Kent Ellington - Academia.edu (original) (raw)

Papers by Kent Ellington

Foot & Ankle Orthopaedics, 2020

Category: Diabetes; Ankle; Hindfoot; Other Introduction/Purpose: Charcot arthropathy of the ankle... more Category: Diabetes; Ankle; Hindfoot; Other Introduction/Purpose: Charcot arthropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity. When indicated, the surgical goals are to restore a stable plantigrade foot, reduce the risk of ulceration, and improve function to independent ambulation. Techniques for reconstruction of the neuropathic ankle/hindfoot include external and/or internal fixation. Current literature involving small series of surgical patients has shown a high rate of limb salvage and low complication rate. Our experience has been less promising, although we believe it remains a viable option. It is our goal to report the outcomes of Charcot patients undergoing corrective ankle and hindfoot reconstruction. Methods: We retrospectively reviewed 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent ...

The journal of bone and joint surgery, Aug 1, 2003

taphylococcus aureus is the bacterial pathogen which is responsible for approximately 80% of all ... more taphylococcus aureus is the bacterial pathogen which is responsible for approximately 80% of all cases of human osteomyelitis. It can invade and remain within osteoblasts. The fate of intracellular Staph. aureus after the death of the osteoblast has not been documented. We exposed human osteoblasts to Staph. aureus. After infection, the osteoblasts were either lysed with Triton X-100 or trypsinised. The bacteria released from both the trypsinised and lysed osteoblasts were cultured and counted. Colonies of the recovered bacteria were then introduced to additional cultures of human osteoblasts. The number of intracellular Staph. aureus recovered from the two techniques was equivalent. Staph. aureus recovered from time zero and 24 hours after infection, followed by lysis/trypsinisation, were capable of invading a second culture of human osteoblasts. Our findings indicate that dead or dying osteoblasts are capable of releasing viable Staph. aureus and that Staph. aureus released from dying or dead osteoblasts is capable of reinfecting human osteoblasts in culture.

Microbial Pathogenesis, 1999

Staphylococcus aureus is a bacterial pathogen causing approximately 80% of all cases of human ost... more Staphylococcus aureus is a bacterial pathogen causing approximately 80% of all cases of human osteomyelitis. This bacterium can adhere to and become internalized by osteoblasts and previous studies indicate that osteoblasts are active in the internalization process. In the current study, we examined the roles of microfilaments, microtubules and clathrin-dependent receptor-mediated endocytosis in the internalization of S. aureus by MC3T3-E1 mouse osteoblast cells. Microfilament and microtubule polymerization was inhibited with cytochalasin D and colchicine. Clathrin-coated pit formation was examined by using the transaminase inhibitor, monodanslycadaverine. The results of this study indicate that mouse osteoblasts utilize actin microfilaments, microtubules and clathrin-coated pits in the internalization of S. aureus; however, microfilaments seem to play the most significant role in the invasion process.

Infection and Immunity, 2000

ABSTRACTStaphylococcus aureusandSalmonellaspp. are common causes of bone diseases; however, the i... more ABSTRACTStaphylococcus aureusandSalmonellaspp. are common causes of bone diseases; however, the immune response during such infections is not well understood. Colony-stimulating factors (CSF) have a profound influence on osteoclastogenesis, as well as the development of immune responses following infection. Therefore, we questioned whether interaction of osteoblasts with two very different bacterial pathogens could affect CSF expression by these cells. Cultured mouse and human osteoblasts were exposed to various numbers ofS. aureusorSalmonella dublinbacteria, and a comprehensive analysis of granulocyte-macrophage (GM)-CSF, granulocyte (G)-CSF, macrophage (M)-CSF, and interleukin-3 (IL-3) mRNA expression and cytokine secretion was performed. Expression of M-CSF and IL-3 mRNAs by mouse osteoblasts was constitutive and did not increase significantly following bacterial exposure. In contrast, GM-CSF and G-CSF mRNA expression by mouse osteoblasts was dramatically upregulated following in...

