bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-Utility Analyses in Foot & Ankle Surgery
Authors: Karhade Aditya , Kwon John
Published: September 2018

Category:

Other

Introduction/Purpose:

Orthopedic surgery lies at the forefront of the initiative to deliver value-based care. As a result, cost utility analyses have gained increased importance in the orthopedic literature. While other authors have previously reviewed the quality of US-based cost-utility analyses in orthopedic trauma, spine, sports, and arthroplasty, a similar analysis specific to foot and ankle surgery has not been performed. As such, the practicing foot and ankle surgeon does not yet have a comprehensive analysis of the available cost-utility analyses or the quality of the available evidence. The purpose of this study was to perform a systematic review of cost-utility analyses in foot and ankle surgery.

Methods:

A systematic review of foot and ankle studies was conducted to identify cost-utility based analyses published between 2000 and 2017. Of 687 studies screened by abstract, eight cost-utility foot and ankle studies were identified that met inclusion criteria and were scored by the Quality of Health Economic Studies instrument for overall quality.

Results:

Of the eight studies that met inclusion criteria, four were published in the U.S. Regarding topic, three examined end-stage arthritis, two examined diabetic foot ulcers, two examined ankle fractures and one examined ankle sprains. Cost-effective interventions identified by these studies included total ankle arthroplasty over ankle fusion or nonoperative treatment, adjunctive hyperbaric oxygen therapy for diabetic foot ulcers, suture button fixation over syndesmotic screws for unstable supination-external rotation type IV ankle fractures, and below knee cast and fracture boot immobilization over tubular bandages for acute severe ankle sprains respectively. The mean Quality of Health Economic Studies scores for these studies was 81.9 with interquartile range, 25th percentile score of 74.8 to 75th percentile score of 86.

Conclusion:

Despite the increasing focus on value-based care delivery, there are few foot and ankle cost-utility analyses in the current literature. Nonetheless, the quality of existing analyses is high as rated by the Quality of Health Economic Studies and certain interventions have been identified as cost-effective as highlighted above. The findings of this review can be used to help design future analyses in order to best demonstrate the cost-effectiveness of foot and ankle interventions.
Optimization of Tenocyte Lineage-Related Factors from Mesenchymal Stem Cells
Authors: Lee Seung Yeol , Kim Hyang , Kwon Soon-Sun
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Researchers should consider various potential factors that affect tenogenic differentiation of MSCs. Numerous experimental settings are associated with high cost and time. Response surface methodology (RSM), a component in the design of experiments (DOE), is gaining recognition as a powerful tool in optimizing conditions for the production of industrially important products such as chemicals and enzymes. The purpose of this study was to access the differential effects of transforming growth factor beta 3 (TGF-β3) on the tenogenesis of tonsil-derived mesenchymal stem cells (T-MSCs) and bone marrow-derived mesenchymal stem cells (BM-MSCs) using RSM.

Methods:

Bone marrow was collected from four patients (mean age: 79.0±2.2) and mononuclear cells were separated. The tonsillar tissues were collected from four patients (mean age: 7.6±0.6). After isolation of MSCs, they were treated with 5ng/ml and 10ng/ml of TGF-β3 with vehicle control. The full-factorial experimental design was employed to study the effect of tension based on T-MSCs. The design was composed of three levels being coded as -1, 0 and +1 and a total of 18 runs were carried out in duplicates to optimize the level of chosen variables, such as days and amount. A total of 84 trials were utilized and fitted with RSM; they were then used to obtain mathematical prediction models.

