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- Author or Editor: Gary R. Bauer x
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The flexor digitorum accessorius longus muscle was observed during a cadaveric surgery course on the foot and ankle for third-year podiatric medical students. The cadaveric foot had been amputated just proximal to the ankle level so that the muscle origin could not be determined; its insertion, however, was found to be into the flexor digitorum longus tendon, just before the tendon split into its digital slips. This article reviews the literature on the muscle and its clinical implications and describes and shows the muscle as it was seen in this case. (J Am Podiatr Med Assoc 92(8): 463-466, 2002)
Stability of the Offset V-Osteotomy
Test Jig Development and Saw Bone Model Assessment
In the offset V-bunionectomy used for hallux valgus repair, both the Kalish and the Vogler variations have a long dorsal arm, but the apex is more distal in the Kalish procedure. This study investigated the effect that pin orientation and location of the osteotomy apex have on weightbearing stability. The authors studied saw bone models that were loaded to failure in an Instron 4201 materials testing machine and, in addition, designed, fabricated, and used a unique jig assembly to help minimize data variability. Statistically significant differences were found between the surgical techniques and pin orientations: the Kalish osteotomy was stronger than the Vogler procedure, and in both osteotomies, the plantarly directed Kirschner wire orientation was stronger than the dorsally directed orientation. (J Am Podiatr Med Assoc 92(2): 82-89, 2002)
Lesser Proximal Interphalangeal Joint Arthrodesis
A Retrospective Analysis of the Peg-in-Hole and End-to-End Procedures
A retrospective study was performed to compare the prevalence of complications in peg-in-hole and end-to-end arthrodesis procedures. The authors reviewed 177 second, third, and fourth proximal interphalangeal joint fusions for the correction of hammer toe deformities in 85 patients from 1988 to 1998 at the Temple University School of Podiatric Medicine. The average age of the patients was 49 years. Sixteen percent (14) of the subjects were male and 84% were (71) female. Upon follow-up, the fourth digit was generally associated with a greater number of complications for the end-to-end and peg-in-hole procedures, with the second digit being the most common site of fusion. The prevalence of complications was evaluated using contingency table analysis and expressed as a percent of total complications (27%, the end-to-end group; 17%, the peg-in-hole group). A subset of complications deemed clinically relevant was also computed. Similarly, the prevalence of clinically relevant complications for the end-to-end (10%) and the peg-in-hole (9%) procedures was not statistically significant. Therefore, this study showed no statistically significant differences in the total or clinically relevant complications between end-to-end and the peg-in-hole arthrodesis procedures. (J Am Podiatr Med Assoc 91(7): 331-336, 2001)
Peg-in-Hole, End-to-End, and V Arthrodesis
A Comparison of Digital Stabilization in Fresh Cadaveric Specimens
The proximal interphalangeal joint arthrodesis is frequently performed to correct hammer toe deformities. This study was conducted to compare the inherent stability of the three proximal interphalangeal joint arthrodeses—peg-in-hole, end-to-end, and V constructs—in the sagittal plane by means of load-to-failure testing of 30 fresh-frozen cadaveric specimens fixated with a 0.045 Kirschner wire. The peg-in-hole construct was associated with significantly higher peak loads at failure compared with the other two procedures. Furthermore, the peg-in-hole construct had significantly higher stiffness values as compared with the V procedure. This study thus provides evidence that the peg-in-hole procedure is the most biomechanically stable surgical construct for proximal interphalangeal joint fusions under sagittal plane loading. (J Am Podiatr Med Assoc 91(2): 63-67, 2001)
