Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of cases in orthopaedic and maxillofacial surgery. Autologous bone graft remains to be the 'gold standard' and the iliac crest to be the most common harvesting site. The intramedullary canal of long bones represents another potential site for large volume of autologous bone graft harvesting and is recently being used as an alternative donor site. However, harvesting of autologous bone graft is associated with morbidity and a number of complications. The aim of this systematic review was to collect and summarise the existing data on reported complications after harvesting autologous bone from the iliac crest (anterior and posterior) and the long bone intramedullary canal using the RIA device. We searched the PubMed Medline and Ovid Medline databases, from January 1990 to October 2010, to retrieve all relevant articles. A total of 92 articles (6682 patients) were included in the analysis. Overall, the complication rate following RIA was 6% (14 complications in 233 patients) and 19.37% after iliac crest bone graft harvesting (1249 complications in 6449 patients). The rate of each of the reported complications was assessed and, when the donor site was properly documented, comparison within the anterior and posterior iliac crest donor sites was performed. Although the difference of the overall morbidity rates between the two harvesting sites was not statistically significant (p=0.71); the rates of certain complications were found to significantly differ when anterior or posterior iliac crest was used. The rates of infection (p=0.016), haematoma formation (p=0.002), fracture (p=0.017), and hyperthrophic scar (p=0.017) were significantly higher when the donor site was the anterior iliac crest compared to the posterior iliac crest; whereas the rates of chronic donor site pain (p=0.004) and sensory disturbances (p=0.003) were significantly lower. The incidence of bone graft harvesting related complications can be reduced further if certain principles are followed depending on the performed harvesting methods; but overall the use of RIA device as harvesting method seems a promising alternative with a low complication rate.

Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.

Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.

https://bjsm.bmj.com/content/bjsports/36/4/239.full.pdf

Patellar tendinopathy: some aspects of basic science and clinical management.

Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.

The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010

Originally known as posterior tibial tendon dysfunction or insufficiency, adult-acquired flatfoot deformity encompasses a wide range of deformities. These deformities vary in location, severity, and rate of progression. Establishing a diagnosis as early as possible is one of the most important factors in treatment. Prompt early, aggressive nonsurgical management is important. A patient in whom such treatment fails should strongly consider surgical correction to avoid worsening of the deformity. In all four stages of deformity, the goal of surgery is to achieve proper alignment and maintain as much flexibility as possible in the foot and ankle complex. However, controversy remains as to how to manage flexible deformities, especially those that are severe.

Adult-acquired Flatfoot Deformity

study, however, 31% of 58 patients with this condition did not participate in vigorous physical activity. 3 In this article, we have concentrated on tendinopathy of the main body of tendo Achillis. We have not dealt with Haglund's condition, insertional tendinopathy, or with lesions of the myotendinous junction. Anatomy. The gastrocnemius muscle merges with the soleus to form tendo Achillis. 4 It has a round upper part and is relatively flat in its distal 4 cm. Its fibres spiral through 90°, increasing the release of stored energy during locomotion. 5 Tendo Achillis is enveloped by a paratenon, originating from the deep fascia of the leg, the fascia cruris. Blood flow in the tendon increases considerably with exercise, probably due to the marked rise in the negative tissue pressure

Tendinopathy of tendo achillis.

Chronic disorders of the Achilles tendon are commonly seen by the orthopaedic surgeon. In cases that are resistant to conservative treatment, a variety of surgical procedures have been utilized in the past. The indications for a previously described technique of flexor hallucis longus tendon transfer for reconstruction of chronic Achilles tendon rupture have been expanded to include further subsets of chronic Achilles tendinopathy, including rupture and tendinosis. We evaluated 20 patients (mean age 61) who underwent flexor hallucis longus transfer for treatment of chronic Achilles tendinopathy at a mean of 14 months following surgery. Our results were measured with the SF-36 survey, AOFAS Ankle-Hindfoot Scale, and Cybex strength and range of motion testing. Wound complications, tip-toe stance, and calf circumference were also assessed. There were no postoperative reruptures, tendinopathy recurrences, or wound complications. Despite a small loss of calf circumference, range of motion, and plantarflexion strength, 90% of patients scored 70 or higher on the AOFAS scale. SF-36 testing revealed significantly lower scores in the physical function category when compared with United States norms. Flexor hallucis longus tendon transfer/augmentation is a reasonable option for treatment of chronic Achilles tendinosis and rupture.

Treatment of Chronic Achilles Tendon Disorders with Flexor Hallucis Longus Tendon Transfer/Augmentation

Background:Dislocations and fracture-dislocations involving the tarsometatarsal joint are a relatively common injury. These injuries are associated with long-term disability from subsequent painful...

Open reduction internal fixation versus primary arthrodesis for lisfranc injuries: a prospective randomized study.

Background: Gastrocnemius recession is performed to correct an isolated gastrocnemius equinus contracture of the ankle that may accompany foot and ankle pathology in the adult. It has been proposed...

Gastrocnemius Recession to Treat Isolated Foot Pain

Background: The purpose of this study was to determine the overall first tarsometatarsal joint (TMTJ) union rate in patients after they had a modified Lapidus procedure or a TMTJ arthrodesis as par...

Fusion rate of first tarsometatarsal arthrodesis in the modified Lapidus procedure and flatfoot reconstruction.

Calcaneus fractures are a significant burden to society. Assessment and treatment of these injuries has improved significantly. The use of CT scanning has allowed a greater understanding of the pathologic anatomy of these fractures, and has provided for prognostic classification systems with respect to outcome. The treatment options are diverse and are reviewed.

https://www.foot.theclinics.com/article/S1083-7515(05)00028-8/pdf

Donald R. Bohay

Papers

Treatment of Chronic Achilles Tendon Disorders with Flexor Hallucis Longus Tendon Transfer/Augmentation

Open reduction internal fixation versus primary arthrodesis for lisfranc injuries: a prospective randomized study.

Gastrocnemius Recession to Treat Isolated Foot Pain

Fusion rate of first tarsometatarsal arthrodesis in the modified Lapidus procedure and flatfoot reconstruction.

Calcaneus fractures: a review article.