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Biomedical subjects

L M Fallat

Publications and source records attributed to L M Fallat.

At least 19 recordsLinked to original sources
PubMed1990

Pathology of the fifth ray, including the tailor's bunion deformity.

Pathology of the fifth ray has been reviewed with emphasis on the tailor's bunion. Based on a thorough radiographic analysis, the bunionette has been grouped into four types, and surgical criteria has been proposed. The goal of this study is to provide guidelines that may enable both podiatric and orthopedic surgeons to recognize the types of tailor's bunions and assist in the selection of an appropriate surgical procedure.

Adult↗
PubMedDate not supplied

Autogenous bone grafting for the treatment of talar dome lesions.

This study evaluated a surgical bone grafting technique, which restores the talar dome weightbearing articular surface for the repair of a transchondral lesion. An autogenous bone graft combined with viable cartilage is used to recreate a normal talar articular surface. In a retrospective analysis of talar dome lesions, 14 patients surgically treated with bone grafts were compared to 17 patients treated with curettage and subchondral drilling. Post surgical follow-up was collected at 71.5 +/- 21.1 months (mean +/- SD). Age, lesion stage, and gender did not differ between the groups, but the mean fracture area was selectively smaller in the curettage and drilling group (85.2 +/- 58.7 mm2 vs. 156.4 +/- 69.4 mm2). Clinical evaluation consisted of an 8-point scale which took into account range of motion, the presence of pain and crepitus, and radiographic assessment. Significantly better overall clinical scores were observed for the bone graft group (graft, 6.9 +/- 1.6, curettage plus drilling, 4.5 +/- 1.9; p = .001), due to better results for range of motion (1.6 degrees +/- 0.5 degrees; 1.1 degrees +/- 0.4 degrees), less pain (2.7 +/- 0.50; 2.0 +/- 0.7), and presence of subchondral bone on x-ray (0.9 +/- 0.4; 0.2 +/- 0.4). Patients were also asked their perception of their own surgical outcome (considering pain frequency and ability to participate in sporting activities or walk at a similar level compared to before the surgery), and if they would have the surgery again. No differences in the patients' preoperative symptoms or their subjective assessment post surgery were detected between the groups. While curettage plus drilling is the most common surgical procedure for chronic symptomatic talar dome lesion, our results suggest that bone grafting of the lesion yields better long-term clinical results.

Adolescent↗
PubMedDate not supplied

Computer-assisted assessment of lateral column movement following plantar fascial release: a cadaveric study.

In patients who fail conservative treatment, releasing the plantar fascia relieves heel pain but destabilizes the lateral column of the foot. After surgery, pain can present in the area of the sinus tarsi, extensor digitorum brevis muscle, between the fourth and fifth metatarsals, and at the calcaneocuboid joint. The precise mechanism and involved structures for this painful compensation remains unclear. The authors hypothesized that the lateral plantar fascial band, bifurcate and cervical ligaments, lateral talocalcaneal ligament, and interosseous talocalcaneal ligament become excessively strained after this surgery. Using eight cadaver lower extremity limbs amputated 7 cm above the ankle joint, structural changes in the foot in response to staged release of the plantar fascia were measured. All ligament, tendon, and osseous structures were exposed along the plantar, medial, and lateral aspects of the foot and ankle. Using a servohydraulic system, compressive loads in increasing increments (50 lbs) were applied along the tibial axis. Tissue and bony structure displacement in the foot was measured using images electronically captured from two fixed cameras and a digital camera following each load change. All measurements were made in pixels and converted to millimeters in a spreadsheet program. Except for plantar fascial measurements, data were expressed as percentage of initial baseline. As expected, increasing compressive loads changed all measurements [repeated measures ANOVA, p<.04]. When releasing the plantar fascia, the inferior sinus tarsi space widened (intact, 85.4+/-10.8%; 1/4 release, 87.7+/-13.0; 1/2 release, 88.3+/-9.2; 3/4 release, 91.2+/-8.8; p<.04). Lateral length increased and medial height decreased, while medial length and lateral height were unchanged as the fascia was sequentially released. Significant movement of the inferior sinus tarsi strained the bifurcate and cervical ligaments, the lateral talocalcaneal ligament, and interosseous talocaneal ligament, which may account for pain following surgery. The initial 1/4 cut of the plantar fascia exerted the greatest mechanical alteration of the foot, suggesting that a partial release may relieve heel pain while optimizing the patient's chances of maintaining structural integrity with 75% of the plantar fascia intact.

