WUTH publication: Osteochondral distal metatarsal allograft reconstruction: a case series and surgical technique

Citation: Foot and ankle international. 2013, 34(8), 1158-67
Author: Ajis A, Seybold JD, Myerson MS
Abstract:  BACKGROUND: Painful degenerative diseases of the metatarsophalangeal joints (MTPJs) are frequently progressive and difficult to treat. Traditional operative treatments such as debridement, distal metatarsal osteotomies, and arthroplasty present a unique set of complications, and pain and deformity may still occur. Osteochondral distal metatarsal allograft reconstruction (ODMAR) is presented as a salvage procedure, reserved for patients with significant bone loss or avascular necrosis in whom traditional interventions have failed or are inadequate to address the underlying joint deformity. METHODS: A retrospective review identified all ODMAR cases performed by the senior author over the past 10 years. Patient symptoms, satisfaction, and MTPJ range of motion were measured at each postoperative evaluation. Graft healing and subsequent degenerative changes at the MTPJ were observed at each visit with foot radiographs. The surgical techniques for both first and lesser metatarsal reconstructions are described. RESULTS: Six patients were identified with average follow-up interval of 36 months (range, 6-66). Preoperative diagnoses included infection (1), fracture (1), and avascular necrosis (4). Mean total arc of motion was 40 degrees (range, 30-50). All patients maintained viability of the allograft metatarsal head and joint space was normal or Kellgren-Lawrence grade 1 in 5 of 6 patients at final follow-up. All patients demonstrated osseous union of the metatarsal osteotomy site. No patients have undergone revision surgery to date. CONCLUSIONS: ODMAR is a safe and effective procedure for treatment of painful, degenerative conditions of the MTPJs. Further studies are required to determine the definitive indications and long-term outcomes for this procedure. LEVEL OF EVIDENCE: Level IV, retrospective case series. KEYWORDS: allograft, arthritis, forefoot disorders, metatarsal, necrosis, osteochondral

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WUTH publication: Preoperative mapping of fistula in ano: a new 3D MRI based modelling technique

Citation: Colorectal Disease. 2013, 15(11), e699-701
Author: Day N, Earnshaw D, Salazar-Ferrer P, Walsh C
Abstract: AIM: We aimed to develop an intuitive, interactive, 3D MRI modelling technique to produce a 3D image of fistula in ano. METHOD: The 3D model is created from standard 2D MRI sequences to produce an image which is anatomically correct. Individual muscle and soft tissue layers are extracted from T1 weighted sequences and fistula pathology from STIR sequences, to produce two separate volumes. These are then fused using post processing software (Vitrea Workstation version 6.3) to generate a 3D model. RESULTS: The final 3D model is incorporated into a PDF file which has an integrated CAD viewer allowing the surgeon to rotate it in any direction during pre operative planning or whilst in theatre. CONCLUSION: As an adjunct to 2D MRI images and the associated radiology report, this model communicates better the fistula anatomy to the clinician and should be particularly useful in complex cases. This article is protected by copyright. All rights reserved.

Link to Pubmed record 

Consultation

The Trust Library & Knowledge Service is currently undertaking its annual review of subscription sources to ensure that we have access to the most appropriate titles, across a wide range of subjects, for Wirral University Teaching Hospital NHS Foundation Trust.

We subscribe to 100s of journals, either print or electronic. You can check which titles we have by consulting our print journal lists or by looking at the electronic titles via the Journals link on NICE Evidence Search. Please note you will need an NHS Athens account to access the full list of titles available to you.

Alternatively, please get in touch with us and we can send you a list of the journals available in your subject area.

If you have any comments about the range of titles available, or feel that there are any key journals missing, please let us know by Friday 1st November 2013. While we welcome any suggestions you may have for new titles, the final decision will be based on cost, ease of access and coverage of subjects.

We look forward to receiving your comments and suggestions.