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Biomedical subjects

Steven M Raikin

Publications and source records attributed to Steven M Raikin.

17 recordsLinked to original sources
PubMed2006

Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics.

PURPOSE: To determine retrospectively the magnetic resonance (MR) findings associated with pedal neuropathic arthropathy with and without superimposed osteomyelitis and to identify any useful discriminating features. MATERIALS AND METHODS: Investigational review board approval was obtained and allowed review of records and images without informed consent. HIPAA compliance was observed. Contrast-enhanced MR images in patients with diabetic neuropathic arthropathy of the foot were examined by two reviewers in consensus. Affected joints were examined for marrow, articular, periarticular, and soft-tissue findings. Presence of superimposed osteomyelitis was documented. A subgroup that had undergone MR before infection was evaluated for comparison; chi(2) and t tests were used to evaluate the associations. RESULTS: Of 128 neuropathic joints in 63 patients (24 female, 39 male; aged 31-78 years), 43 had superimposed osteomyelitis. Effusion was common in all neuropathic joints, but thin rim enhancement was more common in noninfected joints (62% vs 21%, P < .001) and diffuse joint fluid enhancement was more common with infection (47% vs 26%, P = .052). Subluxation, bone proliferation, fragmentation, and erosion were seen in both groups, but intraarticular bodies were more common in noninfected joints (53% vs 12%, P < .001). In the periarticular soft tissues, edema, enhancement, and ulceration were common in both groups. Fluid collections in the soft tissues were more commonly associated with infected joints (95% vs 48%, P < .001) and, when present next to an infected joint, were larger than those next to noninfected neuropathic joints (2.6 cm(2) [range, 0.3-8.6 cm(2)] vs 1.6 cm(2) [range, 1.0-2.4 cm(2)]). Soft-tissue fat replacement (68% vs 36%, P = .002) and sinus tracts (84% vs 0%, P < .001) were also more common with infection. In the marrow, periarticular signal intensity abnormality was common in both groups, but the extent was greater with infection. Subchondral cysts were seen almost exclusively in noninfected joints (76% vs 2%, P < .001). Similar results were obtained in the subgroup of 21 joints (15 patients) with both pre- and postinfection MR images. CONCLUSION: Sinus tract, replacement of soft-tissue fat, fluid collection, and extensive marrow abnormality are MR imaging features indicating superimposed infection. Thin rim enhancement of effusion, presence of subchondral cysts, or intraarticular bodies indicate absence of infection.

Adult↗
PubMed2006

Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems.

BACKGROUND: MRI findings are used in several staging systems to help determine appropriate treatment. The purposes of this study were to evaluate longitudinal changes in MRI characteristics of osteochondral lesions of the talus (OLT) and to evaluate published staging systems in a cohort of nonoperatively treated patients. METHODS: Twenty-nine patients were identified; MR images were reviewed for location, size, and interface signal of OLT as well as cysts, marrow edema and osteoarthritis. Lesions were classified as unchanged, progressed, or improved based on changes in size or interface signal. Each lesion was assigned a stage based on four different staging systems. RESULTS: Of the 29 lesions, 13 progressed, seven improved, and nine were unchanged over an average followup of 13.7 months. In the 13 that progressed, marrow edema remained present in ten and developed in two. Four had persistent cysts and four developed new cysts. Two had progression of osteoarthritis and two developed it anew. In the seven that improved, six had some degree of marrow edema that persisted and one had a persistent cyst. Initial staging changed for at least one classification system in 16 (55%) of the 29 lesions at followup. Change in stage was primarily due to development (four of 16) or disappearance of cysts or progression of the lesion in the extent of bone marrow edema (five of 16). CONCLUSIONS: OLT did not invariably progress over the short-term without operative intervention. Because some cysts and bone marrow edema resolved on MRI, they may not be reliable signs of lesion severity nor show progression of degenerative changes. Since these findings determine the stage and severity of OLT in some staging systems, they may require reconsideration and adjustment of the current staging systems.

Adolescent↗
PubMed2006

Avoiding and managing complications of the Agility Total Ankle Replacement system.

