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Biomedical subjects

S J Palladino

Publications and source records attributed to S J Palladino.

16 recordsLinked to original sources
PubMed1994

Distraction systems for ankle arthroscopy.

It is clear that for most of the routine pathology addressed with ankle arthroscopy, including most talar dome transchondral fractures, manual distraction (or none at all) is all that is necessary to successfully complete the procedure. There is little need to add the expense and potential complications associated with some distraction systems. However, some cases involve pathology or surgical techniques that either would be better addressed with distraction or absolutely demand distraction. It is recommended that invasive ankle distraction be reserved for (1) cases in which noninvasive distraction has not yielded adequate field visualization or instrument maneuvering room, (2) cases of preoperatively documented pathology involving the posterior talar dome (including some medial talar dome fractures) or inferior tibial surface, or (3) arthroscopic ankle fusion. Consideration should be given to providing 6 to 12 weeks of protected function of the extremity to avoid delayed fracture presentation. In general, the invasive distraction system should be reserved for those cases that would not ordinarily be managed with aggressive rehabilitation and early return to activities. For those cases where the benefits of distraction are desired (some dome fractures, meniscoid lesions, gutter pathology, and adhesive capsulitis) and aggressive rehabilitation with early return to activities may be planned, noninvasive distraction systems are now available that offer a sustainable joint separation of good magnitude. With the growing availability and effectiveness of the commercial noninvasive ankle distractors, I do not disagree with Stone and Guhl98 when they advocate the use of noninvasive distraction for routine arthroscopic procedures, with conversion to invasive distraction should there be insufficient joint separation. In summary, providing optimal field visualization and maneuvering room for instrumentation is essential for the successful performance of arthroscopic ankle surgery. This article has discussed options available to the arthroscopist that can assist in achieving these objectives. The exact method of distraction selected for a given case may be determined by the arthroscopist by weighing the issues discussed in this article.

Ankle Joint↗
PubMed1994

Pressure-removing strategies in neuropathic ulcer therapy. An alternative to total contact casting.

Technical considerations, advantages, and disadvantages of felt and foam contact pads have been presented. Anecdotally, it appears the technique provides a more dynamic, safe, and practical method of ulcer decompression compared with total contact casting. In light of the apparent advantages of felt and foam contact padding, a randomized prospective study would be worthwhile to determine the effectiveness of this modality as compared with total contact casting.

Casts, Surgical↗
PubMed1992

Metatarsus adductus and selected radiographic measurements of the first ray in normal feet.

Radiographic evaluation of hallux abducto valgus frequently involves the measurement of the metatarsus adductus angle, first-second intermetatarsal angle, hallux abductus angle, and proximal articular set angle. While the concept that there is a relationship between untreated metatarsus adductus and hallux abducto valgus deformity is not new, a quantifiable relationship between the metatarsus adductus angle and intermetatarsal angle, hallux abductus angle, and the proximal articular set angle in normal feet is relatively undocumented. The purpose of this study is to document relationships between the metatarsus adductus angle and the other three measurements, and to establish normal values for the intermetatarsal angle, hallux abductus angle, and proximal articular set angle within metatarsus adductus angle subgroups.

Adolescent↗
PubMed1991

Cubonavicular coalition.

The cubonavicular coalition is a rare form of tarsal coalition that probably accounts for less than 1% of all coalitions. The authors present a new case of cubonavicular coalition as well as the findings of the 17 previously published accounts. Etiology, clinical presentation, diagnosis, and treatment of the condition are discussed.

Adolescent↗
PubMed1991

Surgical approaches of the rearfoot and ankle.

The number of alternative approaches for the variety of rearfoot and ankle procedures commonly performed is clearly as great as the imagination of the surgeon. To ensure that the incisional approach is to contribute to the overall success of the procedure, the right approach must be selected and properly performed. To facilitate this process, general principles of incision placement and performance in the rearfoot and ankle have been presented. Building on those principles, one can learn the various techniques, as well as their respective advantages and disadvantages. Finally, the discerning surgeon should be able to apply the information presented here to select and perform the right incisional approach. Furthermore, the same process may lead the surgeon to improvise and create a successful alternative.

Achilles Tendon↗
PubMed1990

Fixation of the Austin procedure with the Herbert screw. A modified technique.

Although the Austin osteotomy is intrinsically stable, some surgeons use fixation to enhance stability. One form of fixation that may be used for this procedure is the Herbert screw. The author presents a modification of a previously reported technique, and describes it as a five-step process. The advantages and potential disadvantages of the use of the Herbert screw with the presented technique are discussed.

Bone Screws↗
PubMed1989

Electrical stimulation of cutaneous ulcerations. A literature review.

The effect of electrical currents on living cellular systems has been studied by many researchers and is becoming useful in clinical medicine. Alteration of cellular activity with externally applied currents can positively or negatively influence the status of a healing tissue, thereby directing the healing process to a desired outcome. A review of the literature pertaining to the effect of electrical currents on tissue healing is presented and the relevance of this modality to ulcer healing is discussed.

Clinical Trials as Topic↗
PubMedDate not supplied

Intra-evaluator variability in the measurement of proximal articular set angle.

