New miniplate for osteosynthesis of mandibular angle fractures designed to improve formation of new bone.

The purpose of this article is to present the study of a new miniplate designed to keep the maximum strains developed in the cortical bone near the fracture line during accidental biting to values below the threshold causing bone resorption. Designed to offer maximum fracture stability with minimal implanted volume and patient intrusion, the design uses a novel approach to account for the effects of the distance from the fracture line to the nearest screws. Its geometry minimizes the peak forces that can develop during most cases of mandible biomechanical loadings.

Remission of severe restless legs syndrome and periodic limb movements in sleep after bilateral excision of multiple foot neuromas: a case report.

Introduction: Restless legs syndrome is a sensorimotor neurological disorder characterized by an urge to move the legs in response to uncomfortable leg sensations. While asleep, 70 to 90 percent of patients with restless legs syndrome have periodic limb movements in sleep. Frequent periodic limb movements in sleep and related brain arousals as documented by polysomnography are associated with poorer quality of sleep and daytime fatigue.

Actin-binding proteins in a postsynaptic preparation: Lasp-1 is a component of central nervous system synapses and dendritic spines.

CNS synapses are complex sites of cell-cell communication. Identification and characterization of the protein components of synapses will lead to a better understanding of the mechanisms of neurotransmission and plasticity. We applied multidimensional protein identification technology (MudPIT) to purified, guanidine-solubilized postsynaptic fractions to identify novel synaptically localized molecules.

Subcutaneous phaeohypomycosis caused by Scytalidium dimidiatum in the foot of an immunosuppressed host.

The authors present a case report of a subcutaneous phaeohypomycosis of the foot in an immuno-suppressed patient. The lesion was caused by Scytalidium dimidiatum, a dematiaceous fungus, which has only been reported to cause three previous similar lesions. To our knowledge, this is the first reported case of this fungus causing a deep-seated mycoses in the United States.

Z-bunionectomy: retrospective long-term study.

Long-term patient satisfaction and objective clinical and radiographic examinations of patients who had undergone the Z-bunionectomy at the University of Chicago Medical Center were evaluated. Fifty-six surgeries were performed on 31 patients, with a follow-up range of 5 to 9 years. The University of Maryland 100-Point Painful Foot Center Scoring System was modified to be more specific to bunion surgery, and we used this modification to measure patient satisfaction.

The use of ultrasonography for the detection of retained wooden foreign bodies in the foot.

The efficacy of ultrasonography for the detection of wooden foreign bodies in the foot was analyzed retrospectively. Twenty patients underwent real-time, high-resolution ultrasound studies (7.5 or 10 MHz, linear array transducers) to rule out the presence of a wooden foreign body in their feet.

Complications of foot surgery. Nonunions and related disorders.

Management of malunions, delayed unions, and nonunions is a complex task that initially requires appropriate diagnosis and classification. Diagnostic modalities currently used include radiography, fluoroscopy, tomography, computed tomography, and radionucleotide evaluations. Based on these evaluations, nonunions may be classified as hypervascular or avascular in nature.

Z-bunionectomy with internal screw fixation.

A new procedure for the correction of hallux valgus was performed on 39 patients (66 feet). The follow-up period averaged 29 months, with a range of 24 to 32 months. The new procedure is a horizontally directed displacement Z-osteotomy in the head and shaft region of the first metatarsal.

Retrospective analysis of surgical treatment of hallux rigidus/limitus: clinical and radiographic follow-up of hinged, silastic implant arthroplasty and cheilectomy.

Many authors have hypothesized on the etiology of hallux limitus and have proposed grading systems for classifying the degree of first metatarsophalangeal joint derangement and dysfunction. Several opinions exist regarding surgical treatment, should a patient fail with conservative therapy. Hinged, Silastic implant arthroplasty and cheilectomy account for a significant proportion of procedures accomplished.

Prophylactic surgery in the diabetic foot.

