Below is a picture of post-surgical ankle fusion using a cross screw technique. This type of procedure is typically necessary to relieve pain and disability from severe arthritis in the ankle as result of significant trauma or repetative trauma. The goal of this procedure is to eliminate pain and continues to be the gold standard for severe joint arthritis.
Abnormal anatomical position in addition to increased activity throughout a period of time or in same cases an injury will lead to irregular shaping of the bones around the big toe joint from abnormal wear and tear. This will cause arthritis type pain with stiffness and swelling.
With abnormal wearing of the joint, spurring of the top of the joint occurs from jamming causing decreased motion of the big toe in an upwards direction.
Post-operative x-ray of a joint that was repaired with a hemi (partial) joint replacement to alleviate limiting arthritis which also involves reshaping of the bones to eliminate spurring.
Open Fasciotomy for Acute Compartment Syndrome
Pictured below is an opening of the fascial muscle compartments of the left leg. This procedure is performed to release pressure that has built up in the muscle from activity in which the pressure does not go down after a certain amount of time. This increased, sustained pressure within the compartments is very painful and puts at risk loss of blood supply to the muscles, and in severe cases can cause death of the muscle tissue.
Below is a picture of retention sutures placed over the fasciitomy site in order to allow the muscle compartment to decompress but also does not allow the skin to retract and make closure of the large inscision difficult to perform at a later date.
This is primary closure of the incision site once the compartment has been adequately decompressed,
Juvenile Medial Malleolar Fracture in which the fracture runs from the ankle joint through the growth plate (pictured left) which is the jagged line running from side to side above the ankle joint. This growth plate will remain open until skeletal maturity to allow growth. The fracture running through the growth plate can jeopardize the growth and must be fixed to assure best results. Pictured on the right is the fracture after surgical repair with a screw that helps to compress the fracture without crossing the growth plate, but also aligning the growth plate as to not disrupt the growth of the bone. If possible crossing the growth plate with surgical hardware should be avoided in order to not affect the growth of the bone.
MeidmMmMedial Malleolar Fracture demonstrating displacement of the fracture fragment that could lead to abnormal healing and altering the mechanical function of the ankle joint necessitating the need for surgical repair. PostPPost
Post-surgical repair of fracture with realignment of fracture fragment held with two surgical screws to allow appropriate position of the fragment and compression which is most ideal for healing of the fracture. This also will allow return to function of the ankle joint which will decrease the potential degenerative problems than can occur after this type of injury.
Salter Harris IV Fracture (illustration), which is a classication for fracture in children involving the growth plate, of distal Tibia depicted on the left side with the fracture that extends above the growth plate and also disrupts the growth plate which can also stop the grown of the bone. It is important to repair this surgically to ensure that the bone heals and has the best change for unaltered growth of the bone.in the juvenile patient. Picture on the right is after surgical repair demonstrating good approximaion of the fracture fragment and re-establishment of the growth plate.
Jones Fracture Status Post Percutaneous Screw Fixation
Jones fractures are specific in that they occur at the base of the 5th metatarsal occuring away from the articular surface, and are a common injury in certain sports such as basketball. This fractures are precarious in their character in that the area of the bone in question where the fracture takes place which has less blood supply than the remainder of the bone, therefore compromising healing potential of this area.
This is a side view (lateral) of the foot after surgical repair of the Jones Fracture which is important to stabilize this fracture not only for adequate healing but also because of soft tissue structures such as ligament and tendon that attach to the base of the the 5th metatarsal.
Chondrolysis of 2nd MPJ arthritis before and after microfracture
There is damage to the articular surface cartilage which can occur either from an acute injury or more commonly after repetative injury and/or wear and tear. If the the bones at the joint in questions are not aligned properly then this mechanically adds to the wear the the joint receives with activity and increases the propensity of this occuring. Pictured below is linear damage to the articular surface of the 2nd metatarsal head.
The following pictures are debridement of damaged cartilage that is abnorml in appearance and/or loose. This is removed completely to expose the subchondral (underneath cartilage) bone plate.
Drills holes are then placed through the bone plate to allow bleeding in the area which will aide in healing of the cartilage surface with fibrocartilage which is a kind of scarring of cartilage.
Bunion & Hammertoes
The following is depicting a bunion deformity of the great toe that has worsened a hammertoe contraction of the second toe. The outside deviation of the great to cause underriding of the second to which leads to increased dorsal (upward) dislocation of the toe.
Post-operative repair of the bunion and hammertoe deformities which straightens the great to utilizing a combination of bone cuts and soft tissue releases of the great toe and second toe to correct abnormal position of the toes and significantly improve pain with activities and use of shoes.
Below is a photograph a a severe overlapping bunion and hammertoe deformity. At this point in he mechanical process, the digits especially the second digit is dislocated from its articulation with the longer bone in the foot called the metatarsal. Severity of these deformities is multi-factorial involving genetics, altered mechanics with soft tissue contractures, and bad shoegear.
Below is a photograph of the top view of the same deformities that is pictured above.
Pictured below is the same foot after surgical correction of the bunion deformity of the great toe and hammertoe correction of the second, third and fifth toes. The plastic balls at the top of the second and third toe are covering wires that hold the position of the second and third toes into the longer bones (metatarsals) of the foot so that the soft tissue contractures heal in the correct place. Depending on the deformity, the wires will stay in place for a period of 4-6 weeks and then are removed.