Results:

Exposure of TGF-β3 to T-MSCs and BM-MSCs resulted in an increase in the expression of SCX, TNMD, decorin, collagen I, and tenacin C. Most tenocyte lineage-related factors from T-MSCs and BM-MSCs presented a maximum increase in 2- 3 day treatment. Considering all of tenocyte lineage-related factors that we assessed, the predicted value of the factors was significantly induced at 2.7 ng/mL of TGF-β3 (p < 0.001) on 2.5-day culture (p = 0.001). (Fig A) Considering all of tenocyte lineage-related factors that we assessed, the predicted value of the factors was significantly induced on 2.3-day culture (p = 0.004) regardless of the concentration of TGF-β3. (Fig B)

Conclusion:

We demonstrated that tenocyte-like cells can be successfully differentiated from T-MSCs and BM-MSCs under TGF- β3 stimulation. This study demonstrated that T-MSCs and BM-MSCs in tenogenic stimulation with TGF-β3 have a similar tenogenic differentiation potential using RSM.
Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity
Authors: Lee Seung Yeol , Kwon Soon-Sun , Park Moon Seok , Lee Kyoung Min
Published: September 2018

Category:

Bunion

Introduction/Purpose:

There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus.

Methods:

We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect.

Results:

Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p<0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (<10 years). The hallux valgus angle increased by 1.5° per year (p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up.

Conclusion:

These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.
Defining A Safe Zone For Percutaneous Screw Fixation Of The Posterior Malleolus
Authors: LeMass Harry , Whitworth Nicholas , Platt Simon
Published: September 2018

Category:

Trauma

Introduction/Purpose:

Fixation of the posterior malleolar fragment of an ankle fracture confers stability. Not all posterior fragments are displaced, necessitating open reduction. We hypothesised that a safe anatomic corridor is possible for percutaneous screw fixation in some fracture variants. We conducted an anatomic study to determine if percutaneous fixation was possible and safe. This anatomic assessment of significant structures at the posterior ankle, combined with cadaveric dissection following placement of screw tracts shows that percutaneously fixing the posterior malleolus is achievable in medially positioned fragments.

Methods:

Multiple percutaneous Kirschner wires were passed into a cadaveric ankle specimen at reproducible anatomic points. The wires were passed into typical locations for posterior malleolus fixation. The specimen was dissected and all wires threatening significant structures were removed. A single safe medial passage was identified. The surface anatomy landmarks for the single safe wire was recorded. Multiple (6) cadaveric specimens were further wired via an entry point using only the surface anatomy landmarks previously determined to be safe. These were dissected to confirm the presence of a safe zone for percutaneous wiring of the posterior malleolus. Image intensifier was used to confirm adequate placement of the wire in the posterior malleolus.

Results:

A safe medial zone for percutaneous fixation of the posterior malleolus was consistent; this was successfully replicated utilising surface anatomy alone. The entry point for safe percutaneous fixation was found to be 1 cm proximal to the tip of the medial malleolus and immediately lateral to the tendo-achilles.

Conclusion:

A safe passage for percutaneous screw placement for medially located posterior malleolar fragments (Haraguchi I/II) was identified. A safe zone for percutaneous fixation of the posterior malleolus has been newly defined.
Radiographic predictors for improved outcomes after hammertoe correction surgery
Authors: Maidman Samuel , Bariteau Jason , Boden Stephanie , Boden Allison , Tenenbaum Shay
Published: September 2018

Category:

Lesser Toes

Introduction/Purpose:

Hammertoe deformities are common, often painful deformities of the lesser foot and are known to severely affect daily activities. When patients seek surgical management, x-rays are utilized for diagnosis, evaluation for surgical candidacy, and selection of the operative technique. Postoperatively, radiographs are retaken to assess bone health, healing status, and alignment. Despite the frequent use of radiographs pre- and post-operatively, radiographic results are not necessarily indicative of clinical presentation or surgical outcomes. The aim of this study is to identify specific radiographic parameters that are predictive of improved pain and function after surgical correction of hammertoe deformity.

Methods:

Prospectively collected data was reviewed on 51 consecutive patients who underwent operative correction of hammertoe deformity. Patient demographics, comorbidities, and post-surgical complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component (SF-36 PCS) scores with a minimum of six-month follow-up. Radiographs were scored by a foot & ankle fellowship-trained orthopaedic surgeon to assess preoperative severity, postoperative joint fusion, and both pre- and postoperative joint instability and arthritis. Data was examined using a multivariable analysis.

