Biomedical subjects

Timothy R Daniels

Publications and source records attributed to Timothy R Daniels.

4 recordsLinked to original sources

PubMed2005

Functional outcome of the foot and ankle after free fibular graft.

BACKGROUND: The vascularized fibular bone graft (VFBG) is one of most common grafts used for free flap transfer. There have been no reports in the literature evaluating the functional outcome of the foot and ankle after a VFBG using validated functional outcome measures. In addition, most of the patients in published studies have had contralateral or ipsilateral lower limb pathology. The purpose of this study was to evaluate the functional outcome of the foot and ankle after a VFBG using validated functional outcome measures in patients with no preexisting lower limb pathology. METHODS: We conducted a retrospective analysis of our health center database and identified 28 patients who underwent free flap transfer for maxillofacial reconstruction. Patients were contacted by phone and mailed functional questionnaire packages. Functional outcome assessments were obtained through the use of the following validated functional outcome instruments: the Short Form-36 (SF-36), the Functional Foot Index (FFI), and the lower limb component of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). A matched student t-test was used to compare the experimental limb to the appropriate control group. RESULTS: The response rate was 77%. The incidence of wound complications was 23% (five of 22). Two of the five were caused by wound dehiscence, and three were caused by infection. There was an 18% incidence of clawing of the great toe. The SF-36 scores were not significantly different between the VFBG cohort and the control group. There was a statistically significant difference in FFI scores for all three categories: pain (p = 0.01), disability (p = 0.03), and activity limitation (p = 0.01). Nine patients (41%) were dissatisfied with their foot and ankle function at 3.1 years. CONCLUSIONS: The VFBG is an ideal source for a free flap. The impact of the procedure on overall patient health is relatively minimal. However, there is a significant deleterious effect on foot and ankle function.

Adult↗

PubMed2003

Primary fusion as salvage following talar neck fracture: a case report.

For a 29-year-old man with a three-week-old Hawkins Type IV talar neck fracture, intra-operative reduction and fixation were not possible due to soft tissue contractures and severe comminution. A primary talonavicular and subtalar arthrodesis with the use of iliac crest bone graft was performed. Postoperative follow-up at 16 months demonstrated solid fusions, no avascular necrosis of the talus and a functional range of motion at the ankle. He was not capable of returning to his job of roof maintenance.

Adult↗

PubMed2003

Ankle arthritis.

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Ankle Joint↗

PubMedDate not supplied

Avascular necrosis of the talus: a pictorial essay.

The talus is predisposed to avascular necrosis (AVN), or bone death due to ischemia, owing to its unique structure, characteristic extraosseous arterial sources, and variable intraosseous blood supply. Both traumatic and atraumatic causes have been implicated in talar AVN. The risk of posttraumatic AVN can be predicted using the Hawkins classification system. In addition, the "Hawkins sign" can be used as a radiographic marker that excludes the development of AVN. At radiography, talar AVN typically manifests as an increase in talar dome opacity (sclerosis), followed by deformity and, in severe cases, articular collapse and bone fragmentation. At any stage of this sequence, the radiographic findings can vary depending on differences in the vascular status of the talus and the degree of bone repair. Magnetic resonance imaging is the most sensitive technique for detecting talar AVN and can be used when AVN is strongly suspected clinically despite normal radiographic findings. Computed tomography (CT) also demonstrates typical patterns and can be used to confirm radiographic findings. Coronal CT is required for viewing the articular surface of the talar dome to rule out subtle depression, collapse, and fragmentation. Nevertheless, radiography remains the mainstay of the diagnosis and temporal observation of talar AVN.

Adolescent↗