Biomedical subjects

R H Cofield

Publications and source records attributed to R H Cofield.

76 records · Page 5Linked to original sources

PubMedDate not supplied

Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change.

The diagnosis of diabetic neuroarthropathy of the foot can be difficult. A series of 96 patients (116 extremities) who had diabetes and peripheral neuropathy with bone and joint changes was reviewed. Typically, the patients were middle-aged or older, were taking insulin, and had had diabetes for more than 10 years. Retinopathy, nephropathy, and peripheral vascular disease were often present. There were abnormalities of vibratory sensation (94%) and of the gastrosoleus reflex (88%). The finding of specific radiographic abnormalities assisted but did not reliably differentiate neuropathy from infection. Three patterns of radiographic changes were noted: (1) at the metatarsophalangeal and interphalangeal joints, usually with underlying ulceration; (2) at the tarsometatarsal joints; and (3) in the anterior pillar-medial column of the foot, with talus, talonavicular, navicular, or naviculocuneiform destruction. Ulceration and infection in patients with patterns (2) and (3) were rare. When correlated, the demographic features, mode of presentation, physical signs, specific radiographic abnormalities, and patterns of change were distinctive and allowed the diagnosis of this complication of diabetes to be readily made.

Adolescent↗

PubMedDate not supplied

Local treatment for neuropathic foot ulceration and osteoarthropathy.

Forty-one patients with 42 involved feet received local care for neuropathic foot disease. Thirty-one patients had ulcers (nine with associated fractures), and 10 did not (eight with fracture and two with severe ligamentous injury). Patients were examined at least 1 year after initiation of treatment, and follow-up averaged 3 years (range, 1 to 9). Treatment included ulcer cleansing, debridement, local bone excision, molded plaster casts, and antibiotics for patients with significant infection. Most patients used special shoes. Of the 42 involved extremities, 39 (93%) healed with treatment, 21 extremities (50%) remained healed at follow-up examination, and 16 patients (39%) continue to have difficulty with recurrent foot ulceration or osteoarthropathy. Thirty-nine patients (95%) have avoided the need for a major amputation.

Adult↗

PubMedDate not supplied

Osteonecrosis of the humeral head: results of replacement.

One hundred twenty-seven shoulders treated with replacement arthroplasty for osteonecrosis of the humeral head were reviewed and assessed by mailed questionnaire for results, durability, and complications. These included 71 humeral head replacements and 56 total shoulder replacements. Thirty-six shoulders were lost to follow-up because of death of the patient; an additional 3 shoulders were locking survey follow-up. Thus current follow-up was available for 88 shoulders. At an average follow-up of 8.9 years, subjective improvement was expressed for 70 (79.5%) of the shoulders and no to occasional moderate pain for 68 (77.3%). The mean American Shoulder and Elbow Surgeon score was 63, and the median was 68. Inferior results in American Shoulder and Elbow Surgeon score and range of motion were noted in post-traumatic osteonecrosis, and superior results were noted in steroid-induced osteonecrosis. Little difference was found between humeral head replacement and total shoulder replacement. The most common postoperative complication was rotator cuff tearing, found in 23 (18.1%) of 127 shoulders. This complication was more common in shoulders with a history of any surgery. The cause of osteonecrosis and previous treatment have important implications for the results of shoulder replacement for this disease.

Aged↗

PubMedDate not supplied

Chevron osteotomy for hallux valgus.

The chevron osteotomy for realignment of the first metatarsal head in metatarsus primus varus deformity has been utilized at the Mayo Clinic since 1976 on 26 feet (18 patients). Follow-up evaluation disclosed excellent relief of pain, good cosmetic correction, and overall patient satisfaction. Radiographic evaluation demonstrated reduction in the angle between the phalanx and the metatarsal bone of the great toe as well as narrowing of the forefoot with a decreased angle between the first and the second metatarsal bones. The stability of the osteotomy, the technical ease, and the absence of secondary difficulties such as transfer metatarsalgia make this procedure preferable when osteotomy of the distal portion of the first metatarsal bone is used for correction of moderate deformity.

Adolescent↗