire instead of screws for fixation of metatarsal neck osteotomies combined with proximal interphalangeal (PIP) joint resection arthroplasty in patients with dislocated metatarsophalangeal (MTP) joints and severe hammertoe deformities. Eleven consecutive patients (13 toes) were treated between January 1999 and January 2002 (mean age, 69 years; range, 44-81 years; seven women, four men) at a tertiary care foot and ankle center. Records and radiographs were reviewed retrospectively, and all patients were examined at follow-up by one of the authors (mean follow-up, 13 months; range, 6-32 months). RESULTS: All 13 metatarsal neck osteotomies had clinical and radiographic union by 6 weeks, with no evidence of nonunion, malunion, avascular necrosis of the metatarsal head, deep wound infection, pin-tract infection, broken pins, or other serious complications. Two metatarsals (18%) had minor residual plantar calluses beneath the metatarsal head. The mean postoperative American Orthopaedic Foot and Ankle Society score was 76 of 95 points possible. All patients were satisfied with the procedure and would do it again. CONCLUSION: The use of a single, temporary K-wire provides adequate fixation for combined PIP joint resection arthroplasty and metatarsal neck osteotomy in patients with central metatarsalgia and severe hammertoe deformity.
Adult↗
Salvage technique for treatment of periplafond tibial fractures: the modified fibula-pro-tibia procedure.
We describe a technique of fixation for treatment of distal tibia periplafond fractures and nonunions that uses a modification of the principle of the fibula-pro-tibia procedure (fusing the tibia and fibula together to create a one-bone lower leg). The fibula is plated, and the screws are brought across to the medial tibial cortex. The procedure is accomplished with or without a tibial buttress plate and always includes iliac crest bone grafting of the nonunion site and synostosis. We have used this technique in five patients with satisfaction.
Adult↗
Residual bacterial contamination after surgical preparation of the foot or ankle with or without alcohol.
To investigate the usefulness of a standard surgical preparation in prevention of surgical site contamination, 49 consecutive patients undergoing foot or ankle surgery were randomly assigned to standard preparation with chlorhexidine gluconate home scrubs and preoperative povidone-iodine or to standard preparation plus preoperative preparation with 70% alcohol. Results were available for all 49 patients. Cultures were positive for normal aerobic bacteria from the toes of nine of 26 patients (35%) receiving standard surgical preparation and from the toes of 13 of 23 patients (57%) receiving standard preparation plus alcohol (P = 0.12). No patient had a positive culture for anaerobic organisms or clinical evidence of infection or wound problems. Standard surgical preparation did not provide a completely sterile field, and the inclusion of alcohol added no benefit.
Alcohols↗
Adjacent interdigital nerve irritation: single incision surgical treatment.
Twenty-three patients with clinical signs of adjacent intermetatarsal nerve irritation who underwent adjacent nerve release with single-nerve excision through one incision were studied. Mean follow-up was 11 months. Of 21 patients interviewed, 19 (90%) had resolution of all or most of their pain, 20 (95%) had no or only minimal activity limitation, and 20 (95%) were completely satisfied with their outcome. Of 19 patients examined, none had pain with compression of the interspace of the excised nerve, although two (11%) had discomfort with compression of the interspace of the nerve that was only released. Protective sensation was present postoperatively in all patients except one who had preoperative neuropathy.
Adult↗
Surgical templates for orthopedic operative reports.
Generating an operative report after a surgical procedure is a critical but time-consuming and expensive task for every physician. Use of a template can shorten this process. This article describes an easy method by which a physician can create a template that can be customized to allow discussion of unique features of a given case.
Forms and Records Control↗
Imaging characteristics of bone graft materials.
Bone graft materials are widely used in reconstructive orthopedic procedures to promote new bone formation and bone healing, provide a substrate and scaffolding for development of bone structure, and function as a means for direct antibiotic delivery. Bone graft materials include autografts, allografts, and synthetic substitutes. An autograft (from the patient's own bone) supplies both bone volume and osteogenic cells capable of new bone formation. The imaging appearance of an autograft depends on its type, composition, and age. Autografts often appear as osseous fragments at radiography. At computed tomography (CT), autografts appear similar to the adjacent cortical bone. At magnetic resonance (MR) imaging, however, autografts have a variable appearance as a consequence of the viable marrow inside them, a feature not present in other graft materials. An allograft (from cadaveric bone) has an appearance similar to that of cortical bone on radiographs and CT images. An allograft in the form of bone chips or morsels does not show those features on radiographs and CT images, but instead appears as a conglomerate with medium to high opacity and attenuation within the bone defect. In the immediate postoperative period, allografts appear hypointense on both T1- and T2-weighted MR images. Hematopoietic tissue replaces the normal fatty marrow in the later phases of graft incorporation. Synthetic bone substitutes are much more variable in imaging appearance. As the use of bone allografts and synthetic substitutes increases, familiarity with postoperative imaging features is essential for differentiation between grafts and residual or recurrent disease.
Bone Substitutes↗