Foot & Ankle Orthopaedics

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Primary arthrodesis of Lisfranc and midf... more Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Primary arthrodesis of Lisfranc and midfoot fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion and dorsiflexion malunion. The use of a new generation of nitinol staples has proliferated in midfoot arthrodesis. The purpose of this study is to examine the use of nitinol staples in primary arthrodesis of acute Lisfranc fracture-dislocations, comparing outcomes to traditional plate and screw fixation. The primary hypothesis is that nonunion rates are lower with constructs that include nitinol staples than those with plates and screws alone. Secondary hypotheses are: 1. Total operative and tourniquet time are shorter using nitinol staples. 2. Reoperation rates are lower using nitinol staples. 3. Dorsiflexion malunion rates are lower using nitinol staples. 4. Functional outcome scores will indicate comparable post-arthrodesis disability. Methods: Midfoot fracture-dislocations treated with primar...

Stroke, 2021

Background: Our 10-hospital network (2 CSCs, 2PSCs, 6 non-SCs) switched our standard stroke throm... more Background: Our 10-hospital network (2 CSCs, 2PSCs, 6 non-SCs) switched our standard stroke thrombolytic from alteplase (ALT) to tenecteplase (TNK; 0.25 mg/kg) in September 2019. Methods: We designed a two-year prospective cohort analysis of key processes and clinical outcomes for TNK-treated patients with planned quarterly assessments of feasibility and safety. The TNK cohort is compared to the retrospective historical cohort of all unique patients at these hospitals treated with ALT during the prior 2-year period (n=354). Analysis were taken from a local REDcap registry that recorded data fields required for Stroke Center certification and submission to Get-With-The Guidelines (GWTG). Interim results through three quarters ending June 30, 2020. Results: 151 patients were treated with TNK. The samples TNK v ALT were well matched on age (median, IQR) 66.0 (55.0, 76.0) v 67.0 (55.0, 78.8) and NIHSS at admission (median, IQR), 8 (4, 13) v 8 (4, 15). Symptomatic ICH (ECASS 3 definition...

Objective: Ankle sprains are common affecting 2.15 per 10,000 persons per year. They are among th... more Objective: Ankle sprains are common affecting 2.15 per 10,000 persons per year. They are among the most common athletic injuries and represent 15 to 20% of all athletic injuries. Typically patients injure the lateral ligaments; however, a subset of patients sustain injury to the medial and lateral ligamentous complexes, representing a more severe injury. We present a group of patients with this disease, and evaluate the results of surgical treatment and its evolution. Methods: We retrospectively reviewed a consecutive cohort of patients that were treated with medial sided ligamentous reconstruction and were greater than 6 months from their index procedure. Patients that had an isolated medial sided repair or patients that had a medial sided repair in conjunction with a degenerative flatfoot reconstruction were excluded. Patients returned for radiographs, clinical examination by a blinded observer and a functional evaluation. Descriptive statistics were performed. Results: The mean f...

Objective: To describe an unusual presentation of isolated pontine PRES and highlight the imaging... more Objective: To describe an unusual presentation of isolated pontine PRES and highlight the imaging findings. Background: Isolated pontine PRES is a rare variant of PRES which affects the brainstem without cortical or subcortical cerebral involvement. In a case study from Alexander et al, this was found in 4% of the patients presenting with PRES. As described in literature, this syndrome can present with altered consciousness, seizures, and speech problems. Our case is unique due to its unusual presentation. Design/Methods: Case Report Results: A 54 year-old male with history of untreated hypertension was brought to our emergency department for sudden onset of confusion and right body weakness. Upon arrival, his blood pressures was elevated at 220/100 mmHg. Neurological examination revealed a normal level of consciousness, dysarthria with mildly decreased fluency, mild right facial palsy, and right hemiparesis. Symptoms resolved within 30 minutes. Computed tomography (CT) of the head ...

