Matthew H. Paden

Arthroscopic De Novo NT Juvenile Allograft Cartilage Implantation in the Talus: A Case Presentation

Osteochondral defects of the talus are a challenging subject facing foot and ankle surgeons. The available treatment options have relatively good subjective outcomes; however, they are limited by the ability to reproduce hyaline cartilage, the need for multiple surgeries, and high morbidity. We present a new technique using DeNovo NT(®) juvenile allograft cartilage implantation introduced into a talar lesion arthroscopically in a single procedure to repair a posteriomedial talar osteochondral defects in a healthy, active 30-year-old female. The patient tolerated the procedure well. At the 6-month follow-up visit, the patient had returned to full activity, and at 24 months, she remained completely pain free.

First Metatarsal Head Osteoarticular Transfer System for Salvage of a Failed Hemicap-Implant: A Case Report

UNLABELLED Osteochondral defects are frequently seen in patients with hallux limitus. Historically, such patients have been treated with cheilectomy, arthroplasty, osteotomy, fusion, and other joint destructive procedures. We present a case of a 54-year-old man who presented with a failed hemicap implant of the first metatarsal head. Seven months after his initial implant surgery, the patient was still experiencing pain and limited function despite conservative treatment efforts. In an effort to salvage the joint, an osteoarticular transfer system procedure was undertaken. After removal of the 12-mm hemicap implant, a 15 x 12 mm osteochondral plug was taken from the ipsilateral femoral condyle and press fit into the defect in the first metatarsal head. At 6 weeks postoperatively, complete consolidation of the graft was observed radiographically. By 6 months postoperatively, the patient was able to walk more than 15 miles per week without pain while wearing regular shoes. He was subsequently discharged at 1-year postoperatively, at which time he neither described nor demonstrated any signs or symptoms related to hallux limitus/rigidus. To our knowledge, this particular technique has not been previously reported for lesions of this size in the first metatarsal head. LEVEL OF CLINICAL EVIDENCE 4.

Lateral Leg Compartment Syndrome Caused by Ill-fitting Compression Stocking Placed for Deep Vein Thrombosis Prophylaxis During Surgery: A Case Report

Isolated lateral leg compartment syndrome is a relatively rare event, with potentially devastating consequences. We present a case of a 44-year-old man with isolated lateral leg compartment syndrome caused by a compression stocking used for deep vein thrombosis prophylaxis during surgery. It was found to be excessively tight around the patients proximal calf postoperatively. He underwent lateral leg compartment fasciotomy and delayed wound closure with a split-thickness skin graft. At the 7-month follow-up visit, he had returned to full activity, had no muscle deficits, and had numbness in the distribution of the intermediate dorsal cutaneous nerve.

Late Hematogenous Infection of First Metatarsophalangeal Joint Replacement: A Case Presentation

Late hematogenous infection of previously asymptomatic orthopedic implants is extremely rare and usually associated with total joint replacements, such as those of the hip or knee. We present the case of an otherwise healthy female who developed a deep space infection 18 months after a first metatarsophalangeal joint implant arthroplasty. The patient presented with pain and swelling at the site, and over the course of several days developed fever and tachycardia and leukocytosis. Cultures of the surrounding soft tissues and the implant grew Streptococcus pneumoniae. The patient reported a 1- to 2-week history of symptoms consistent with an upper respiratory tract infection and it is believed that this distant focus of infection was the probable source of late hematogenous seeding of the first metatarsophalangeal joint implant.

Fungal Osteomyelitis of Calcaneus due to Candida albicans: A Case Report

Osteomyelitis can be a challenging entity to treat. Because of the emergence of risk factors, including broad-spectrum antibiotics, intravenous drug abuse, immunocompromised hosts, and other factors, opportunistic pathogens have increased in prevalence in bone infections. A review of the published data revealed few reported cases of fungal osteomyelitis localized to the foot. In the present report, we describe a rare case of fungal osteomyelitis localized to the calcaneus in an elderly female patient who was successfully treated with surgical debridement and a 6-week course of oral fluconazole.

