Dr. Watson’s Published Articles
Treatment of Lisfranc Joint Injury: Current Concepts
by Troy S Watson, MD, the late Paul S. Shurnas, MD and Jacques Denker
Injuries to the tarsometatarsal joint complex, also known as theLisfranc joint, are relatively uncommon. However, the importance ofan accurate diagnosis cannot be overstated. These injuries,especially when missed, may result in considerable long-termdisability as the result of posttraumatic arthritis. A high level ofsuspicion, recognition of the clinical signs of injury, and appropriateradiographic studies are needed for correct diagnosis. Whensurgery is indicated, closed reduction with percutaneous screwfixation should be attempted. If reduction is questionable, openreduction should be performed. Screw fixation remains thetraditional fixation technique.
Correction of Moderate to Severe Hallux Valgus With Isometric First Metatarsal Double Osteotomy
by Werner Siekmann, MD, Troy S Watson, MD and Matthias Roggelin, MD
The operative treatment of moderate to severe hallux valgus presents various challenges for the surgeon. Despite the multitude of operative techniques and their combinations, the indications for single, double, or triple osteotomies remain muddled and treatment requires independent decisions for each foot. To correct a higher 1-2intermetatarsal angle (IMA), a more proximal metatarsal osteotomy is necessary. Biomechanical studies have identified the alignment of the first tarsometatarsal joint to be of high importance in the development of hallux valgus.
Therefore, while preserving the tarsometatarsal joint, the proximal procedure realigns the first ray to a greater extent than a distal procedure is capable of doing. According to biomechanical studies, the differences in stiffness and stability of various osteotomy types have led to the development of a medially placed low-profile plate for a proximal first metatarsal opening-wedge osteotomy. The plate should be thin enough to be self-bending while stabilizing the opening wedge osteotomy.
The Proximal Opening Wedge Osteotomy for the Correction of Hallux Valgus Deformity
by Troy S Watson, MD and the late Paul S. Shurnas, MD
Many surgical procedures exist to correct metatarsus primus varus associated with hallux valgus deformity. Among these procedures are various first metatarsal osteotomies. Both distal and proximal osteotomies have been described to correct these deformities with the latter typically used for the more severe deformity. The goal of the operative procedure is correction of the intermetatarsal and hallux valgus angles with restoration of pain-free shoe wear. The complications associated with the various described proximal metatarsal osteotomies are many, and the techniques can be technically demanding, especially for the surgeon without assistance in the operating room. Although generally good results are observed with traditional osteotomies, the complication rate remains high, leading many surgeons to search for alternative means for correcting these deformities. In this paper, we review a novel technique with a proximal opening wedge osteotomy of the first metatarsal for the correction of moderate-to-severe hallux valgus deformity.
Outpatient Management of Low-Velocity Gunshot-Induced Fractures
by Troy S Watson, MD, Kyke Dickson, MD , Mitch Harris, MD, Charles Haddad, BS and Joel Jenne, BS
This prospective study evaluated the efficacy of an out-patient management protocol for patients with gunshot-induced fracture with a stable, nonoperative configuration. Forty-one patients (44 fractures) with a grade I or II open, nonoperative fracture secondary to a low-velocity missile comprised the study population. Patients were treated by a standard protocol, which included 1 g of cefazolin administered in the emergency room and a 7-day course of oral cephalexin. Follow-up visits were performed until complete wound and fracture healing achieved.
Thirty-two (78%) of 41 patients underwent full follow-up. Average follow-up was 5.2 months. One (2.8%) fracture (distal fibula) developed a superficial infection, which responded to an additional week of oral antibiotics, and no patient with painful retained shrapnel. These results demonstrate that patients with stable, low-velocity, gunshot-induced fractures can be managed effectively and safely on an outpatient basis using this protocol.