What is it? In layman's translation, it's "the filling of bone cysts with sea coral" for the treatment of bone cysts and bone grafting.

Sounds like science fiction? Well, this actually makes perfect scientific sense. Viewed under an electron microscope, sea coral and human bone tissue are nearly identical. When scientists discovered this, the next step was using the ocean matter to repair damaged bones.

The process works like this: when a patient suffers from a bone cyst, the bone becomes as fragile as an eggshell. In a single operation, the cyst is drained and sea coral is used to fill the cyst and fortify the bone. The porous coral acts as a latticework, over which existing bone can crawl and grow across the gap. The end result is solid, natural bone matter. There is one limitation. Since the coral itself is not solid, it cannot be used for weight-bearing bones. Cystic long leg bones, for instance, are ineligible for the process. For spongy bones (knees, heels, ankles, etc.), sea coral is ideal and one that might revolutionize bone surgery.

Ask our doctors if Interpore Coralline Hydroxyapatite can work for you.

Our doctors were among the first in the state to use Interpore for bone surgery and have been doing so since 1996. Since then, Dr. Lefkowitz has lectured on this topic across the globe!

DIABETIC FOOT FACTS
Provided By:
MICHIGAN FOOT AND ANKLE
Harvey Lefkowitz, D.P.M.
Michelle Jupin, D.P.M.
Anthony Mastrogiacomo, D.P.M.

Did you know that if you are a diabetic you are at a higher risk of developing serious foot conditions in your lifetime?

Some of the most common conditions that effect diabetic patients are:

• Neuropathy (Nerve Damage)
  Your ability to detect sensations or vibration may be diminished. Neuropathy allows injuries to remain unnoticed and untreated for lengthy periods of time.
• Poor Circulation
  Persons with diabetes often have circulation disorders (peripheral vascular disease)
• Infection
  Persons with diabetes are generally more prone to infections than non-diabetic people.
• Foot Deformities
  Foot deformities such as hammertoes, bunions, and metatarsal disorders have special significance in the diabetic population. Neuropathy places the foot at increased risk for developing corns, calluses, blisters and ulcerations. If left untreated, serious infections may result.

It is very important that diabetics inspect their feet daily for blisters, bleeding, and sores between your toes. Use a mirror to inspect the bottoms of your feet, and always make sure to wear proper fitting shoe gear.

As a diabetic you may qualify for "extra depth" shoes. These are custom molded or extra depth shoes that adapt to your particular needs, or orthoses to provide cushioning and support.

As a benefit under Medicare, many diabetics qualify for these shoes and insoles.

According to the Feet Can Last a Lifetime - a publication of the National Diabetes Education Program

• The total annual cost for the more than 86,000 amputations is over $1.1 billion dollars. This cost does not include surgeons' fees, rehabilitation costs, prosthesis; time lost from work, and disability payments. Foot disease is the most common complication of diabetes leading to hospitalization. In 1995, foot disease accounted for 6 percent of hospital discharges listing diabetes and lower extremity ulcers.
• 15 percent of people with diabetes will experience a foot ulcer and between 14 and 24 percent of those with a foot ulcer will require an amputation
• After an amputation, the chance of another amputation of the same extremity or of the opposite extremity within 5 years is as high as 50 percent. The 5-year mortality rate after lower extremity amputation ranges from 39 to 68 percent. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (60-70 percent of patients with diabetes have some form of neuropathy.)

Call one of our offices today for a diabetic foot exam and a consultation with one of our physicians. Find out if you qualify for the Medicare Diabetic Shoe Program.

Dr. Harvey Leflcowitz, D.P.M., D.A.B.P.S.
Formatted by Brandi Keyosky

Clinical History:

50-year-old female with right ankle pain for approximately two months. Patient may have injured her foot from walking over a long period of time during the month of December, 2007. Patient did not report any overt injury other than the increased walking in the mall during the holiday season of December.

Patient Symptoms & Signs:

Pain over the anterior lateral ankle mortise and talar neck area

No instability on range of motion, palpable click on supination and pronation

Marked pes planus and history of synovitis and difficulty with healing

MM Diagnosis - 2/28/08 (Figure 1):

Incomplete stress fracture of talus specifically at the talar neck. Review of scans reveals obvious lack of blood flow to the head of the talus while the body is well perfused on T2 weighted images. Concern for osteonecrosis of the talar head concerning the fracture line going through the nutrient artery of the talar neck. Posterior tibial tenosynovitis secondary to talar neck injury.

Thought and Rationale:

Due to patient's previous history of difficulty with healing from prior surgical procedures in the foot and anide, as well as the wrist and various other areas of her musculoskeletal system, recoimnendations and decision for use of PRP along with external bone stimulator and immobilization was recommended and followed through.

Description of Procedure - 3/11/08:

Patient presented with chronic delayed union of the right talus, which had been present now for approximately three months. A total ankle block was performed, and under ultrasound guidance 3.3 cc of hemocyte tissue matrix was implanted into the sinus tarsi laterally to the talar neck and dorsally to the talar neck. Patient was instructed to refrain from taking all of her NSAIDS and only to use Tylenol. She was placed into a below-knee AirWalker, and an external bone stimulator from FBI was ordered.

Patient Follow-up:

3/18/08 - The patient received her EBI bone stimulator and was trained appropriately.

4/1/08 - The patient continued to have a stabbing type pain and having used the FBI bone stimulator for 11 hours/day x 13 days with 0 unused days.

4/8/08 - We prescribed a Roll-A-Bout for the patient to remain essentially nonweightbearing, as our concern with healing continued. In addition, she was put on had used her external bone stimulator 40 days with 11.4 hours/day and continued to guard the area with the Cam Walker and the EBI unit. Our thought process was that she might require another APC should the talar neck fracture not heal. Our main concern was the fact that the fracture was traversing the nutrient artery in the talar neck. We previously recommended the patient go for bone density testing, which had been performed by her primary care doctor with the results indicating osteopenia with increased risk for fracture.

Repeat Mill - 5/20/08 (Figure 2):

Revealed marked improvement and healing of the edema and stress fracture of the talus since previous examination. 12 weighted images are consistent for the body, neck and head of the talus, being well perfused. Patient continued to use her external bone stimulator with 61 days x 11.22 hours/day used. She remains in an AirWalker for several more weeks, and we anticipate complete recovery (see copies of before and after MRIs).

Patient Follow-up - 6/1 7/08:

She is returned to shoes and has minimal pain. APC enabled neovascularization into the head of the talus.

Fig. 1(2/28/08)

Incomplete stress fracture of the talus with lack of blood flow to the head of talus

Fig. 2 (5/20/08)

Well perfused, healing talus

Conclusion:

Autologous platelet concentrate injections can be an effective minimally invasive treatment on stress fractures and enables neovascularization into bones. The Harvest SmartPRep process for concentrating autologous platelet rich plasma is a fairly simple outpatient procedure.