A new modified technique for harvest of calcaneal bone graft in surgery on the foot and ankle

Pain after cheilectomy of the first metatarsophalangeal joint: diagnosis and management

Cheilectomy is commonly performed for osteoarthritis of the first metatarsophalangeal joint and generally has a successful outcome and high rate of patient satisfaction over the short to medium term. Despite the relatively good results achieved in most cases, a proportion of patients have ongoing pain after cheilectomy. This article outlines the potential causes of ongoing pain, including progression of osteoarthritis, neuralgic symptoms, and transfer metatarsalgia. Management strategies for treating the ongoing symptoms are discussed.

Complications associated with autogenous bone marrow aspirate harvest from the lower extremity: an observational cohort study

The purpose of this article is to report the complications associated with autogenous bone marrow aspirate harvested from the lower extremity (ie, tibia and/or calcaneus) for soft tissue and/or osseous healing augmentation. This is a multisite, multisurgeon, observational cohort study involving retrospective review of prospectively collected data of 548 autogenous bone marrow aspirate harvests from the lower extremity of 530 consecutive patients between August 2000 and March 2009. Each patient underwent autogenous bone marrow aspirate harvest from the proximal medial tibial metaphysis, distal medial tibial metaphysis, medial malleolus, lateral calcaneus, medial calcaneus, or a combination of both the proximal tibial metaphysis and lateral calcaneus for application to split-thickness skin graft application sites or for mixture with allogeneic bone graft material for osseous defects or arthrodesis. Patients were kept non-weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 324 female and 206 male patients with a mean age of 54.7 +/- 14.1 years (range: 14 to 84 years). There were 276 left feet/ankles and 272 right feet/ankles undergoing operative interventions with 18 harvests occurring from the proximal medial tibial metaphysis, 183 from the distal medial tibial metaphysis, 11 from the medial malleolus, 325 from the lateral calcaneus, 3 from the medial calcaneus, and 8 from both the proximal tibial metaphysis and lateral calcaneus. All procedures were deemed successful with no nerve-related injury, infection, wound-healing complications, or iatrogenic fracture occurring. When properly performed, autogenous bone marrow aspirate harvest from various locations about the lower extremity as described here represent safe and minimally invasive techniques useful for soft tissue and osseous healing augmentation.

LEVEL OF EVIDENCE

4 (Case Series; Therapeutic Study).

Percutaneous bone marrow aspirate and bone graft harvesting techniques in the lower extremity

Autogenous bone marrow aspirate and cancellous bone graft represent a useful adjuvant to enhance soft tissue and osseous healing in high-risk patients. The authors present a review of the pertinent literature and step-by-step guidelines for performing reliable, simple, and reproducible percutaneous surgical techniques to harvest autogenous bone marrow aspirate and cancellous bone graft from the proximal medial tibial metaphysis and lateral calcaneus. In addition, these techniques are associated with low morbidity and financial cost.