The Journal of the American Academy of Orthopaedic Surgeons, Jan 12, 2018

Foot and Ankle Clinics, 2015

Understanding the subtalar joint is extremely important in order to grasp the complexity of the f... more Understanding the subtalar joint is extremely important in order to grasp the complexity of the foot. The anatomy and biomechanics are crucial to the function of the hindfoot, ankle, midfoot, and even forefoot. This issue provides expertise in areas ranging from anatomy, radiology, biomechanics, congenital and acquired conditions, and treatment options of the subtalar joint. Proper history and physical examination, along with imaging, are important to diagnose and appropriately treat the patient. Subtleties are important, and attention to detail can be the difference in a satisfied patient versus a poor outcome.

Foot & ankle international, Jan 4, 2015

Preoperative computer navigation and patient-specific instrumentation have had promising results ... more Preoperative computer navigation and patient-specific instrumentation have had promising results in total knee arthroplasty and in a previous cadaveric total ankle arthroplasty (TAA) study. Potential benefits of patient-specific guides include improved implant alignment and decreased surgical time. The purpose of this retrospective case series was to evaluate the accuracy, reproducibility, and limitations of TAA tibia and talar implant placement and radiographic alignment using preoperative computed tomography (CT) scan-derived instrumentation in a clinical setting. Between 2012 and 2014, 42 consecutive TAA cases in 42 patients using preoperative CT scan-derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis TN) were reviewed from a single center of foot and ankle fellowship-trained orthopaedic surgeons. TAA implants used included 29 intramedullary referencing implants (INBONE II, Wright Medical Technology) and 13 low-profile tibia and talar resurfac...

Foot & ankle international, Jan 8, 2015

Limited incision techniques for acute Achilles tendon ruptures have been developed in recent year... more Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures. Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision wit...

Foot and Ankle Clinics, 2015

The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial inc... more The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial incision, and the extensile lateral approach. The choice of one over the other depends on the underlying pathology, previous surgeries, associated foot pathologies, soft tissue quality, and medical comorbidities. This article reports on several cases of subtalar joint fusion.

Foot and ankle clinics, 2011

Hammertoe and clawtoe deformities are common forefoot problems. The deformity exists owing to the... more Hammertoe and clawtoe deformities are common forefoot problems. The deformity exists owing to the underlying pathoanatomy. Hallux valgus, longer metatarsals, and intrinsic imbalance are the most common etiologies. Understanding the cause of the deformity is important to be able to successfully treat the condition, whether nonoperative or with operative intervention. When nonoperative measures fail, PIP correction is best obtained through arthroplasty or arthrodesis. The key to successful PIP correction is obtaining a well-aligned toe and reducing pain as demonstrated by Coughlin and Mann.15 When choosing a technique, the author prefers PIP joint arthrodesis because it has several advantages, including a decreased risk of recurrence and a more predictable toe posture. The authors prefers an intramedullary device to avoid the well-known complications of K-wires. The best surgical correction and fixation techniques are still to be determined. Each patient much be evaluated thoroughly a...

Foot & Ankle Specialist, 2014

The distal tibial blind spot represents an area where improperly measured long screws may pose a ... more The distal tibial blind spot represents an area where improperly measured long screws may pose a risk to surrounding anatomic structures and is not well visualized on AP, mortise, and lateral radiographs. Awareness of this area as well as the use of a 45° external rotation oblique view when placing fixation in this area may prevent iatrogenic injury. Levels of Evidence: Level V, Expert Opinion

Foot & Ankle International, 2013

Background: Ball and socket ankle (BASA) deformity is a rare condition. Little is known about out... more Background: Ball and socket ankle (BASA) deformity is a rare condition. Little is known about outcomes and treatments in the adult population. Methods: Retrospective comparative review was performed of 13 patients treated for BASA with a minimum follow-up of 2.5 years. Evaluation included clinical and radiographic review, outcome scores, a questionnaire, and a subjective satisfaction survey. Results: Nine patients with correctable valgus deformity not associated with arthritis of the ankle joint underwent a supramalleolar osteotomy (SMO). Four patients underwent arthrodesis—2 a tibiotalocalcaneal (TTC) arthrodesis and 2 a pantalar arthrodesis. AOFAS scores improved from 30.1 to 77.6 (range, 16-82) ( P < .05) in the SMO group. AOFAS scores improved from 24 to 60.5 (range, 16-66) ( P < .05) in the arthrodesis group. Arthritis grade in the SMO patients was unchanged in 4 patients at final follow-up and worsened in 5 patients by only 1 grade. Nine patients reported good results (a...