The following is the fascial covering over a muscle compartment. The condition occurs when pressure within this compartment builds up after an injury or can also occur after excercise from the inability of the muscle to decompress naturally. This leads to pain that is unrelenting and could lead to decreas blood flow and oxygen to muscle tissue causing death of that tissue.
The picture below demonstrates the fascia overlying the tissue being lifted by the forceps at the top of the picture.
Below is demonstrates incision into the compartment exposing the muscle tissue that is a deeper red color where the retractor is to the left of the picture. The opening of the this fascial tissue is vital in releasing pressure in the compartment after injury or from excercise. It also important that this release be extensive as so the fascial tissue does not heal closed allowing build of pressure again.
Achilles Tendon Rupture
Most achilles tendon tears occur from chronic degeneration of the tendon in conjunction with improper conditioning of the tendon to perform certain activities such as jumping and sudden changes in direction. This is why this type of injury occurs in what is considered the "Weekend Warrior". This person usually does not train and condition the tendon to handle intense physical activity then goes and plays a sport over the weekend and the tendon gives out. In the picture below one can see the frayed ends of the torn Achilles tendon.
The image below is the tendon after repair with a complex suture technique called the Krachow stich. This is a very strong repair and prognosis after repair with physical therapy is very good.
Picture of a large benign bone tumor at the front of the ankle
Benign Tumore after removal of tumor
Pes Cavus (High arch foot)
Pre operative films of a Cavus foot with a high arch, which you can see the high pitch of the heel bone (calcaneus) relative to the ground (left). Post-surgical reconstruction of the cavus foot with a calcaneal sliding osteotomy fixated with two screws and a bone cut of the base of the first metatarsal to decrease the apex of the deformity near the joint fixated with a surgical staple (right).
This is Pre and Post op xrays of surgical correction of a syndesmotic rupture that failed the first time by a different physician due to screw break. On the Post operative films by our physicians, the space between the medial malleolus and talus is decreased and the joint is congruent and symmetrical. We bore a hole in the bone at the prior screw sites, added two syndesmotic screws that went across both bones for added stability as well as 2 Arthrex tightopes.
The following are pictures of a healed talar neck fracture status post ORIF. Due to the severity of the injury, the patient suffered subtalar arthritis and pain. The patient's heal also began to tilt in due to the injury. We performed a calcaneal osteotomy with subtalar fusion to correct the patient's foot.
These are pictures of a Pilon fracture that was performed by a different surgeon. The anterior tibial plate was placed too distal and invaded the patient's joint. These injuries often cause post-traumatic arthritis regardless of the fixation. The plate was removed and the patient had some relief. Approximately 1 year later, the patient underwent a successful arthroscopic fusion.
S/P Pilon with anterior plate too distal
After removal of the plate prior to arthroscopic fusion
After arthroscopic fusion
Intraoperative picture of an avulsion of the Achilles off the calcaneus
Below the Achilles is pulled through a trough in the heel bone to re-anchor it down)
Pic below of an avulsion of the Achilles off the heel bone prior to repair and re-anchor through the heel
Intraop pictures during hemi-implant for hallux limitus
Osteochondral Autograft Transfer System (O.A.T.S.)
Ankle fusion with fibular onlay graft after severe post traumatic arthritis post Pilon fracture
Achilles rupture intraoperatively before and after repair
Intraoperative pics of a bunion correction with a bone cyst in the first metatarsal. The cyst is curreted and autogenous bone graft from the bunionectomy is morselized and packed into the bone cyst.
Surgical resection of the coaltion allows removal of restriction of range of motion in the affected joint and elimination of pain associated with the attempted motion. Pictured is the coalition at the point of the metal instrument. Pictured right is the newly created space where that coalition once was located. The last picture is using the FDB muscle belly as an interpositional graft to occupy the deadspace and decrease chance of recurrence.
These are operative pictures of a child who had an enlarged fifth toe with a full extra set of bones that were removed to make the toe look more anatomic.
These are intraoperative pictures of removal of a painful spur in the back of the heel bone that failed conservative treatment.
This is an intraoperative pic of a heel spur in the back of the heel prior to resection. It is next to the instrument on the bottom right. The spur causes pain as it irritates the Achilles tendon
This is the bone cut performed to remove the spur and bone that causes pain.
This is a picture of the bone that is removed. Underneath the bone is the void left after removal.
This is a picture of the size of the bone removed. The top portion should have glistening white cartilage. It is yellowish and devoid of cartilage due to constant irritation from the Achilles. The spur is at the bottom portion 30% of the bone.
This is a picture of the suture placement in the Achilles tendon to reattach the tendon to bone. There are anchors in the bone that have the suture already attached. The anchors are driven into the bone to allow the Achilles tendon to reattach to the heel. These sutures are then tightened down for an intimate bone to tendon apposition.
Intraoperative pics of anterior and lateral compartment release for Chronic Exertional Compartment Syndrome
Intraop Arthroscopic Pics of talar OCD Surgery
Series of Pics Biopsy for Subungal Melanoma