Results:

Preoperatively, 15.7% (8/51) of patients had a deformity classified radiographically as mild, 37.3% (19/51) as moderate, and 47.1% (24/51) as severe. Additionally, 60.8% (31/51) had joint instability, 17.7% (9/51) had joint dislocation, and 7.8% (4/51) had joint arthritis. Postoperatively, 74.5% had PIP joint fusion, 35.3% (18/51) had joint arthritis, and 9.8% (5/51) had joint instability. A significant association was found between PIP joint fusion and improved SF-36 PCS scores (p=.004). Preoperative anticoagulant therapy was associated with reduced rates of PIP joint fusion (p=0.02). There was no association found between the other demographic or radiographic parameters, and no parameters were associated with improvement in VAS scores.

Conclusion:

After undergoing surgical correction of hammertoe deformity, postoperative PIP joint fusion was the only variable determined to be indicative of improved physical function. However, pre- and postoperative metatarsophalangeal joint arthritis nor instability was predictive of outcomes. This work informs foot & ankle specialists that healing of the PIP joint is critical to successful hammertoe surgery.
Anatomic Description of the Anterior Body Calcaneal Z-Osteotomy
Authors: McGann Maria , Larson David , Hyer Christopher
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Flexible pes planovalgus is a common condition encountered by foot and ankle physicians. Many treatment options exist to correct this deformity. One such procedure is an Evans osteotomy of the anterior process of the calcaneus. Due to the complications seen with this type of osteotomy, there has been an attempt to reduce these complications and as a result, an anterior body calcaneal z-cut osteotomy was developed. This osteotomy is inherently more stable by design and fewer complications have been reported. In an attempt to further understand this osteotomy and to determine how much bony interface remained following this osteotomy, a cadaveric study was performed.

Methods:

A Z-cut osteotomy was performed on 10 cadaveric specimens with the distal arm exiting dorsal and 1 cm proximal to the calcaneocuboid joint, while the proximal arm exited plantarly. The central axis lengths of 15 mm and 20 mm were compared. An 8-mm wedge was placed in both the distal and proximal arms, and fixated with a staple. Digital calipers were used to measure the amount of bony apposition on the central arm between the wedges.

Results:

The average amount of bone apposition was 9.13 mm. When comparing the 20 mm to 15 mm central arm groups, the average bony apposition was 10.66 mm and 7.61 mm, respectively.

Conclusion:

Based on these results, the anterior body calcaneal Z-osteotomy provides enough bony apposition between both groups with an 8-mm wedge distraction. Further studies are warranted to evaluate the union rate between the classic lateral column lengthening osteotomy and the anterior body calcaneal Z-osteotomy.
Effect of the adjacent-joint osteoarthritis after arthroscopic ankle arthrodesis
Authors: Minokawa So , Yoshimura Ichiro , Hagio Tomonobu , Yamamoto Takuaki
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Arthroscopic ankle arthrodesis (AAA) is a good clinical outcome, because the arthroscopic method has been deemed to have shorter union time, less blood loss, less morbidity, shorter hospital stays, and more rapid mobilization. However, it is unclear about the relationship between progression of adjacent-joint arthritis and clinical outcome at long-term follow-up. The purpose of this study was to investigate the relationship between AAA and adjacent-joint arthritis at 2 years postoperatively.

Methods:

We evaluated 17 feet of 17 patients at a minimum of two years after surgery that were able to be followed, from among 59 feet in 55 patients with ankle osteoarthritis who underwent AAA between January 2006 and April 2015. The mean age was 66.1 ± 8.1 (range, 57-79) years, and postoperative follow-up was performed at a mean of 4.5 ± 2.3 (range, 2-10) years after surgery. The radiographic evaluation examined a union rate of the ankle, and a progression of adjacent-joint osteoarthritis (OA) change. We examined the relationship between the presence of adjacent-joint OA and Japanese Society for Surgery of the Foot (JSSF) score before surgery and last follow up. Additionally, we examined the relationship between the presence of adjacent-joint OA and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) at last follow up.