In the evaluation of the distal articular orientation of the first metatarsal in hallux abducto valgus, one tool that can be employed is the radiographic measurement of the proximal articular set angle (PASA). Although it has been demonstrated that the inter-evaluator reliability of the measurement of PASA is suboptimal, the measurement may still retain usefulness. If intra-evaluator reliability is acceptable and the measurement is a valid predictor of the intraoperative condition, then the measurement retains clinical usefulness. The present study was designed to determine the intra-evaluator reliability of the measurement of PASA. Five evaluators were asked to make the measurement on five radiographs. Measurements were repeated approximately every 2 weeks until a total of 12 measurements on each radiograph were complied. A Chi-square distribution test of variance was utilized to analyze the data. The results demonstrated that the intra-evaluator reliability of the measurement of PASA was acceptable in three of the five evaluators, suggesting that some physicians can achieve satisfactory consistency in the measurement. It is unclear why the intra-evaluator reliability of the measurement of PASA is suboptimal for some physicians. Further study is required to address this issue, as well as the issue of the validity of the measurement.

Chi-Square Distribution↗
PubMedDate not supplied

Plantaris tendon reconstruction of the lateral ankle ligaments.

Numerous procedures have evolved to operatively stabilize the ankle suffering from chronic inversion instability. The use of the plantaris tendon to anatomically reconstruct the lateral collateral ankle ligaments is among those that avoid the complication of restriction of subtalar joint range of motion. The authors present a modified technique of reconstructing the calcaneofibular and anterior talofibular ligaments using a plantaris tendon that maintains its insertion. A retrospective study of eight patients that elected the procedure for chronic ankle instability was conducted. The average follow-up was 12.7 months. Significant improvement in functional score (p less than 0.01) and talar tilt (p less than 0.05) was noted following the procedure. No restriction of subtalar joint motion was observed in any patient after the procedure. The advantages and disadvantages of the procedure are discussed. The authors conclude that the procedure appears to be a desirable alternative in achieving ankle stability while maintaining normal hindfoot function.

Adolescent↗
PubMedDate not supplied

Concurrent calcaneonavicular and talocalcaneal coalitions.

Dual calcaneonavicular and talocalcaneal coalitions are probably not rare. Given the possibility for failed calcaneonavicular bar resection if a concurrent talocalcaneal bar goes undetected, careful preoperative evaluation is suggested. A case presentation has been made to illustrate the clinical significance of this problem.

Adult↗
PubMedDate not supplied

Orientation of the first metatarsal base wedge osteotomy: perpendicular to the metatarsal versus weight-bearing surface.

Changes have been proposed in the orientation of the first metatarsal base closing abductory wedge osteotomy based on sound theoretical reasoning. The newer proposed method, utilizing an orientation of the osteotomy perpendicular to the weight-bearing surface, produces only pure transverse plane motion and no loss of ground contact by hinge axis mechanisms. In contrast, the traditional orientation of the osteotomy, perpendicular to the long axis of the metatarsal, produces extraneous frontal plane motion that results in loss of ground contact as the osteotomy site is closed. The presented study formulates a mathematical model to calculate the amount of loss of ground contact produced by the traditional osteotomy orientation. The values obtained from 168 calculations suggest far less clinical significance to the change than has been implied or stated previously.

Humans↗
PubMedDate not supplied

Interevaluator variability in the measurement of proximal articular set angle.

The proximal articular set angle (PASA) is used in the evaluation of hallux abducto valgus, as well as a criterial parameter for the selection or rejection of various hallux abducto valgus corrective procedures. The authors casually observed variability in the measurement of PASA in clinical situations, stimulating the development of the presented study to determine if, in fact, the measurement of PASA varies excessively from one physician to another. The results clearly indicate that the interevaluator measurement of PASA is excessive (p less than 0.001 in seven of eight x-ray series and p less than 0.01 in one of eight x-ray series). The authors discuss the clinical implications of the findings. Furthermore, the shortcomings of the study are discussed, specifically the inability to conclude about intraevaluator variability.

Analysis of Variance↗
PubMedDate not supplied

Adhesive capsulitis of the ankle.

Adhesive capsulitis is a rheumatologic complication that may be encountered in the ankle joint in posttraumatic situations. The condition presents with chronic ankle pain, stiffness, and swelling. The diagnosis can be confirmed arthrographically. A report is made of a severe case that was successfully treated with arthroscopic surgery. The shortcomings of the existing literature are discussed. The authors suggest that, where applicable, arthroscopy should be utilized in the diagnosis and treatment of this condition.

Adult↗
PubMedDate not supplied

Vasoconstrictive agents commonly used in combination with local anesthetics: a literature review.

A review of the current medical literature concerning the use of various vasoconstrictive agents with local anesthetics is presented. These agents are employed in podiatry primarily for the purpose of prolonging the duration of anesthesia and surgical hemostasis. Epinephrine, phenylephrine, levonordefrin, felypressin, and norepinephrine have all been utilized in conjunction with the local anesthetics by the various medical professions. Although controversy surrounds the use of these agents, this article should assist the podiatric physician in making an informed decision.

Anesthetics, Local↗