


|
|
|
|
Search
01/05/2017 David E. Samuel, DPM
The MIS Akin Osteotomy (Joe Boylan, DPM)
I appreciate Dr. Boylan's post and non- disparaging thoughts regarding treating other doctors' complications. I can't agree more. We all see them and do them and understand, that we usually don't see bad surgery but bad outcomes, that can happen to all of us.
However, if I saw one of my post-op x-rays with the capital fragment teetering on a 2-4mm area on the met shaft with what appears to be a first met angle easily 18 deg, if not more, I WOULD BE VERY WORRIED. Dr. Boylan is correct. My residents are not taught this, will never be taught this, and I hope when they move on to their own careers, I will never see a post-op film like this, with very large IM angle, and this tiny bone to bone apposition of a capital fragment, with their names on it.
There may be some limited use of a burr for foot surgery, but not this. This is why we teach them Lapidus, base wedge, opening wedge, etc etc to appropriately correct deformity within a reasonable standard of care for bunion surgery. I'm sorry but this is no way standard of care across the country nor should it ever be, whether pod, ortho, etc. We have come a long way. Much better training. Better didactics, etc.
There are many ways to fix met primus varus, all dealing with the appropriate management of the first met angle. Whether someone likes a Scarf or base type corrections or even decides to under correct, based on age or bone stock is certainly surgeons preference and within reasonable standards. But I cannot see these post-op films as ever being acceptable as reasonable standard of care. My personal feelings is that this can takes us all back if we as a group accept this as okay. What I hear is, 'can you believe this is what those podiatrist do ?'
These forums are great for frank intra- disciplinary discussion. It makes us all think and I hope makes us all better. I cannot be the only one out there who, after seeing these films did not cringe a little. Otherwise, meaning no disrespect at all, please let me know if what I am saying is wrong or needs a different look. Am I missing anything ? Is this OK? Do others agree with me or should I be looking at this whole thing differently?
David E. Samuel, DPM, Springfield, PA
Other messages in this thread:
01/05/2017 Burton J. Katzen, DPM
The MIS Akin Osteotomy (Joe Boylan, DPM)
Regarding Dr. Boylan's response concerning MIS surgery, First, let me ask Dr. Boylan if he actually had training and experience in MIS surgery? Also, does he believe that none of his patients have ended up in another physician's office with less than optimal results? That being said, assuming your limited experience was 25 to 35 years ago, comparing MIS surgery at that time to the present would be the equivalent to comparing bloodletting to today's modern medical treatment.
MIS is an accepted standard of care in almost every other medical specialty. The MIS foot and ankle procedures, instrumentation, and training (all of us have originally be trained open) are completely different than your experience. The real tragedy of his post is not his uninformed prejudice against MIS, but the fact that he is closing young practitioners minds to learning a skill that not only benefits patients, is being performed throughout the world, but they will need to survive going forward given today's medical climate.
With that in mind, The Academy of Ambulatory Foot and Ankle Surgery has established a scholarship to bring young graduates to our LSU Cadaver seminars with the hope that they will lean a skill that, unfortunately up to now, that has not been taught in the mainstream residencies. I would advise you to consider attending a seminar, and, I assure you, you will meet the friendliest group in our profession, along with some of the most successful. And by the way, I don't know one member who has ridden off in the sunset. I know I haven't after 43 years.
Burton J. Katzen, DPM, Temple Hills, MD
|
|
|
|
|