Mark E Easley | PubMed Health

PubMed2006

Wound healing agents.

This report presented a review of the process of wound healing as well as influencing factors in the process such as wound healing agents. A greater understanding of the alterations in diabetes mellitus allows selection of the optimal wound healing agents to provide a more optimistic approach to wound closure for this large population of diabetics. We have reviewed some of the most common products use adjuncts to the healing process. With newer innovation such as the use of negative pressure dressings and HBO therapy, the treatment of diabetic wound continues to improve. With the increased number of healing agents, it is important to consider the kind of wound and the conditions present when selecting one healing agent over another.

Bandages↗

PubMed2005

Salvage of the failed Keller resection arthroplasty. Surgical technique.

BACKGROUND: A number of typical complications have been associated with Keller resection arthroplasty. Recurrent valgus deformity, cock-up deformity, and a flail toe may be difficult problems for the treating surgeon because options for salvage are limited. In this study, we evaluated arthrodesis of the first metatarsophalangeal joint as a salvage technique following a failed Keller procedure. In addition, the outcomes of motion-preserving procedures were reviewed in a separate series. METHODS: Arthrodesis of the first metatarsophalangeal joint was performed in twenty-eight patients (twenty-nine feet, group A), and either a repeat Keller procedure or an isolated soft-tissue release was performed in eighteen patients (twenty-one feet, group B). The patients were evaluated at least twenty-four months postoperatively, with a personal interview and a clinical examination with use of a modification of the hallux metatarsal-interphalangeal scale. Radiographs were also made for the group treated with the arthrodesis. RESULTS: In group A, the average duration of follow-up was thirty-six months and fusion was achieved in twenty-six of the twenty-nine feet. Satisfaction was excellent or good in twenty-three cases, and the postoperative score according to the modified hallux metatarsal-interphalangeal scale averaged 76 points (maximum, 90 points). A repeat arthrodesis was necessary in five feet because of malposition or pseudarthrosis. In group B, the average duration of follow-up was seventy-four months. Satisfaction was excellent or good in only six cases, and the patient was dissatisfied in eleven cases. The score according to the modified hallux metatarsal-interphalangeal scale averaged 48 points. Valgus deviation and cock-up deformity had recurred in the majority of the feet at the time of follow-up. CONCLUSIONS: Although it is more technically demanding, we recommend arthrodesis for salvage following a failed Keller procedure since it may be associated with a higher rate of patient satisfaction and better clinical results.

Arthrodesis↗

PubMed2004

An augmented fixation method for distal fibular fractures in elderly patients: a biomechanical evaluation.

This biomechanical investigation compared two fixation techniques for distal fibular fractures. Elderly cadaver lower extremities with simulated fibula fractures underwent fixation either with a plate and intramedullary Kirschner wires (K-wires) with or without the addition of three screws inserted through the four cortices of the fibula and the tibia. The specimens were axially loaded to body weight on a materials testing machine, and the supinated foot was externally rotated to failure. Displacement at the fracture site was monitored with an extensometer. Comparing the augmented technique with the technique without additional screws, mean stiffness was 460 +/- 100 and 320 +/- 200 N-mm/deg, strength at failure was 31 +/- 10 and 19 +/- 7 N-m, strength at 30 degrees external rotation was 15 +/- 5 and 10 +/- 6 N-m, and axial deformation was 0.04 +/- 0.06 mm and 0.10 +/- 0.04 mm, respectively. All differences were statistically significant.

Aged↗

PubMed2004

Salvage of a failed Keller resection arthroplasty.

BACKGROUND: A number of typical complications have been associated with Keller resection arthroplasty. Recurrent valgus deformity, cock-up deformity, and a flail toe may be difficult problems for the treating surgeon because options for salvage are limited. In this study, we evaluated arthrodesis of the first metatarsophalangeal joint as a salvage technique following a failed Keller procedure. In addition, the outcomes of motion-preserving procedures were reviewed in a separate series. METHODS: Arthrodesis of the first metatarsophalangeal joint was performed in twenty-eight patients (twenty-nine feet, group A), and either a repeat Keller procedure or an isolated soft-tissue release was performed in eighteen patients (twenty-one feet, group B). The patients were evaluated at least twenty-four months postoperatively, with a personal interview and a clinical examination with use of a modification of the hallux metatarsal-interphalangeal scale. Radiographs were also made for the group treated with the arthrodesis. RESULTS: In group A, the average duration of follow-up was thirty-six months and fusion was achieved in twenty-six of the twenty-nine feet. Satisfaction was excellent or good in twenty-three cases, and the postoperative score according to the modified hallux metatarsal-interphalangeal scale averaged 76 points (maximum, 90 points). A repeat arthrodesis was necessary in five feet because of malposition or pseudarthrosis. In group B, the average duration of follow-up was seventy-four months. Satisfaction was excellent or good in only six cases, and the patient was dissatisfied in eleven cases. The score according to the modified hallux metatarsal-interphalangeal scale averaged 48 points. Valgus deviation and cock-up deformity had recurred in the majority of the feet at the time of follow-up. CONCLUSIONS: Although it is more technically demanding, we recommend arthrodesis for salvage following a failed Keller procedure since it may be associated with a higher rate of patient satisfaction and better clinical results.