Foot & Ankle International, 2011

Background: Dorsal plate fixation is used commonly for arthrodesis of the hallux first metatarsop... more Background: Dorsal plate fixation is used commonly for arthrodesis of the hallux first metatarsophalangeal (MTP) joint. Custom dorsal plates incorporating locking technology have been developed recently for applications in the foot to provide relative ease of application and theoretically superior mechanical properties. The purpose of this study is to compare the radiographic and clinical outcomes of patients undergoing hallux MTP joint arthrodesis using a locked plate, or a nonlocked plate. Materials and Methods: We compared consecutive patients who underwent hallux MTP arthrodesis for a variety of diagnoses with either a precontoured locked titanium dorsal plate (Group 1) or a precontoured, nonlocked stainless steel plate (Group 2). All patients were evaluated with radiographs, visual analog pain scale, American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and a detailed patient satisfaction survey. Results: There were 73 feet in Group 1 and 107 feet in Group 2. There ...

Foot & Ankle International, 2010

Background: Tibialis anterior tendon rupture is an uncommon injury that can cause significant fun... more Background: Tibialis anterior tendon rupture is an uncommon injury that can cause significant functional deficit. Recent series have supported surgical reconstruction in younger, more active patients. We investigated our clinical outcomes of patients having undergone surgical management of tibialis anterior tendon ruptures. Materials and Methods: Fifteen tibialis anterior tendon ruptures in 14 patients were retrospectively reviewed after surgical management. Five had primary repair, while 10 had tendon transfers. Average age at time of surgery was 70.6 years with an average followup of 27.2 months. Patients were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and SF-36 clinical outcome scores. Strength measurements utilizing a dynamometer and range of motion (ROM) were documented on the operative and non-operative ankles. Patient satisfaction surveys were performed. Results: Average postoperative AOFAS hindfoot score was 88.8 and SF-36 score was 76.4. There was a ...

Foot & Ankle International, 2010

Background: The purpose of this study was to retrospectively review the results of patients treat... more Background: The purpose of this study was to retrospectively review the results of patients treated with hallux MTP joint arthrodesis using dome-shaped reamers for joint preparation and a precontoured dorsal stainless steel plate for internal fixation. Materials and Methods: A series of 145 patients (155 feet) were identified. Postoperative evaluation included weightbearing radiographs, physical examination, and chart review. Outcomes were assessed with a pain visual analog scale, AOFAS hallux score, as well as a detailed questionnaire and a subjective satisfaction survey. Results: 98 patients (107 feet) met the criteria for the study. The mean followup was 61 weeks. Revision cases accounted for 18.7% (20/107). Rheumatoid arthritis (RA) was present in 32.7% (35/107). The average postoperative AOFAS hallux score was 79.7 and pain VAS was 19. The average pre and postoperative hallux valgus angle was 26.5 and 12.3 degrees, respectively ( p < 0.05). Eighty-nine of 107 patients (83.1%...

Foot & Ankle International, 2010

Background: Lesser toe deformities are frequent and bothersome conditions. Many options exist for... more Background: Lesser toe deformities are frequent and bothersome conditions. Many options exist for the treatment of hammertoes and clawtoes. The purpose of this study was to review our experience with the use of an intramedullary fusion device. Materials and Methods: An IRB approved retrospective review was performed to identify 38 toes in 27 patients treated with the StayFuse™ (Nexa Orthopaedics) device with a mean followup of 31 months. The indications for surgery were primary deformity in 12 toes and recurrent deformities in 26 toes. Results: Union occurred in 23 of 38 (60.5%). The union rate was nine of 12 for primary procedures and 53.8% (14/26) for revisions. Coronal PIP alignment demonstrated no change in 33 of 38 cases (86.8%) and changed in five of 38 (13.2%). Sagittal PIP alignment demonstrated no change in 36 of 38 cases (94.7%), and changed in 2/38 (5.3%). Including nonunion, the overall complication rate was 55.3% (21/38) (15 nonunions; three hardware failures (two (bent...