Intermediate clinical and radiographic results of the new generation of total ankle arthroplasties have been encouraging. Many of the devastating problems of earlier designs have been avoided, yet these newer implants are not without complications. Many problems can be avoided with careful preoperative planning and by paying meticulous attention to technique during implantation. Common pitfalls with the implantation process of the Agility Total Ankle Replacement (DePuy, Warsaw, Ind) are discussed. The diagnosis and treatment of complications occurring intraoperatively and in the intermediate- and longer-term postoperative period are outlined, with recommendations on how to avoid them.

Ankle Joint↗
PubMed2005

Bioabsorbable fixation in foot and ankle.

Bioabsorbable implants are playing an increasing role in the surgical management of foot and ankle pathologies. Current technology allows implants to have acceptably comparable strength and pull-out characteristics to metallic implants. The advantages include elimination of secondary surgeries, biodegradability of implants placed across mobile articular surfaces, as well as acceptable biocompatibility and resorption properties to limit historical complication concerns.

Absorbable Implants↗
PubMed2005

Local bone graft harvested from the distal tibia or calcaneus for surgery of the foot and ankle.

BACKGROUND: Numerous operative procedures around the foot and ankle use bone graft to augment healing. Autologous bone graft remains the preferred type for these procedures. This can be harvested from the iliac crest, but complications are frequent. The purpose of our study was to investigate the option of harvesting the bone graft from the ipsilateral distal tibia or calcaneus. METHOD: Bone graft was harvested in 114 patients from the distal tibia (70 patients) or calcaneus (44 patients). The patients were followed postoperatively for an average of 16 (range 5 to 28) months and were evaluated for complications (minor and major), satisfaction, and healing rates. RESULTS: There were no major complications. Ten patients (8.7%) had minor complications including initial incisional sensitivity or local numbness, none of which affected function or required additional treatment. Satisfaction rate for the procedure was 100%. CONCLUSION: Use of autologous bone graft harvested from the ipsilateral distal tibia or calcaneus is a safe and reliable alternative to iliac crest bone graft harvest for operative procedures of the foot and ankle.

Adolescent↗
PubMed2005

Bilateral simultaneous fasciotomy for chronic exertional compartment syndrome.

BACKGROUND: Chronic exertional compartment syndrome (CECS) occurs bilaterally in approximately 60% of patients. Fasciotomy is the primary corrective treatment. We hypothesized that bilateral fasciotomy can be done during the same operative procedure with early return to sports and low complication rates METHOD: Sixteen patients had simultaneous bilateral lower extremity fasciotomies for CECS confirmed by compartment pressure testing before and after exercise. Ten patients had concomitant superficial peroneal neurolysis for associated numbness. All patients who were athletes (six runners; nine ball sports) (average age 25 years) had sports related pain limiting participation. RESULTS: Patients were followed for an average of 16.4 (range 6 to 48) months. Full return to sports participation occurred at an average of 10.7 weeks. Three patients continued to have mild, but much improved, pain with active sports participation, while 13 were pain free. All 11 patients with exertional related numbness had resolution after operative release. All patients were satisfied and all patients stated that they would have simultaneous fasciotomies again if required. As a nonmatched comparison, three patients who had staged fasciotomies for bilateral CECS were also evaluated, but because of the small number no statistical comparison was made. All three also returned to their previous levels of sports participation, however, at an average of 22.7 months as compared to 10.7 weeks in patients with simultaneous bilateral releases. CONCLUSION: Bilateral simultaneous fasciotomies for CECS can be done safely and effectively with early return to sports participation and low complication rates.

Adolescent↗
PubMed2004

Stage VI: massive osteochondral defects of the talus.

This article addresses very large osteochondral lesions of the talus with an osteonecrosis overlap. Six cases are discussed where lesions were deemed too large for osteochondral autograft transfer (OATS) or autologous chondrocyte transplant (ACT). These cases were treated with bulk fresh or fresh frozen matched talus allograft transplantation. The associated literature is reviewed.

Adolescent↗
PubMed2004

The accessory navicular.

