External fixators for elective rearfoot and ankle arthrodesis. Techniques and indications.

Since its introduction to the western hemisphere in the mid 1980's, Gavriel Ilizarov's ring fixator system has been studied extensively and shown to be a superior mechanical construct for stabilizing limb segments. This newfound form of external fixation has radically changed many elements of foot and ankle reconstruction, providing a modular device that can accommodate the complex limb deformities while performing multiple tasks. This article summarizes the authors' experience with compression arthrodesis of the rearfoot and ankle using external fixation.

Sectioning the plantar fascia. Effect on first metatarsophalangeal joint motion.

A study on the effect of sectioning the plantar fascia on the range of motion at the first metatarsophalangeal joint is presented. Dorsiflexion and plantarflexion range-of-motion data from 18 patients who had no first metatarsophalangeal joint pathology and had undergone an in-step plantar fasciotomy for recalcitrant plantar fasciitis were analyzed. The average increase in dorsiflexion of the first metatarsophalangeal joint after plantar fascia release was 9.

Analysis of release of the first branch of the lateral plantar nerve.

The authors conducted a retrospective study of the release of the first branch of the lateral plantar nerve in the treatment of chronic heel pain unrelieved by conservative treatment modalities. A total of 17 patients (18 feet) were evaluated following external neurolysis for heel pain caused by entrapment of the first branch of the lateral plantar nerve. The average postoperative follow-up time was 32.

Metastatic breast cancer presenting as heel pain.

The authors present a case of breast cancer metastasizing to the calcaneus that was confirmed by bone biopsy. The patient's complaint of heel pain provided the initial evidence of skeletal metastasis. Metastatic spread of cancer to the hand or foot (acrometastasis) is considered rare.

Multiple stress fractures of the tibia in a healthy adult.

Multiple stress fractures in the same bone are a rare occurrence. This paper presents an unusual case of a 19-year-old, healthy man who sustained a pathologic fracture of the proximal tibia through a stress-fracture site. The radiographic examination of the tibia also revealed multiple stress fractures inferior to the pathologic fracture.

Use of the Ilizarov external fixator in the treatment of lower extremity deformities.

The authors present a brief history of the development of the Ilizarov external fixator, and the classic uses associated with it. A preliminary study of 3 patients using 56 frames is presented. The Ilizarov external fixator is successfully used in these cases in place of traditional fixation.

Recurrent intermetatarsal neuroma. A follow-up study.

Sixteen patients were evaluated following excision of recurrent intermetatarsal neuroma. Each underwent removal of a segment of nerve through an incision on the plantar aspect. The nerve stump was buried in the flexor digitorum brevis muscle.

Perioperative monitoring of potentially toxic drugs.

A list of drugs considered to have a narrow therapeutic margin are discussed. These potentially toxic drugs will be reviewed, including recommended therapeutic ranges, when therapeutic levels should be obtained, and additional laboratory studies that may be required for patients on these medications who are preparing to undergo surgery.

Bilateral osteochondritis dissecans of the first metatarsophalangeal joint.

The authors present a review of the literature concerning the pathogenesis, diagnosis, and treatment of osteochondral defects of the lower extremity. A case of bilateral osteochondritis dissecans of the first metatarsophalangeal joint in a 43-year-old female is presented, including surgical treatment with 1- and 3-year follow-up examinations. The correlation between articular damage to the first metatarsal head and concomitant hallux limitus and hallux rigidus is discussed.

Juvenile hallux abducto valgus association with metatarsus adductus.

The authors evaluated the radiographs of 40 patients (72 feet) under 21 years of age who underwent surgery for symptomatic hallux abducto valgus deformity at Northlake Regional Medical Center. Forty-eight of 72 feet had metatarsus adductus angles greater than 15 degrees. A statistically significant correlation was found between an increasing metatarsus adductus angle and an increasing hallux abductus angle.

Self-administered versus nurse-administered epidural analgesia after cesarean section.

Objective: To compare two methods of administering analgesia by the epidural route after cesarean sections.

Design: Quasi-experimental.

Setting: The postpartum area of a large community hospital.

Fractures of the posteromedial process of the talus.

The authors discuss fractures of the posteromedial process of the talus. The surgical approach for open reduction of these injuries is detailed.

MRI evaluation of Orthosorb pin insertion for surgical treatment of hallux abducto valgus.

This preliminary study considers the advantage of magnetic resonance imaging over plain film radiography in assessing pin resorption and bone marrow regeneration over a 6-month period. The Orthosorb pin was used to fixate an Austin osteotomy in a patient and was followed with serial magnetic resonance imaging at scheduled intervals. This study expands on the preceding study in this issue of the Journal, which was carried out in the rat model.

Orthosorb resorption evaluation using MRI and histologic analysis.

Resorbable bone fixation devices may be used in various surgical procedures for internal fixation in place of traditional metallic devices. Currently, there is no radiographic technique for tracing the postsurgical location and resorption of these devices. This study was undertaken to ascertain whether magnetic resonance imaging is a suitable tool for performing such evaluations.

A surgical approach to a vascular malformation in the plantar medial foot.

Vascular malformations are infrequent findings in the foot, especially the plantar medial foot. Deeper vascular malformations may be more difficult to diagnose due to the depth and oblique course of the medial neurovascular structures into plantar aspect of the foot. The authors present an interesting case report of a vascular anomaly mimicking a heel spur syndrome and describe a surgical approach for the resection of this type of lesion with a 10-month follow-up.

Bilateral syndactyly. A unique case with surgical correction.

Cases must be treated on an individual basis, appreciating the complexity of the syndactyly, considering the patient compliance, and understanding the goals of the surgical correction. Extensive discussion with the patient and parents must occur to clarify the goals of the surgery, the expectations, and possible complications. Careful preoperative planning and incision design is paramount in obtaining satisfactory results.

1993 William J. Stickel Bronze Award. Imaging of the infected foot. Fact or fancy?

Advancements in methods of imaging infection have surpassed their worth. Although scientifically substantiated, their clinical pertinence is frequently disappointing. Diabetic infections, postoperative or traumatic sequelae, rheumatologic conditions, and Charcot disease are difficult to differentiate from osseous infection because they all manifest as inflammation.

Systemic complications of human immunodeficiency virus infection.

HIV infection causes a wide spectrum of complications affecting all organ systems. These complications may be primary to the direct infection of a specific organ system by HIV or secondary to the immunodeficiency associated with HIV infection. These complications may be specific to certain stages of HIV infection.

Penicillins, cephalosporins, quinolones.

This article details the mechanisms of action, antimicrobial spectrum, pharmacokinetics, and adverse reactions of these three antibiotics.

Brachymetatarsia. A new surgical approach.

Although most practitioners are familiar with brachymetatarsia, it is a relatively uncommon clinical entity presenting for surgical correction. Traditional methods of surgical correction have been successful for the most part; however, a number of potentially devastating complications exist with these procedures. The authors present a review of the deformity, including the historical surgical techniques, and introduce a new surgical approach that minimizes the risk of complication.