Foot & Ankle Orthopaedics, 2020

Category: Diabetes; Ankle; Hindfoot; Other Introduction/Purpose: Charcot arthropathy of the ankle... more Category: Diabetes; Ankle; Hindfoot; Other Introduction/Purpose: Charcot arthropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity. When indicated, the surgical goals are to restore a stable plantigrade foot, reduce the risk of ulceration, and improve function to independent ambulation. Techniques for reconstruction of the neuropathic ankle/hindfoot include external and/or internal fixation. Current literature involving small series of surgical patients has shown a high rate of limb salvage and low complication rate. Our experience has been less promising, although we believe it remains a viable option. It is our goal to report the outcomes of Charcot patients undergoing corrective ankle and hindfoot reconstruction. Methods: We retrospectively reviewed 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent ...

The journal of bone and joint surgery, Aug 1, 2003

taphylococcus aureus is the bacterial pathogen which is responsible for approximately 80% of all ... more taphylococcus aureus is the bacterial pathogen which is responsible for approximately 80% of all cases of human osteomyelitis. It can invade and remain within osteoblasts. The fate of intracellular Staph. aureus after the death of the osteoblast has not been documented. We exposed human osteoblasts to Staph. aureus. After infection, the osteoblasts were either lysed with Triton X-100 or trypsinised. The bacteria released from both the trypsinised and lysed osteoblasts were cultured and counted. Colonies of the recovered bacteria were then introduced to additional cultures of human osteoblasts. The number of intracellular Staph. aureus recovered from the two techniques was equivalent. Staph. aureus recovered from time zero and 24 hours after infection, followed by lysis/trypsinisation, were capable of invading a second culture of human osteoblasts. Our findings indicate that dead or dying osteoblasts are capable of releasing viable Staph. aureus and that Staph. aureus released from dying or dead osteoblasts is capable of reinfecting human osteoblasts in culture.

Microbial Pathogenesis, 1999

Staphylococcus aureus is a bacterial pathogen causing approximately 80% of all cases of human ost... more Staphylococcus aureus is a bacterial pathogen causing approximately 80% of all cases of human osteomyelitis. This bacterium can adhere to and become internalized by osteoblasts and previous studies indicate that osteoblasts are active in the internalization process. In the current study, we examined the roles of microfilaments, microtubules and clathrin-dependent receptor-mediated endocytosis in the internalization of S. aureus by MC3T3-E1 mouse osteoblast cells. Microfilament and microtubule polymerization was inhibited with cytochalasin D and colchicine. Clathrin-coated pit formation was examined by using the transaminase inhibitor, monodanslycadaverine. The results of this study indicate that mouse osteoblasts utilize actin microfilaments, microtubules and clathrin-coated pits in the internalization of S. aureus; however, microfilaments seem to play the most significant role in the invasion process.

Infection and Immunity, 2000

ABSTRACTStaphylococcus aureusandSalmonellaspp. are common causes of bone diseases; however, the i... more ABSTRACTStaphylococcus aureusandSalmonellaspp. are common causes of bone diseases; however, the immune response during such infections is not well understood. Colony-stimulating factors (CSF) have a profound influence on osteoclastogenesis, as well as the development of immune responses following infection. Therefore, we questioned whether interaction of osteoblasts with two very different bacterial pathogens could affect CSF expression by these cells. Cultured mouse and human osteoblasts were exposed to various numbers ofS. aureusorSalmonella dublinbacteria, and a comprehensive analysis of granulocyte-macrophage (GM)-CSF, granulocyte (G)-CSF, macrophage (M)-CSF, and interleukin-3 (IL-3) mRNA expression and cytokine secretion was performed. Expression of M-CSF and IL-3 mRNAs by mouse osteoblasts was constitutive and did not increase significantly following bacterial exposure. In contrast, GM-CSF and G-CSF mRNA expression by mouse osteoblasts was dramatically upregulated following in...