Prophylactic surgery in the diabetic foot is often fraught with complications, according to a five-year retrospective study at the University of Chicago Hospitals and Clinics. The findings indicate that seven major areas need be addressed in order to properly evaluate the potential diabetic surgical patient. These include careful evaluation of preoperative nutritional status, vascular status, neurologic status, bacteriologic culture status, deformity status, radiologic status, and surgical predictive index.

Retrospective analysis of intermetatarsal neuroma excision with preservation of the transverse metatarsal ligament.

The authors present a retrospective analysis of intermetatarsal neuroma excision with preservation of the transverse metatarsal ligament. They reviewed a series of 43 patients who had undergone a total of 59 such surgical resections. No other surgical procedures were performed on the foot.

Sports-related tendon injuries of the foot and ankle.

Treatment of major tendon injuries is a complex and challenging subject. It is necessary to have a thorough understanding of the mechanism of injury to successfully treat these soft tissue injuries of the foot and ankle.

Posterior tibial tendon rupture in a world class runner.

Complete rupture of the posterior tibial tendon occurs infrequently. It can be caused by a variety of factors, including repeated steroid injections, chronic tenosynovitis, and decreased blood supply to the tendon. The authors report a world class runner who sustained a rupture requiring surgical intervention.

Percutaneous transluminal angioplasty in the treatment of ischemic disease of the lower extremity.

Symptoms of severe peripheral vascular disease in the lower extremity necessitate attempts to revascularize the limb. Patients refusing or unable to undergo direct arterial surgery may be candidates for percutaneous transluminal angioplasty. Combined with realistic goals regarding foot salvage, careful selection of patients for angioplasty may prevent unnecessary amputations and permit local surgical care of the foot.

Foot trauma in a rural hospital.

The authors made a survey of a rural hospital emergency room to determine the types of foot injuries seen and the frequency of foot injuries in relation to total emergency room visits. The study showed that foot fractures made up a significant portion of emergency room admissions.

The effect of a thigh tourniquet on the incidence of deep venous thrombosis after operations on the fore part of the foot.

We performed a prospective randomized clinical study to determine whether use of a thigh tourniquet influences the incidence of deep venous thrombosis. The lower limbs of patients who were scheduled for elective surgery on the fore part of the foot were randomized and assigned to one of three treatment categories: Group I, no tourniquet; Group II, exsanguination by an Esmarch bandage before tourniquet application; and Group III, exsanguination by elevation of the extremity prior to application of a tourniquet. The 117 limbs of seventy-one patients included in this study were evaluated preoperatively and twenty-four and seventy-two hours postoperatively with 125I-labeled fibrinogen, and preoperatively and seventy-two hours postoperatively with Doppler ultrasound studies and phleborheography.

Peroneus longus tendinitis: a possible biomechanical etiology.

Tendinitis of the foot and ankle is becoming increasingly common, or at least more commonly recognized, with the recent widespread interest in running. In runners seen in our clinics we have encountered several cases of peroneus longus tendinitis. The authors present a case report and possible biomechanical etiology for peroneus longus tendinitis.

Subacute anterior tibial compartment syndrome.

Although acute anterior tibial compartment syndrome has been discussed frequently in the literature, there are few reports on the subacute or chronic syndrome. This problem may result from running or strenuous exercise, or even from walking. Additional demands are placed on the muscles of the anterior compartment by exercise, and this may result in varying degrees of symptomatology.

Acute gouty arthritis in a first metatarsophalangeal joint replaced with a flexible-hinge implant: a case report.

Use of the flexible-hinge, double-stemmed implant has eliminated many of the complications that followed correction of an arthritic first metatarsophalangeal joint caused by hallux valgus. There were no reports in the literature of acute gout after this type of correction. The authors present such a case in a patient with a history of gout, and they suggest that, when a synovectomy is performed in a patient with gouty arthritis, the joint should be freed of synovial tissue in which a uric acid crystal-induced synovitis could occur.

Patterns of lower-extremity injury in 224 runners.

Knee problems are the most common injury sustained in both male and female runners. Other problems include toe and forefoot injuries, inferior heel and arch pain, shin splints, ankle pain, calf and Achilles tendon pain, groin and hip pain, and stress fractures. The average total treatment for all injuries required 4.