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Biomedical subjects

Thomas S Roukis

Publications and source records attributed to Thomas S Roukis.

35 records · Page 2Linked to original sources
PubMedDate not supplied

BIOPRO resurfacing endoprosthesis versus periarticular osteotomy for hallux rigidus: short-term follow-up and analysis.

Forty-four patients (47 feet) were enrolled in a prospective hallux rigidus study. A subjective evaluation, physical examination, and radiographic analysis were performed preoperatively and at a 1-year follow-up. Twenty patients (20 feet) underwent a periarticular osteotomy, with 16 patients (16 feet) returning. Seven patients (9 feet) underwent a BIOPRO resurfacing endoprosthesis, with all patients returning. The subjective evaluation was based on a modified American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal 100-Point scale. The physical examination included first metatarsophalangeal joint range of motion. Radiographic analysis included the metatarsal protrusion distance, transverse plane angulation of the second digit, lateral talo-first metatarsal angle, sagittal plane relationship of the first and second metatarsals, and hallux equinus angle. Statistically significant differences between preoperative and postoperative values were found for the periarticular osteotomy group for the metatarsal protrusion distance (P =.000), transverse plane angulation of the second digit (P =.000), and lateral talo-first metatarsal angle (P =.015). No other statistically significant differences between the pre-operative and post-operative values for either procedure group were found to exist. For this specific patient population the short-term results of surgical intervention for hallux rigidus, whether through a periarticular osteotomy or resurfacing endoprosthesis, provided subjective patient improvement and satisfaction, as well as, minimal increase in first metatarsophalangeal joint range of motion.

Arthroplasty, Replacement↗
PubMedDate not supplied

Hypermobility of the first ray: a critical review of the literature.

The authors provide a detailed review of the available literature regarding first ray sagittal plane direction and range of motion with special emphasis on whether or not hypermobility of the first ray can truly be supported as a definable clinical entity. They also describe a novel clinical test for assessing sagittal plane instability of the first ray. The authors believe that this test, when combined with previously defined clinical tests, helps to identify those few patients that would benefit from an arthrodesis procedure of the medial pillar of the foot for the treatment of the hallux valgus deformity.

Foot Joints↗
PubMedDate not supplied

Predicting articular erosion in hallux valgus: clinical, radiographic, and intraoperative analysis.

The authors present a prospective intraoperative evaluation of the articular wear pattern of the first metatarsal, tibial and fibular sesamoids, and base of the proximal phalanx of 166 feet undergoing hallux valgus surgery. The collected data were compared with various clinical parameters and radiographic measurements to determine if any of these variables can predict the incidence and location of articular erosion. The incidence and predictability of the location of the articular erosion increased significantly as the patient's age ( P = .000), intermetatarsal angle 1-2 ( P = .004), hallux abductus angle ( P = .000), tibial sesamoid position ( P = .016), and proximal articular set angle ( P = .02) increased. The association of foot type (ie, digital length pattern), metatarsal protrusion distance, metatarsal head shape, and hallux abductus interphalangeus was not significant. Therefore, preoperative clinical parameters (ie, age) and radiographic measurements (ie, intermetatarsal angle 1-2, hallux abductus angle, tibial sesamoid position, and proximal articular set angle) can directly define the incidence and location of articular erosion and are helpful in the preoperative assessment of the hallux valgus deformity. In addition, nearly every first metatarsophalangeal joint evaluated had some degree of articular erosion and, in certain circumstances (ie, advanced age and increased proximal articular set angle), it was universal and extensive.

Adult↗
PubMedDate not supplied

Determining the insertion site for retrograde intramedullary nail fixation of tibiotalocalcaneal arthrodesis: a radiographic and intraoperative anatomical landmark analysis.

Literature regarding the optimal entry point at the plantar aspect of the heel for performing tibiotalocalcaneal arthrodesis with a locked retrograde intramedullary nail is plentiful, but fails to provide meaningful guidance beyond broad generalizations. Because of the complex nature of the procedure, which requires precise alignment of multiple joints, difficulties in guide-wire placement frequently arise. Furthermore, proper guide-wire placement is usually performed under image intensification, placing the patient, surgeon, and operating room personnel at risk of ionizing radiation. This study evaluates weight-bearing lateral radiographic and anatomical landmarks to determine the optimal guide-wire entry point at the plantar heel fat pad, as well as a prospective intraoperative evaluation of the efficacy of using these landmarks to properly seat the guide wire. Radiographic and anatomical landmark portions of the study revealed that the calcaneocuboid joint was located 18.5+/-3.4 mm anterior to the tibia mid-diaphyseal line, and that the lower leg soft tissue outline approximated the calcaneocuboid joint to within 0.3+/-1.2 mm. The intraoperative portion of the study revealed that by first aligning the guide wire with the lower leg soft tissue outline, which approximated the location of the calcaneocuboid joint, and then translating the wire approximately 2.0 cm posteriorly, the increase in the efficacy of properly seating the guide wire was statistically significant (P<or=.0001). The author proposes that this technique improves the accuracy of guide-wire placement and decreases dependency on intraoperative image intensification.

Arthrodesis↗
PubMedDate not supplied

Salvage of the first ray in a diabetic patient with osteomyelitis.