Foot & Ankle Orthopaedics

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Primary arthrodesis of Lisfranc and midf... more Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Primary arthrodesis of Lisfranc and midfoot fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion and dorsiflexion malunion. The use of a new generation of nitinol staples has proliferated in midfoot arthrodesis. The purpose of this study is to examine the use of nitinol staples in primary arthrodesis of acute Lisfranc fracture-dislocations, comparing outcomes to traditional plate and screw fixation. The primary hypothesis is that nonunion rates are lower with constructs that include nitinol staples than those with plates and screws alone. Secondary hypotheses are: 1. Total operative and tourniquet time are shorter using nitinol staples. 2. Reoperation rates are lower using nitinol staples. 3. Dorsiflexion malunion rates are lower using nitinol staples. 4. Functional outcome scores will indicate comparable post-arthrodesis disability. Methods: Midfoot fracture-dislocations treated with primar...

Stroke, 2021

Background: Our 10-hospital network (2 CSCs, 2PSCs, 6 non-SCs) switched our standard stroke throm... more Background: Our 10-hospital network (2 CSCs, 2PSCs, 6 non-SCs) switched our standard stroke thrombolytic from alteplase (ALT) to tenecteplase (TNK; 0.25 mg/kg) in September 2019. Methods: We designed a two-year prospective cohort analysis of key processes and clinical outcomes for TNK-treated patients with planned quarterly assessments of feasibility and safety. The TNK cohort is compared to the retrospective historical cohort of all unique patients at these hospitals treated with ALT during the prior 2-year period (n=354). Analysis were taken from a local REDcap registry that recorded data fields required for Stroke Center certification and submission to Get-With-The Guidelines (GWTG). Interim results through three quarters ending June 30, 2020. Results: 151 patients were treated with TNK. The samples TNK v ALT were well matched on age (median, IQR) 66.0 (55.0, 76.0) v 67.0 (55.0, 78.8) and NIHSS at admission (median, IQR), 8 (4, 13) v 8 (4, 15). Symptomatic ICH (ECASS 3 definition...

Objective: Ankle sprains are common affecting 2.15 per 10,000 persons per year. They are among th... more Objective: Ankle sprains are common affecting 2.15 per 10,000 persons per year. They are among the most common athletic injuries and represent 15 to 20% of all athletic injuries. Typically patients injure the lateral ligaments; however, a subset of patients sustain injury to the medial and lateral ligamentous complexes, representing a more severe injury. We present a group of patients with this disease, and evaluate the results of surgical treatment and its evolution. Methods: We retrospectively reviewed a consecutive cohort of patients that were treated with medial sided ligamentous reconstruction and were greater than 6 months from their index procedure. Patients that had an isolated medial sided repair or patients that had a medial sided repair in conjunction with a degenerative flatfoot reconstruction were excluded. Patients returned for radiographs, clinical examination by a blinded observer and a functional evaluation. Descriptive statistics were performed. Results: The mean f...

Objective: To describe an unusual presentation of isolated pontine PRES and highlight the imaging... more Objective: To describe an unusual presentation of isolated pontine PRES and highlight the imaging findings. Background: Isolated pontine PRES is a rare variant of PRES which affects the brainstem without cortical or subcortical cerebral involvement. In a case study from Alexander et al, this was found in 4% of the patients presenting with PRES. As described in literature, this syndrome can present with altered consciousness, seizures, and speech problems. Our case is unique due to its unusual presentation. Design/Methods: Case Report Results: A 54 year-old male with history of untreated hypertension was brought to our emergency department for sudden onset of confusion and right body weakness. Upon arrival, his blood pressures was elevated at 220/100 mmHg. Neurological examination revealed a normal level of consciousness, dysarthria with mildly decreased fluency, mild right facial palsy, and right hemiparesis. Symptoms resolved within 30 minutes. Computed tomography (CT) of the head ...

The Journal of the American Academy of Orthopaedic Surgeons, Jan 12, 2018

Foot and Ankle Clinics, 2015

Understanding the subtalar joint is extremely important in order to grasp the complexity of the f... more Understanding the subtalar joint is extremely important in order to grasp the complexity of the foot. The anatomy and biomechanics are crucial to the function of the hindfoot, ankle, midfoot, and even forefoot. This issue provides expertise in areas ranging from anatomy, radiology, biomechanics, congenital and acquired conditions, and treatment options of the subtalar joint. Proper history and physical examination, along with imaging, are important to diagnose and appropriately treat the patient. Subtleties are important, and attention to detail can be the difference in a satisfied patient versus a poor outcome.

