Osteochondral Lesions of the Talus – Allograft Repair
Co-Authors: Milford H. Marchant Jr., M.D.; Mark E. Easley, M.D.; James A. Nunley II., M.D. Osteochondral Lesions of the Talus Review Etiology – Primary Causes – Trauma … Read more
Tibia and Fibula
Steindler Flexorplasty
– Theory: – flexor-pronator muscles arising from medial epicondyle are transposed to more proximal point on the humerus so that their moment for elbow flexion is incresed enough to permit active control; – muscles originating from the medial epicondyle (Pronator Teres, FCR, PL, & FCU) must have normal or … Read more
Stance Phase of Gait
– See: – Gait Menu: – Orthotics for the Foot – Discussion: – stance phase represents about 60% of the gait cycle, swing 40%; – normal gait is symmetric & thus, relationship between swing and stance phases of each leg are consistent; … Read more
Staged Revision for Infected Total Knee Joint
– see 2 stage hip spacer – Discussion: – staged revision w/ antibiotic spacer: (see antibiotics in cement and local antibiotic delivery for septic joints) – debridement of components is followed by 6 weeks of IV antibiotics; – it is essential that all foreign material including cement be … Read more
Stage III: Posterior Tibial Tendonitis
– Discussion: – following lengthening or rupture of tibialis posterior, pt will develop fixed hindfoot deformity w/ hindfoot valgus and forefoot in abduction; – if site of maximal deformity is at talonavicular joint, then an isolated talonavicular or talonavicular & calcaneocuboid may be performed; – sub-talar arthrodesis: – w/ more … Read more
Stage II: Posterior Tibial Tendonitis
– Discussion: – inflammation causes tenosynovitis and elongation; – hindfoot remains supple and is reducible; – pt has flexible flat foot, & w/ removal of weight, foot resumes its normal arch; – it is essential to distinguish the supple type II lesion from the type III lesion … Read more
Stage II Supination Inversion Injury
– Discussion: – involves injury to distal tibial ephiphysis, & are due to plantar hyperflexion or external rotation force; – presents as SH II, SH III, or SH IV type injury of distal tibia which may disrupt articular surface as well as physis; – Salter Harris III: … Read more
Stage I: Posterior Tibial Tendonitis
– See: rupture of tibialis posterior – Dicussion: – tendinitis is present but tendon remains at its normal length; – in a young patient consider accessory navicular; – Non Operative Treatment: – arch supports, rubber-soled shoe w/ quarter-inch medial heel, sole wedge, UCBL; – immobilization in a … Read more
Stability of Weber B Fractures
– Discussion: – key to stability of ankle mortise is posterior syndesmotic ligament complex, ligament or posterior tibial tubercle or malleolus; – presence of a posterior lesion always indicates degree of instability, whether or not the medial structures are disrupted; – no matter what mechanism, instability must be assumed … Read more
Spondyloarthropathies / Related Chronic Seronegative Arthritides
Discussion onditions include: AS Reiter’s Syndrome Psoriatic Arthritis Inflammatory Bowel Disease typically involves the axial skeleton; affected areas heal w/ fibroblastic proliferation followed by new bone formation; pathogenesis of these disorders is unknown except for Reiter’s syndrome, which is generally believed to result from aberrant host response to a pathogenic microorganism; Labs RF is negative; HLA-B27 phenotype: … Read more