Aged↗
PubMedDate not supplied

The Maisonneuve fracture.

The authors present a review of the mechanism of injury, classification, and surgical fixation techniques of the Maisonneuve fracture. Previous literature is inconsistent regarding operative criteria and appropriate fixation techniques. The authors recommend surgery of the Maisonneuve fracture to maintain reduction and to stabilize the fibula, preventing the shortening with resultant valgus talar shift that can result in painful degenerative ankle arthrosis. Recommendations are also made regarding fixation, based on the severity of the diastasis.

Ankle Injuries↗
PubMedDate not supplied

The Tillaux fracture.

The Tillaux fracture is an avulsion fracture of the distal anterior tibial tubercle that is seen in adolescents. The authors present a literature review that includes classification, mechanism of injury, epiphyseal development, and treatment. Two cases of the Tillaux fracture are presented that represent patients of different physeal maturity and severity of injury, and different techniques of osteosynthesis.

Adolescent↗
PubMedDate not supplied

Complex regional pain syndrome.

Reflex sympathetic dystrophy is a complex progressive and potentially devastating condition generally affecting the extremities. Because clinical presentation is variable, diagnosis can be difficult. Recently, the Special interest Group of Pain and the Sympathetic Nervous System of the International Association for the Study of Pain developed a new taxonomy to help acknowledge and differentiate the features of reflex sympathetic dystrophy and causalgia. These are categorized under the heading of complex regional pain syndrome. Sympathetically maintained pain is also recognized as a separate component to this group of conditions. The authors present this new taxonomy and present cases of each condition.

Adult↗
PubMedDate not supplied

Comparison of tension band wire and cancellous bone screw fixation for medial malleolar fractures.

A comparison study of the relative strength of tension-band fixation versus cancellous bone screw fixation of medial malleolar ankle fractures was performed on ten fresh-frozen lower limbs from five cadavers. The mean force recorded at clinical failure using cancellous screws was 60.98 N (range 33.49 to 117.86 N) compared with 129.30 N using tension-band fixation (range 85.20 to 194.64 N). Therefore, cancellous screws exhibited only 47.16% the strength of tension-band wiring at clinical failure.

Aged↗
PubMedDate not supplied

The effect of screw holes on bone strength.

Internal fixation devices continue to be used in the fixation of foot and ankle fractures and osteotomies. Because of the increased use of fixation techniques, postoperative care following removal of internal fixation devices assumes a vital role in the success of these procedures. Using 10 fibulas from 5 cadavers, the authors tested the resistance of 5 intact fibulas and 5 contralateral fibulas with one 3.5-mm. drill hole to bending forces. The mean load at failure of the intact fibulas was 360.86 N (range 181.69-800.14 N), whereas the mean load at failure of the drilled fibulas was 215.20 N (range 66.49-600.61 N). The drilled fibulas displayed failure with the application of 59.63% of the mean load applied to the intact fibulas at failure (p = 0.007).

Aged↗
PubMedDate not supplied

Complex regional pain syndrome of the lower extremity: a retrospective study of 33 patients.

Even when diagnosed early and treated appropriately, patients with complex regional pain syndrome (CRPS), a condition that can lead to severe painful dysfunction of the limb, may continue to have long-term pain. A retrospective study was conducted of 33 patients with a positive history of CRPS I, CRPS II, or sympathetically maintained pain (SMP) of the lower limb who were treated in either a clinical setting or a pain management center. The average age of individuals diagnosed with CRPS was 43.5 +/- 12.6 (mean +/-SD) years with 60% being female. The most common diagnosis was CRPS I (75.8%) followed by SMP (21.2%), and finally CRPS II (3.0%). The dominant etiology was confirmed as trauma (73%), with the remaining nine cases resulting from elective foot surgery. Fractures were the most common type of injury (45%) and excision of neuroma was the most frequent elective surgical procedure (30%). Time from injury to diagnosis in patients with foot and ankle trauma was 3.9 +/- 3.0 months and from elective surgery to diagnosis was 9.1 +/- 4.0 months (t test, p < .001). Thirteen patients were contacted for long-term follow-up with an average of 3.5 years after initial diagnosis. There was no difference when the pain rating at long-term follow-up was compared to the initial rating (6.2 +/- 1.2 vs. 7.3 +/- 0.6; p = .287), and 11 continue to have more than moderate pain. Thus, many patients with CRPS who seem to be successfully treated, and are discharged from care, still have severe pain years later.