Foot & ankle international, Jan 4, 2015

Preoperative computer navigation and patient-specific instrumentation have had promising results ... more Preoperative computer navigation and patient-specific instrumentation have had promising results in total knee arthroplasty and in a previous cadaveric total ankle arthroplasty (TAA) study. Potential benefits of patient-specific guides include improved implant alignment and decreased surgical time. The purpose of this retrospective case series was to evaluate the accuracy, reproducibility, and limitations of TAA tibia and talar implant placement and radiographic alignment using preoperative computed tomography (CT) scan-derived instrumentation in a clinical setting. Between 2012 and 2014, 42 consecutive TAA cases in 42 patients using preoperative CT scan-derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis TN) were reviewed from a single center of foot and ankle fellowship-trained orthopaedic surgeons. TAA implants used included 29 intramedullary referencing implants (INBONE II, Wright Medical Technology) and 13 low-profile tibia and talar resurfac...

Foot & ankle international, Jan 8, 2015

Limited incision techniques for acute Achilles tendon ruptures have been developed in recent year... more Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures. Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision wit...

Foot and Ankle Clinics, 2015

The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial inc... more The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial incision, and the extensile lateral approach. The choice of one over the other depends on the underlying pathology, previous surgeries, associated foot pathologies, soft tissue quality, and medical comorbidities. This article reports on several cases of subtalar joint fusion.

Foot and ankle clinics, 2011

Hammertoe and clawtoe deformities are common forefoot problems. The deformity exists owing to the... more Hammertoe and clawtoe deformities are common forefoot problems. The deformity exists owing to the underlying pathoanatomy. Hallux valgus, longer metatarsals, and intrinsic imbalance are the most common etiologies. Understanding the cause of the deformity is important to be able to successfully treat the condition, whether nonoperative or with operative intervention. When nonoperative measures fail, PIP correction is best obtained through arthroplasty or arthrodesis. The key to successful PIP correction is obtaining a well-aligned toe and reducing pain as demonstrated by Coughlin and Mann.15 When choosing a technique, the author prefers PIP joint arthrodesis because it has several advantages, including a decreased risk of recurrence and a more predictable toe posture. The authors prefers an intramedullary device to avoid the well-known complications of K-wires. The best surgical correction and fixation techniques are still to be determined. Each patient much be evaluated thoroughly a...

Foot & Ankle Specialist, 2014

The distal tibial blind spot represents an area where improperly measured long screws may pose a ... more The distal tibial blind spot represents an area where improperly measured long screws may pose a risk to surrounding anatomic structures and is not well visualized on AP, mortise, and lateral radiographs. Awareness of this area as well as the use of a 45° external rotation oblique view when placing fixation in this area may prevent iatrogenic injury. Levels of Evidence: Level V, Expert Opinion

Foot & Ankle International, 2013

Background: Ball and socket ankle (BASA) deformity is a rare condition. Little is known about out... more Background: Ball and socket ankle (BASA) deformity is a rare condition. Little is known about outcomes and treatments in the adult population. Methods: Retrospective comparative review was performed of 13 patients treated for BASA with a minimum follow-up of 2.5 years. Evaluation included clinical and radiographic review, outcome scores, a questionnaire, and a subjective satisfaction survey. Results: Nine patients with correctable valgus deformity not associated with arthritis of the ankle joint underwent a supramalleolar osteotomy (SMO). Four patients underwent arthrodesis—2 a tibiotalocalcaneal (TTC) arthrodesis and 2 a pantalar arthrodesis. AOFAS scores improved from 30.1 to 77.6 (range, 16-82) ( P < .05) in the SMO group. AOFAS scores improved from 24 to 60.5 (range, 16-66) ( P < .05) in the arthrodesis group. Arthritis grade in the SMO patients was unchanged in 4 patients at final follow-up and worsened in 5 patients by only 1 grade. Nine patients reported good results (a...

