Medical Student Research Fellowship for Summer 2010
Mentor: Karl Rathjen, M.D.
Department: Orthopaedic Surgery
Room number: TSRH, 2222 Welborn St., Dallas, TX 75219
Phone number: 214-559-8471 (Research Coordinator Tara Kristof)
Project title: Outcome of Hindfoot Fusion in Pediatric Patients
Human subjects IRB approved project number (where applicable): Not yet submitted.
Animal subjects IRB approved project number (where applicable): N/A
Project Type: Prospective patient-based research.
Brief Description of Project: Description of Proposed Research
a) Specific Aims
The specific aim of this study is to assess the results of hindfoot fusion in patients with a homogenous diagnosis using validated outcome instruments and motion analysis. Our null hypothesis is that a stiff, plantigrade foot obtained by hindfoot is a functional foot with low amounts of complications. Further, we believe that we may find that "neurologically normal" patients (clubfoot and tarsal coalition) will have more adverse sequela related to fusion than neurologically "abnormal" patients (spina bifida and CMT) who will more likely be limited by the severity of their neurologic disease. If there are sufficient numbers, we will compare the results between isolated subtalar fusion and triple arthrodesis within each diagnosis. (This most likely will be possible for patients with a tarsal coalition.) However, if the numbers are insufficient we will exclude patients treated with subtalar fusion. (Presumably the less frequent procedure.)
b) Study Design
This is a prospective study that involves contacting all patients who have been treated with hindfoot fusion prior to 2/15/2008. Appropriate candidates will be asked to return for a single visit. The Research Coordinator will research current contact information, call or mail a letter, set up appointments, consent the patients, and take them to x-ray to have standing AP and lateral views of the feet and an ipsilateral standing AP and lateral views of the knee. An updated medical history including specific data on the frequency and treatment of foot ulceration will be obtained. Patients will be asked to complete several validated clinical outcome questionnaires including the SF-36, visual analog score (VAS), Maryland hindfoot and ankle score and American orthopaedic foot and ankle society (AOFAS) questionnaires. Both neurologically normal patients (those with clubfoot and tarsal coalition) and neurologically abnormal patients (spina bifida and CMT) will then go to the Movement Science Lab (MSL) for a complete gait analysis study. Analysis in the MSL will consist of: clinical range of motion and strength assessment, instrumented kinematic and kinetic analysis and plantar pressures. Subjects will be fit with reflective markers on their lower extremities and feet. They will be asked to complete multiple walking trials of approximately 10 meters while the motion capture system records their motion. Pressure under the feet will be collected during gait as subjects walk over a special pedobarograph plate that measures plantar pressures. Video and standing photographs will also be used for assessment.
Previous Research Activities or Publications with Medical Students:
2007 - Cuyler Dear and Terri Griffith worked on preliminary chart reviews for this same study. No publications since study is still underway.
2006 - Mustafa Alibhai - Recurrence Rate Following Curettage and Bone Grafting of Aneurysmal Bone Cysts of the Extremities. - no publications
2005 - Zachary Vest - Long Term Following Removal of Posterior Spinal Implants
Rathjen, KE, M Wood, A McClung, Z Vest. Clinical and Radiographic Results After Implant Removal in Idiopathic Scoliosis. Spine. (In press)
2004 - Heath McCullough - Outcome of Open Reduction for Treatment of DDH in the Older Child - no publications