The accessory navicular is a common presence in the human foot and must be included in the differential diagnosis of medial foot pain in patients who are of appropriate age. Imaging modalities aid in diagnosis of a symptomatic ossicle and guide classification and treatment. Often, a combination of studies is needed to establish an accessory navicular as the source of foot pathology. Although conservative measures always are the first line of treatment, the benefits of surgical management are well-defined in the literature. Most foot surgeons rely on resection procedures with varied handling of the PTT insertion, although newer modifications that use bony fusion techniques are being investigated. As with any musculoskeletal condition, proper diagnosis and individually-tailored treatment plans are of the utmost importance to a satisfactory outcome. With meticulous patient selection and a thorough understanding of the condition, management of the painful accessory navicular often is successful in alleviating the disability it causes.

Biomechanical Phenomena↗
PubMed2004

Dynamic sonographic evaluation of peroneal tendon subluxation.

OBJECTIVE: Peroneal tendon subluxation is a major cause of posttraumatic lateral ankle pain. Because peroneal subluxation often occurs only when the foot is dorsiflexed and everted, findings on static imaging studies may appear to be normal. We therefore evaluated the effectiveness of sonography in revealing peroneal tendon subluxation in patients performing stress maneuvers. MATERIALS AND METHODS: From June 2001 to June 2003, 13 consecutive patients (10 females and three males; mean age, 30.4 years; age range, 16-66 years) in whom peroneal tendon subluxation was clinically suspected were scanned with a high-frequency linear array transducer by an experienced sonologist. The ankles in 10 asymptomatic volunteers were also scanned. Sequential axial and longitudinal sonograms of the peroneus longus and peroneus brevis tendons at rest were obtained and evaluated for tendinitis and tendon tears. Real-time axial sonograms were then obtained while the foot was dorsiflexed and everted. Of the 13 patients, 12 had sonographic findings of peroneal tendon subluxation and underwent surgical exploration. The sonographic and surgical reports of these 12 patients were compared. RESULTS: All 12 patients with sonographic findings of peroneal tendon subluxation were subsequently found to have subluxation at surgery. The positive predictive value of dynamic sonography for peroneal tendon subluxation was therefore 100%. Sonography revealed peroneus brevis tendon tears in five patients and a peroneus longus tear in one; all findings were confirmed at surgery, with no false-positive sonograms. Only four of the 20 asymptomatic ankles showed subluxation, and none had any other tendon abnormalities. CONCLUSION: Sonography is an effective technique for diagnosing peroneal tendon subluxation, as well as associated tears of the peroneal tendons.

Adolescent↗
PubMed2003

Failed tarsal tunnel syndrome surgery.

Failed tarsal tunnel syndrome surgeries are better prevented than treated. Outcomes for revision procedures are significantly worse than for primaries. Failures should be treated with conservative measures first, then surgery for refractory cases. An adequate release must be ensured, and associatedpathologies must be addressed. One should consider containment procedures for adhesive neuritis and PNS for intraneural or intractable pain.

Algorithms↗
PubMed2003

Arthrodesis of the ankle: arthroscopic, mini-open, and open techniques.

Despite recent advances in ankle arthroplasty technology, arthrodesis remains the gold standard for the operative treatment of advanced ankle arthritis. Choice of technique should be guided by the surgeon's experience and the amount of deformity present. In all cases, close attention to detail is essential in performing this procedure to ensure that the patient is provided with a well-fused, stable ankle and a well-aligned plantar grade foot suitable for functional ambulation.

Ankle Joint↗
PubMed2003

Arthrodesis of the fourth and fifth tarsometatarsal joints of the midfoot.

Maintaining mobility of the fourth and fifth tarsometatarsal joints has been reported to be important in arthrodesis of the midfoot. A review of the records at a tertiary care center of 23 patients (28 feet) with arthrodesis of these joints and a minimum 2-year follow-up showed that 22 complete midfoot arthrodeses were performed as part of the correction for a neuroarthropathic rocker-bottom deformity. Six arthrodeses of the fourth and fifth metatarsal joints were performed on normosensate feet with painful arthritis involving the lateral joints. Clinical and radiographic fusion occurred in 26 of 28 feet. Comparing average preoperative and postoperative scores, functional incapacity from lateral midfoot pathology decreased (8.4/10 to 2.2/10), overall pain scores improved (5.1/10 to 1.3/10), pain scores in the arthritic subgroup decreased (8.2/10 to 2.4/10), and the modified overall AOFAS midfoot score improved (35/100 to 78/100).