Foot & Ankle International, 2011

Background: Dorsal plate fixation is used commonly for arthrodesis of the hallux first metatarsop... more Background: Dorsal plate fixation is used commonly for arthrodesis of the hallux first metatarsophalangeal (MTP) joint. Custom dorsal plates incorporating locking technology have been developed recently for applications in the foot to provide relative ease of application and theoretically superior mechanical properties. The purpose of this study is to compare the radiographic and clinical outcomes of patients undergoing hallux MTP joint arthrodesis using a locked plate, or a nonlocked plate. Materials and Methods: We compared consecutive patients who underwent hallux MTP arthrodesis for a variety of diagnoses with either a precontoured locked titanium dorsal plate (Group 1) or a precontoured, nonlocked stainless steel plate (Group 2). All patients were evaluated with radiographs, visual analog pain scale, American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and a detailed patient satisfaction survey. Results: There were 73 feet in Group 1 and 107 feet in Group 2. There ...

Foot & Ankle International, 2010

Background: Tibialis anterior tendon rupture is an uncommon injury that can cause significant fun... more Background: Tibialis anterior tendon rupture is an uncommon injury that can cause significant functional deficit. Recent series have supported surgical reconstruction in younger, more active patients. We investigated our clinical outcomes of patients having undergone surgical management of tibialis anterior tendon ruptures. Materials and Methods: Fifteen tibialis anterior tendon ruptures in 14 patients were retrospectively reviewed after surgical management. Five had primary repair, while 10 had tendon transfers. Average age at time of surgery was 70.6 years with an average followup of 27.2 months. Patients were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and SF-36 clinical outcome scores. Strength measurements utilizing a dynamometer and range of motion (ROM) were documented on the operative and non-operative ankles. Patient satisfaction surveys were performed. Results: Average postoperative AOFAS hindfoot score was 88.8 and SF-36 score was 76.4. There was a ...

Foot & Ankle International, 2010

Background: The purpose of this study was to retrospectively review the results of patients treat... more Background: The purpose of this study was to retrospectively review the results of patients treated with hallux MTP joint arthrodesis using dome-shaped reamers for joint preparation and a precontoured dorsal stainless steel plate for internal fixation. Materials and Methods: A series of 145 patients (155 feet) were identified. Postoperative evaluation included weightbearing radiographs, physical examination, and chart review. Outcomes were assessed with a pain visual analog scale, AOFAS hallux score, as well as a detailed questionnaire and a subjective satisfaction survey. Results: 98 patients (107 feet) met the criteria for the study. The mean followup was 61 weeks. Revision cases accounted for 18.7% (20/107). Rheumatoid arthritis (RA) was present in 32.7% (35/107). The average postoperative AOFAS hallux score was 79.7 and pain VAS was 19. The average pre and postoperative hallux valgus angle was 26.5 and 12.3 degrees, respectively ( p < 0.05). Eighty-nine of 107 patients (83.1%...

Foot & Ankle International, 2010

Background: Lesser toe deformities are frequent and bothersome conditions. Many options exist for... more Background: Lesser toe deformities are frequent and bothersome conditions. Many options exist for the treatment of hammertoes and clawtoes. The purpose of this study was to review our experience with the use of an intramedullary fusion device. Materials and Methods: An IRB approved retrospective review was performed to identify 38 toes in 27 patients treated with the StayFuse™ (Nexa Orthopaedics) device with a mean followup of 31 months. The indications for surgery were primary deformity in 12 toes and recurrent deformities in 26 toes. Results: Union occurred in 23 of 38 (60.5%). The union rate was nine of 12 for primary procedures and 53.8% (14/26) for revisions. Coronal PIP alignment demonstrated no change in 33 of 38 cases (86.8%) and changed in five of 38 (13.2%). Sagittal PIP alignment demonstrated no change in 36 of 38 cases (94.7%), and changed in 2/38 (5.3%). Including nonunion, the overall complication rate was 55.3% (21/38) (15 nonunions; three hardware failures (two (bent...