Arthrodesis↗

PubMed2003

Osteochondral autologous transfer system.

The OATS technique is one of several cartilage repair procedures that exhibits promising short- to intermediate-term results in the surgical management of OLTs. Although the OATS procedure is generally reserved for salvage of failed debridement and drilling, some investigators are suggesting that it may have applications in primary surgical management of OLTs, particularly those that are associated with subchondral cysts. Long-term outcome of the OATS procedure for OLTs is not yet available.

Ankle Joint↗

PubMed2003

Topography of the distal tibial nerve and its branches.

The tibial nerve trunk and its branches were dissected in 20 embalmed cadaver legs and the relative topographic anatomy was defined at 3-cm intervals up to 15 cm proximal to the medial malleolar-calcaneal (MMC) axis. Each nerve branch was found in various locations. The calcaneal nerve was found to descend from medial to posteromedial. It was never found anterolaterally and only rarely laterally. The lateral plantar nerve was found to rotate externally from lateral and posterolateral to lateral and posteromedial as it descends. This nerve was not found medially or anteromedially. The first branch of the lateral plantar nerve was indistinguishable from the trunk of the tibial nerve descending medially to between the lateral plantar and calcaneal nerves. The overall pattern of the medial plantar nerve was an internal rotation from anteromedial (proximal) to anterior (distally). It was not found posteriorly. The flexor hallucis longus motor branch was located an average of 17.9 cm (range, 10-24 cm) proximal to the MMC axis. Preliminary application of these data has facilitated surgical dissection and afforded an understanding of how tibial nerve trunk pathology correlates with clinical manifestations.

Cadaver↗

PubMed2002

The acquired midtarsus deformity classification system--interobserver reliability and intraobserver reproducibility.

A radiographic classification (Schon's) divides Charcot midtarsus deformities into four types identified by Roman numerals (I to IV), according to the anatomical location of the pathological process,11 and an objective method of severity staging using radiographic criteria is introduced and tested. A beta stage is assigned if one of the following criteria is met: 1. a dislocation is present; 2. the lateral talar-first metatarsal angle is > or = 30 degrees; 3. the lateral calcaneal-fifth metatarsal angle > or = 0; or 4. the AP talar-first metatarsal angle is > or = 35 degrees. An alpha stage can be assigned when all four features are absent. Clinical features useful in assessing and managing these deformities have been associated with the various types and stages. To determine whether the classification system is valid, a study was performed. Two examination booklets and an instructional booklet designed to teach the method were distributed to 75 orthopaedic surgeons at the AOFAS summer meeting to test for intraobserver reproducibility and interobserver reliability. Information about the participants was recorded, and the tests were scored. The highest scores for correct responses were achieved by foot and ankle fellows, followed by orthopaedic residents. Attending orthopaedic surgeons achieved the lowest scores. The most common error was a type I deformity misidentified as a type II. The interobserver reliability for correctly classifying the deformities was 81%, and the intraobserver reproducibility was 97%. We concluded that this classification system, intended to clarify the patterns of acquired midfoot collapse, permits assignment of both anatomic type (I to IV) and degree of severity (alpha-beta) with high reliability and reproducibility. It can therefore be used as a tool for diagnosis, planning treatment, and assessing the prognosis.

Charcot-Marie-Tooth Disease↗

PubMed2002

The transverse dorsal approach to the Lisfranc joint.

While multiple longitudinal skin incisions can be utilized to visualize the joints of the midfoot, we feel that exposure can be difficult. Dorsal transverse and T incisions were undertaken to expose the tarsometatarsal joints (TMTJs) in 12 patients. Five of the 12 had some form of immunosuppression, including diabetes, methotrexate therapy and antirejection transplant therapy. One patient who had a lengthening of the midfoot with a structural autograft suffered a small area of skin necrosis that healed by secondary intention. The remainder of patient's wounds healed without complication. Three to six dorsal access intervals are created between the neurovascular and musculotendinous structures that overlie the TMTJs. The transverse incision can be extended into a medially based T incision to apply a medial plate as required. Transverse incisions are not recommended for patients who require lengthening of the midfoot.

Adult↗

PubMedDate not supplied

Total ankle arthroplasty.

First-generation total ankle arthroplaty designs had unacceptably high complication and failure rates compared with ankle arthrodesis. More recent prostheses have had encouraging intermediate results because of refined surgical techniques and improved designs. Mobile-bearing designs theoretically offer less wear and loosening through full conformity and minimal constraint. The less complex fixed-bearing designs avoid bearing dislocation and the potential for added wear from a second articulation. Four second-generation designs have demonstrated reasonable functional outcomes: the Scandinavian Total Ankle Replacement, the Agility Ankle, the Buechel-Pappas Total Ankle Replacement, and the TNK ankle. Intermediate results are promising but should be interpreted with care.

Ankle Joint↗