Adolescent↗
PubMedDate not supplied

Puncture wounds: therapeutic considerations and a new classification.

Despite abundant documentation in the literature regarding the complications of puncture wounds, emergency room personnel and practitioners alike often undertreat this seemingly innocuous injury. The authors present a review of the literature, recommendations for treatment, and a new classification of puncture wounds to aid the clinician in the management of this injury.

Diphtheria-Tetanus-Pertussis Vaccine↗
PubMedDate not supplied

Distal tibiofibular synostosis and late sequelae of an ankle sprain.

The late sequelae of an ankle sprain is described in the form of an acquired tibiofibular synostosis. A synostosis can result in loss of dynamic motion between the tibia and fibula, which may create decreased and painful ankle motion. A case report and surgical procedure is presented.

Adult↗
PubMedDate not supplied

Crescentic transmalleolar osteotomy for optimal exposure of the medial talar dome.

A review of the literature suggests that surgical treatment of transchondral talar dome fractures affords superior results over lengthy conservative therapy. Medial lesions have been reported most often. The authors perform stress views in acute and chronic ankle injuries, as there are often associated ligament ruptures with suspected talar dome fractures, and routinely use an air-contrast radiographic technique for visualization of the continuity of the articular cartilage. An arthrogram is performed for definitive diagnosis of ligamentous injury. A new osseous surgical approach to the medial talar dome has been presented, entailing a crescentic osteotomy of the medial malleolus. The distinct advantage has proven to be enhanced exposure to the middle and posterior aspects of the medial margin of the talus. The configuration of the crescentic osteotomy is also amenable to internal fixation and tension band wiring has been recommended. Unrestricted access to the site of a medial transchondral talar dome fracture through this osteotomy is the benefit of a technically well-performed procedure.

Arthrography↗
PubMedDate not supplied

Biomaterials: selection and complications.

Basic concepts of bioengineering and biomechanics are presented. The application of these various terms explain the mechanical and physical properties of biomaterials widely used in implanted devices. An explanation and literature review explains the possible biocompatibility reactions to these implants.

Biocompatible Materials↗
PubMedDate not supplied

Lateral ankle sprains: evaluation and treatment.

The increased exposure of podiatric physicians to emergency room trauma, especially lateral ankle injuries, necessitates immediate knowledge to evaluate and treat this complex injury. The appropriate knowledge necessary includes the ability to recognize normal anatomy and variants from pathologic states, either osseous or soft tissue; the ability to perform specialized tests and their relationship to the clinical state; and, lastly, the ability to have at grasp various treatment modalities and the experience to initiate the proper treatment plan. The intent of this paper is, therefore, to present: normal anatomy of the lateral ankle and possible anomalies; mechanism of injury of lateral ankle sprains; performance of specialized tests, especially stress roentgenographs and arthrograms with examples of normal, normal variants, and abnormal findings; and a review of the literature of the present state of treatment, as well as the experience at our institution. Additionally, the authors hope to arrest the thought that a lateral ankle sprain is a simple soft tissue injury.

Ankle↗
PubMedDate not supplied

Accuracy of diagnostic arthroscopy of the ankle joint.

A series of 34 diagnostic arthroscopic examinations of the ankle joint has been performed. All of the patients in this study also had an arthrotomy procedure after the arthroscopy. The arthroscopic diagnosis was confirmed by gross examination of the ankle joint in 32 of 34 patients. This resulted in a 94% diagnostic accuracy.

Ankle Joint↗
PubMedDate not supplied

Ankle joint arthroscopy.

Today, more emphasis is being placed on ambulatory surgery and its decreased morbidity. Arthroscopic surgery is a valid approach to many disease entities and is very responsive to early ambulation. The authors present a brief history of ankle arthroscopy--the technique, indications and contraindications, difficulties, and possible complications of the procedure.

Ankle Joint↗