Aged↗
PubMed2002

Failure of triple arthrodesis.

In the longest-term follow-up study on triple arthrodesis published to date, Saltzman et al found at 44 years post-fusion, 95% of surviving patients were satisfied with their outcomes despite deteriorating function and some increase in pain with time [13]. All of the cases in this review were performed through a single anterolateral surgical approach and without internal fixation. In symptomatic severe or arthritic pes planovalgus or cavovarus deformity, few operative alternatives to triple arthrodesis are available. Attempts at subtalar resurfacing prostheses led to poor results and subsequent abandonment [46,47], whereas tendon transfer procedures and osteotomy realignments are not always possible or feasible in every patient. Although the indications for and surgical techniques used in triple arthrodesis have evolved and improved with time (predictably improving results in the intermediate term), triple arthrodesis remains a salvage procedure. Thus, deteriorating results with time may be an expected consequence and should not necessarily represent a failure of the technique. The surgical procedure is technically challenging and should be reserved for those surgeons trained and comfortable with all aspects of the surgery. Patient selection is vital, with most triple arthrodeses reserved for older patients. The two-incision approach allows better visualization, particularly of the talonavicular articulation, allowing for adequate resection of cartilage and alignment of the joints. Avoidance of excessive bony resection or wedge resection and the use of rigid internal fixation has increased the reliability of the procedure and diminished the pseudarthrosis rate and the rate of recurrence of the deformity. Failure to perform the procedure in an optimal fashion, however, can lead to a devastating failure with severe pain and dysfunction for the patient.

Arthrodesis↗
PubMed2002

Nerve injuries to the foot and ankle in the industrial setting.

Nerve injuries of the foot and ankle are among the most difficult to diagnose and treat. With the added influences of potential secondary gain and poor motivation of the work injured patient, these injuries can be taxing and frustrating to manage in the acute or chronic setting. This article reviews the neuroanatomy, mechanisms of injury, diagnosis and management of these injuries with specific reference to the patient injured in the industrial setting.

Accidents, Occupational↗
PubMed2002

Tendon involvement in pedal infection: MR analysis of frequency, distribution, and spread of infection.

OBJECTIVE: The objective of our study was to evaluate the frequency, distribution, and extent of tendon involvement in patients with pedal infections. MATERIALS AND METHODS: Contrast-enhanced MR imaging examinations of 159 infected feet performed at 1.5 T were reviewed by two musculoskeletal radiologists for the presence and location of tendon infection (peritendinous enhancement contiguous to an adjacent ulcer or cellulitis) and for the spread of infection along tendons, which was defined as peritendinous contrast enhancement extending more than 2 cm beyond surrounding cellulitis. The study group was composed of 156 consecutive patients, 82.7% of whom had diabetes; all patients underwent subsequent surgical treatment. Results of MR evaluations were compared with the patients' charts and surgical reports. RESULTS: Of the 129 MR examinations showing an infection in the forefoot, MR evidence of tendon involvement in the infection was observed in 56 MR examinations (43%). The sum of involved tendons per ray was as follows: first ray (flexor tendon, n = 19; extensor tendon, n = 13), second (flexor tendon, n = 12; extensor tendon, n = 7), third (flexor tendon, n = 5; extensor tendon, n = 4), fourth (flexor tendon, n = 5; extensor tendon, n = 1), and fifth (flexor tendon, n = 11; extensor tendon, n = 6). Of the 32 MR examinations showing infection in the hindfoot, 14 examinations (44%) showed evidence of tendon involvement, most frequently of the distal Achilles tendon (n = 7). MR evidence of the spread of infection along a tendon was seen in 12 examinations, always with proximal spread of infection; and infection led to the development of an abscess in the central plantar compartment in three patients. Intraoperative evidence of a tendon infection was documented in 11 patients. The surgical procedure was altered because of the tendon infection in six patients. CONCLUSION: MR evidence of tendon infection is present in approximately half the patients who require surgery for pedal infection. Evidence of spread of the infection along tendons is seen infrequently on MR imaging. Detection of a tendon infection could influence surgical therapy.

Adult↗