Results of Modified Lapidus Arthrodesis Procedure Using Medial Eminence as an Interpositional Autograft

The Lapidus procedure has received wide acceptance as a valuable operation for correcting moderate to severe hallux valgus, especially in the presence of hypermobility. However, shortening of the first ray inherently occurs as the first metatarsocuneiform joint cartilage and subchondral bone are resected in preparation for arthrodesis. The purpose of this study was to radiographically compare the degree of shortening of the first ray with and without the use of the first metatarsal medial eminence as an interpositional autograft at the site of metatarsocuneiform fusion. Preoperative and postoperative radiographs were measured in 35 consecutive patients who underwent 37 modified Lapidus procedures for hallux valgus repair. In group A, 20 surgeries were performed without use of the interpositional autograft, and served as the control. In group B, 14 surgeries were performed using the medial eminence as an interpositional autograft. The mean amount of first ray shortening was 5.3 ± 1.66 mm in group A and 2.69 ± 1.56 mm in group B, and this difference was statistically significant (P < .001). All patients progressed to complete union, and the median follow-up was 6 months (range, 4-60). Based on these results, the use of the medial eminence as an interpositional autograft in conjunction with Lapidus arthrodesis resulted in a 49.2% reduction in the amount of shortening of the first ray and proved to be a useful source of readily available bone graft.

A Modified Fixation Technique for a Decompressional Shortening Osteotomy: A Retrospective Analysis

A long metatarsal and/or metatarsophalangeal joint dislocation associated with a digital contracture is a surgical challenge. Without appropriate surgical correction, the patient will be predisposed to numerous complications, including persistent subluxation or dislocation, recurrent metatarsalgia, dorsiflexory contracture of the digit, transfer lesions, and inadequate pain relief. The results of the present surgical treatment options have varied, with the most common complication being a floating toe. The purpose of our study was to introduce a decompression, shortening, lesser metatarsal osteotomy with a modified fixation technique using a T-plate and to report our results. Additionally, we have discussed trigonometric analysis of metatarsal declination and shortening. We retrospectively reviewed the outcomes of 30 consecutive patients with 33 osteotomies who had been treated surgically for pathologic features associated with a long metatarsal and varying biomechanical abnormalities. Before surgery, all the patients had been treated conservatively for a minimum of 3 months. The surgical procedure included a dorsal to plantar V-shaped shortening osteotomy of a lesser metatarsal that was fixated with a T plate. The patients were assessed radiographically and using the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale and visual analog scale. The mean age at surgery was 53 (range 37 to 75) years, with a mean follow-up period of 9.1 (range 6 to 15.4) months. The average shortening of the metatarsal was 2.7 mm. One patient (3%) had had asymptomatic delayed union and 2 patients (6%) hypertrophic nonunion. No incidence of malunion or avascular necrosis was identified. Five cases (15.2%) of hardware failure occurred. The mean American Orthopaedic Foot and Ankle Society score was 76.7 postoperatively. The visual analog scale score had improved from 6.7 to 1.7. Of the 30 patients, 72% rated the overall surgical experience as excellent or good. In conclusion, the modified fixation technique for decompression, shortening metatarsal osteotomy using a T plate is a viable option when choosing a procedure to address a long, prominent metatarsal and/or digital contracture at the metatarsophalangeal joint and results in a low incidence of floating toe complications.

A Report of a Rare Phalangeal Periosteal Chondroma of the Foot

Periosteal chondroma is a benign, slow-growing cartilaginous tumor that typically occurs at the metaphysis of long tubular bones beneath the periosteal membrane. A case is presented of a 42-year-old male who developed a firm, tender, uneven mass encircling the lateral, dorsal, and medial aspects of the right second proximal phalanx following a traumatic event. The mass was excised en toto and histopathologic findings are presented.

Disseminated Intravascular Coagulation, Meningococcal Infection, and Ischemic Changes Affecting the Lower Extremities: A Case Study

A middle-aged woman presented from an outside hospital with a diagnosis of Neisseria meningitidis and meningococcemia. A nonpalpable purpuric skin rash evolved into multiple wounds, with gradual necrosis of bilateral lower and upper extremities. Throughout the course of hospitalization, the patient developed ventricular tachycardia, normocytic anemia, thrombocytosis, Clostridium difficile infection, depression, and transient right eye blindness. The finding of decreased CH50 in the complement cascade was considered as the potential cause of the meningococcemia. The subsequent ischemia and necrosis of extremities were attributed to the systemic effect and trauma ensuing from N. meningitidis.

Traumatic Complex Hawkins Type IV Talar Fracture: A Case Report

Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.