Publications (3)4.43 Total impact
Article: Type 0 Ulnar Longitudinal Deficiency[Show abstract] [Hide abstract]
ABSTRACT: To describe the characteristics of type 0 ulnar longitudinal deficiency (ULD) in which deficiencies are present in the hand and carpus without involvement of the forearm or elbow. A retrospective chart, radiograph, and clinical photograph review (1960-2005) of patients previously diagnosed with ectrodactyly, hand hypoplasia, or ULD was performed to evaluate for a diagnosis of ULD isolated to the hand. Thirteen extremities were identified. Three extremities had complete absence of the small-finger ray (phalanges and metacarpal) and 6 extremities had complete absence of the ring- and small-finger rays. Four hands showed hypoplasia of the small finger, 3 in conjunction with a ring- and small-metacarpal synostosis and 1 in isolation. Three extremities also had radial-sided hypoplasia or aplasia of the rays. Additional common findings included simple syndactyly, delta phalanx, and carpal fusions, most commonly of the capitohamate joint. Patients with isolated ulnar-sided hand deficiency such as ectrodactyly of the ring and/or small fingers or synostosis of the small metacarpal of the ring finger in the presence of a normal forearm may be diagnosed as having type 0 ULD. We propose that type 0 be added to the current classification systems for ULD representing those extremities with deficiencies isolated to the hand.
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ABSTRACT: A flatfoot deformity alters the contact characteristics of the ankle joint, shifting the location of articulation posterolaterally, increasing pressure, and decreasing the contact area within the ankle. These changes may explain the pattern of articular degeneration and subsequent angulation observed in a long-standing adult acquired flatfoot. Corrective orthoses and surgical reconstruction have been used to realign pes planovalgus feet, but the effects of these treatments on tibiotalar contact characteristics are unknown. We hypothesized that realignment of a flatfoot with either corrective orthosis or surgical reconstruction would restore the contact characteristics of the ankle to the intact state. The mean value of the contact area, contact pressure, peak contact pressure, and the relative locations of the global contact area and peak pressure within the ankle joint were determined from imprints created on pressure sensitive film for a series of cadaver lower limbs subjected to a weightbearing load in simulated midstance phase of gait. Each limb was loaded sequentially under four conditions: intact, flatfoot, flatfoot realigned with UCBL orthosis, and flatfoot realigned with a medial translational osteotomy of the calcaneus. The use of the UCBL orthosis and calcaneal osteotomy altered the contact characteristics of the ankle when compared with the flatfoot condition. Both interventions significantly decreased the mean global contact pressure from the flatfoot value, with the orthosis, demonstrating a significantly greater correction than the osteotomy. The orthosis also significantly reduced the peak contact pressure from the flatfoot value. Both interventions significantly corrected the lateral shift of the center of the peak contact pressure from the flatfoot value. The shift in the center of the global contact area approached significance when the orthosis was compared with the flatfoot. The changes observed in the magnitude and location of the mean and peak pressures indicate that the UCBL orthosis and calcaneal osteotomy altered hindfoot alignment to significantly influence tibiotalar contact characteristics. The results further suggest that the UCBL orthosis corrected ankle malalignment better than the calcaneal osteotomy in an adult acquired flatfoot. This study provides biomechanical data to support the clinical impression that realignment of the hindfoot corrects the pathologic tibiotalar contact characteristics associated with an adult acquired flatfoot. The results support the conclusion that the clinical management of a pes planovalgus foot with a UCBL orthosis or a medial translational osteotomy of the calcaneus may avert the onset of pantalar disease seen with late-stage posterior tibial tendon dysfunction.
Article: Pediatric Flexor Tendon Injuries[Show abstract] [Hide abstract]
ABSTRACT: Flexor tendon injuries in children differ from adults in their diagnosis and postoperative rehabilitation principles. The child may be uncooperative, so indirect methods of tendon integrity must be used for diagnosis. Radiographs may be useful for associated fracture or retained foreign bodies. A high index of suspicion necessitates surgical exploration. Although surgical approach and repair techniques are identical to those in adults, postoperative immobilization for 3-4 weeks is used instead of an early motion protocol. Delayed diagnosis is more common in the pediatric population, and recognition and management of postoperative complications can be difficult,because the child may be unable to cooperate or comply with the treatment.
The University of Chicago Medical Center
Chicago, Illinois, United States
- Section of Orthopaedic Surgery and Rehabilitation Medicine
Barnes Jewish HospitalSan Luis, Missouri, United States