A case report is presented of a 65-year-old diabetic woman with an 18-month history of a penetrating ulcer of the plantar aspect of the first metatarsal head with associated sepsis of the first metatarsophalangeal joint and adjacent underlying osteomyelitis. Salvage of the first metatarsophalangeal joint was performed through aggressive soft-tissue and osseous debridement, external fixation with antibiotic-loaded polymethyl methacrylate bone cement, and delayed interpositional autogenous iliac crest bone graft arthrodesis. Osseous incorporation of the interposed bone graft occurred 12 weeks postoperatively. No soft-tissue or osseous complications occurred during the postoperative period, and at 1-year follow-up there was no evidence of ulceration recurrence, transfer ulceration, shoe-fit problems, or gait abnormalities. A detailed review of the literature on the use of external fixation and interpositional bone graft distraction arthrodesis of the first metatarsophalangeal joint is presented.

Aged↗
PubMedDate not supplied

Reconstruction of the great toe ski-slope, sunken-nail deformity with a buried adipofascial flap.

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient's persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity.

Adult↗
PubMedDate not supplied

A simple technique for correcting footdrop: suspension tenodesis of the tibialis anterior tendon to the distal tibia.

Surgical correction of the footdrop deformity caused by various neuromuscular diseases is a time-honored technique, with most surgical procedures intended to correct the absence of active dorsiflexion and a concomitant cavovarus foot deformity. We describe suspension tenodesis of the tibialis anterior tendon to the distal tibia to correct the footdrop deformity. This technique is simpler to perform and more secure than transferring the distal attachment of a tendon to a new location in the foot itself or using tendon weaving techniques. In addition, compared with an ankle fusion, our technique allows for a certain amount of shock absorption during gait and is much less invasive, and a future ankle fusion could be performed if needed for full stability and definitive correction of the symptomatic footdrop. Finally, the technique we describe is easily reproducible and seems to remain stable over time.

Foot Deformities, Acquired↗
PubMedDate not supplied

Metatarsus primus elevatus in hallux rigidus: fact or fiction?

Two hundred seventy-five lateral weightbearing radiographs of isolated pathology were reviewed and stratified into hallux rigidus (n = 100), hallux valgus (n = 75), plantar fasciitis (n = 50), and Morton's neuroma (n = 50) groups. The patient population consisted of healthy individuals with no history of foot trauma or surgery. The first to second metatarsal head elevation, Seiberg index, first to second sagittal intermetatarsal angle, first to fifth metatarsal head distance, and hallux equinus angle were measured in each population. Statistically significant differences were found between the hallux valgus, plantar fasciitis, and Morton's neuroma populations and the hallux rigidus population, which showed greater elevation of the first metatarsal relative to the second for each radiographic measurement technique. In the hallux rigidus population, there was a statistically significant difference between grade II and grades I and III regarding the first to fifth metatarsal head distance (greater in grade II) and the hallux equinus angle (lower in grade II). A review of the literature and comparison with historical controls reveals that metatarsus primus elevatus exists in hallux rigidus and is greater than that found in hallux valgus, plantar fasciitis, and Morton's neuroma groups.

Adult↗
PubMedDate not supplied

Spontaneous bilateral ankle and midfoot sepsis in a nonimmunocompromised patient.

We describe a 70-year-old nonimmunocompromised woman with spontaneous bilateral ankle and midfoot sepsis and a deep-space abscess of the right lower leg. Salvage of both limbs was achieved by aggressive bilateral soft-tissue and osseous debridement, including a four-compartment fasciotomy of the right lower leg, antibiotic-loaded polymethyl methacrylate bone cement implantation, delayed allogeneic bone grafting of the osseous defects impregnated with autologous platelet-rich plasma bilaterally, and external fixation immobilization, implantable bone growth stimulation, and split-thickness skin graft coverage of the right lower leg, ankle, and foot. Osseous incorporation of the bone grafts bilaterally occurred 8 weeks after surgery. No soft-tissue or osseous complications occurred during the postoperative period or at 18-month follow-up except for arthrofibrosis in the right ankle; there was no evidence of recurrent abscesses, sequestrum, or wound-related problems. A review of the literature regarding bilateral pedal sepsis and the techniques used for limb salvage in this patient are presented in detail.

Abscess↗
PubMedDate not supplied

Distally based capsule-periosteum interpositional arthroplasty for hallux rigidus. Indications, operative technique, and short-term follow-up.

Twelve patients (15 feet) with severe hallux rigidus underwent distally based capsule-periosteum interpositional arthroplasty of the first metatarsophalangeal joint (mean +/- SD follow-up, 16.8 +/- 7.0 months). Subjective evaluation was based on a modified version of the American Orthopaedic Foot and Ankle Society's 100-point Hallux Metatarsophalangeal-Interphalangeal Joint Scale. Objective evaluation consisted of preoperative and postoperative physical examinations (first metatarsophalangeal joint range of motion and axial grind testing) and radiographic evaluations (joint space width). The short-term results of this novel procedure showed subjective patient improvement and satisfaction, increased first metatarsophalangeal joint dorsal range of motion, maintained hallux plantar range of motion and power, and improved joint space width on anteroposterior and lateral radiographs. None of the patients developed a hallux hammer toe or extensus deformity or lesser metatarsalgia, and none required further surgical intervention. After describing the indications of the procedure and the surgical technique, the authors compare the results with those of the various other procedures available for the surgical treatment of hallux rigidus.

Adult↗
PubMedDate not supplied

Hallux proximal phalanx Akin-Scarf osteotomy.

Numerous hallux proximal phalanx osteotomies have been described, but the Akin-type varisation or adduction osteotomies are currently the most commonly used by foot and ankle surgeons. This article describes the hallux proximal phalanx Akin-Scarf osteotomy. This osteotomy combines the inherent stability of the Scarf-type osteotomy with the versatility of the Akin-type osteotomies to correct pathologic hallux abductus interphalangeus, hallux equinus, or an abnormal digital length pattern, and it is an invaluable tool during the global surgical approach used for hallux valgus repair.

Foot Bones↗