Theodore R. Waugh

The Harris and Beath footprinting mat: diagnostic validity and clinical use.

Pain on the plantar aspect of the forefoot is a common malady whose specific cause is often difficult to diagnose. Using the Berkemann Laboratory version of the original mat of Harris and Beath, and a calibration curve, the patterns on a footprint can be translated into their actual pressure values withhin the range of 0.27 kg/cm2 to 4.80 kg/cm2. Using the procedure presented here, inexperienced subjects were able to estimate the pressure values of random prints of unknown pressure within a standard deviation of 0.28 kg/cm2 from their actual values. The mat is valuable for diagnosis of pressure metatarsalgia and other disorders of the foot. The specificity was 0.77, sensitivity was 0.57, with the sum being equal to 1.34. These results indicate that there is a relatively large population of normal people wit excessive localized pressure under their metatarsal heads who do not complain of pain. The apparently low sensitivty of the mat in this study does not seem to be a limitation, but is an indication of the haziness involved in the differential diagnosis of forefoot pain. Pressure metatarsalgia can be quantitated by analysis of the Harris footprint.

Hypermobility in Hallux Valgus

Hypermobility has been implicated as one of the etiological components in common foot problems such as hallux valgus but has not been substantiated by experimental data. Twenty patients with symptomatic untreated hallux valgus and 20 controls were evaluated with a simple hypermobility scoring system. A statistically significant correlation was found to reveal that female patients aged 20 to 40 yr with symptomatic hallux valgus have a mild generalized hypermobility when compared to a similar group of control patients. The presence of such ligamentous laxity would seem to support the need for bony correction in such patients as soft tissue procedures would have a greater propensity for malalignment due to the underlying hypermobility in combination with everyday environmental stresses of trauma and overuse.

Heterotopic ossification. Incidence and relation to trochanteric osteotomy in 100 total hip arthroplasties.

Heterotopic ossification can impair the functional results of total hip arthroplasty. The causative role of trochanteric osteotomy in heterotopic ossification is uncertain. Postoperative radiographs of 100 total hip arthroplasties were analyzed for incidence of heterotopic ossification. Forty procedures were performed with trochanteric osteotomy and 60 without. There was a 17% overall incidence of clinically significant heterotopic ossification, 22% with osteotomy and 13% without. High- and low-risk categories revealed clinically significant heterotopic ossification in 25% of the high-risk group and in 8% of the low-risk group. In the high-risk group there was a 32% incidence with trochanteric osteotomy and 22% without osteotomy. In the low-risk group there was a 16% incidence without trochanteric osteotomy and a 3% incidence with trochanteric osteotomy. The increase in clinically significant heterotopic ossification in the high-risk group over that of the low-risk group was statistically significant. The present study showed that trochanteric osteotomy tended to increase the incidence and severity of clinically significant heterotopic ossification. These data suggest that trochanteric osteotomy should be avoided, if possible, during total hip arthroplasty to decrease the risk of heterotopic ossification.

Management of arthritis of the ankle. An alternative of arthrodesis.

Twenty-eight patients treated by total ankle arthroplasty at the University of California, Irvine, were evaluated on a 100-point ankle analysis scale preoperatively and postoperatively. The average preoperative score was 35 and the average postoperative score was 74. Significant improvement occurred in function, pain relief and range of motion. The average follow-up period for these patients was 9 months. Although the number in each group is small, it does not appear that the procedure has merit for the treatment of ankle arthritis from such diverse causes as trauma, rheumatoid arthritis, aseptic necrosis of the talus and talectomy. Complications included wound healing problems in 3 patients. Malalignment of the prosthesis occurred in 2 other patients; one required revision. Ankle replacement failed in 2 patients. One patient required a fusion; the other an amputation following occlusion of the posterior tibial artery after surgery. At the present time, ankle replacement appears to be an acceptable alternative to ankle arthrodesis.

UCI knee replacement.

Between March 9, 1972 and December 31, 1973, a total of 103 UCI knee replacements were performed. Follow-up data are available on 83 knees with an average follow-up of 33 months. Patient evaluation of the end results indicates that 78.3 per cent were better, 9.6 per cent unchanged, and 12.1 per cent worse. Patient evaluation of their own knee function averaged 55 per cent preoperatively and 79 per cent postoperatively. Patients were also evaluated on a 100 point Modified Larson Analysis Form. The average preoperative score was 46, and the average postoperative score was 70. There were six (5.8%) biological complications in the 103 knee replacement. Biological complications included infections, wound healing problems and unexplained pain. Mechanical complications were seen in 18 (17.4%) knees, and included knee instability, tibial component loosening or deformation, and patellar problems. Additional surgery was required in 18 (17.4%) knees. Failure of the procedure eventually requiring removal of the prosthesis and fusion or amputation occurred in 4 (3.9%) knees. The intermediate-term results of UCI knee replacement have been clinically satisfactory. We currently recommend consideration of this procedure for patients with disabling arthritis of the knee.

Irvine Ankle Arthroplasty: Prosthetic Design and Surgical Technique

A total ankle arthroplasty (IAA) design is presented for highly selected cases. The design stems from investigations on the anatomical and biomechanical characteristics of the human ankle joint. The prostheses are inserted through an anterior approach. Full weight-bearing is well tolerated within a few days. The immediate results on 20 ankles are most encouraging.

Bilateral simultaneous Achilles tendon ruptures : a case report and review of the literature

Bilateral simultaneous Achilles tendon ruptures are rare, with only ten cases reported in the English literature. Our case is that of a 44-year-old woman, along with a review of the literature. Affected persons usually are on chronic steroid treatment and in the fifth to seventh decades of life. The patient may have concomitant systemic disease, and the injury occurs with relatively mild trauma. The goals of treatment are mainly preventative, i.e., cessation of steroids as soon as possible and protective bracing of the remaining intact Achilles tendon.

The unreducible Lisfranc fracture. Case report and literature review.

In a lateral dislocation that is unreducible by closed methods, one should suspect that the tendon of the tibialis anterior muscle may be preventing reduction because of its interposition. In such a situation an open reduction is mandatory.

The impact of CT in clinical management of pelvic and acetabular fractures.

Thirty-eight consecutive patients admitted to the hospital with pelvic and acetabular fractures underwent CT examination. The axial plane of CT is shown to be the most suitable for evaluation of these fractures. The fracture pattern is readily demonstrated, facilitating fracture classification. The degree of fracture fragment displacement and rotation, hip joint stability, and intra-articular osseous fragments can be determined. A number of unsuspected fractures were detected, including five sacral and four anterior acetabular wall fractures; the latter were due to extension of superior ramus fractures. Soft tissue injuries included several hematomas, serosanguinous cysts in one patient, and bladder laceration in one patient. It is concluded that in patients with pelvic fracture CT examination is the method of choice following preliminary radiographic evaluation, if further radiographic investigation is deemed necessary.

Gluteal compartment syndrome: case report.

A compartmental syndrome can occur in any space limited by fascia or skin. A case of a gluteal compartment syndrome is reported, apparently from prolonged pressure after a drug overdose. Clinical features were a painful expanding gluteal mass with sciatic nerve dysfunction. Fasciotomy of the tensor fascia lata and the overlying fascia of the gluteus maximus resulted in rapid relief of symptoms.