Results:

JSSF score was improved to 56.9 points before surgery and 89.2 points last follow up, and the union rates was 17 feet of 17 feet (100%). At the last follow-up, radiographic signs of developed or progressing arthritis were observed in ten feet at subtalar joint (58.8%) and in three patients at talonavicular joint (17.6%). The postoperative JSSF scale regarding the presence or absence of the adjacent joint OA, there were no significant differences (89.3 ± 6.0 points in the absence group and 89.2 ± 6.1 points in the presence group). Postoperative SAFE-Q was not significantly different, pain and pain-related physical functioning and daily living, social functioning, shoe-related, and general health and well-being.

Conclusion:

There was no significant difference in the JSSF score of presence or absence of the adjacent-joint OA before surgery and at the final follow-up. Additionally, there was no significant difference in the SAFE-Q of presence or absence of the adjacent-joint OA at the final follow-up. The adjacent-joint OA was progressed after AAA, however clinical outcome was relatively maintained.
Mid-term Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis with Bulk Femoral Head Allograft
Authors: Rogero Ryan , Tsai Justin , Shakked Rachel , Raikin Steven
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Tibiotalocalcaneal (TTC) arthrodesis with bulk femoral head allograft has previously been reported as a way to fill large osseous hindfoot deficits in order to restore limb length, but few studies have been performed evaluating outcomes and prognostic factors. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors.

Methods:

A retrospective review of patients undergoing TTC arthrodesis with bulk femoral head allograft performed at an academic institution by a single fellowship-trained foot and ankle surgeon between 2004 and 2015 was conducted. Patient charts and operative reports were reviewed for patient and procedural variables, respectively. Radiographic union was assessed at the ankle and subtalar joints by another fellowship-trained foot and ankle surgeon not involved in any patient’s surgical care. Radiographic stability, defined as proper maintenance of hardware and graft positioning in the hindfoot, was also assessed. A procedure was “failed” if there was a need for revision surgery. Patients with a successful arthrodesis were contacted to score the Foot and Ankle Ability Measure-Active Daily Living (FAAM-ADL) questionnaire, visual analog scale (VAS) for pain, and Short Form-12 (SF-12) mental (MCS) and physical (PCS) components. 22 patients were identified, with average radiograph and functional follow-up times of 39.7 and 57.1 months, respectively.

Results:

Complete radiographic union of involved joints was achieved in 13 patients (59.1%) and in 72.7% (32/44) of all joints. Eighteen patients (81.8%) were assessed to be radiographically stable at final follow-up. Three patients (13.6%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 19 patients (86.4%) did not require additional surgery as of final follow-up. At an average of 57.1 months postoperatively, patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P<.001). The mean VAS for pain significantly improved from 76.8 to 32.9 (P<.001). The mean postoperative SF-12-MCS and SF- 12-PCS scores were 53.9 and 40.6. Additionally, 73.3% (11/15) reported being satisfied with their surgical outcomes. Male sex (P=.03) and a lateral operative approach (P=.03) both resulted in significantly worse outcomes.

Conclusion:

The utilization of a femoral head allograft with TTC arthrodesis in patients with large hindfoot defects is an acceptable method that can offer improved functional and sustained radiographic outcomes and patient satisfaction. Male sex and a lateral approach may be associated with an inferior prognosis.
Surgical Fixation of Type 2 Navicular Fractures
Authors: Smith George
Published: September 2018

Category:

Trauma

Introduction/Purpose:

The navicular plays a vital role in maintenance of the medial column of the foot and provides a pivotal function in hind foot biomechanics. Type 2 fractures demonstrate a primary fracture line from dorsolateral to plantar medial where the major fracture fragment is displaced medially. They are typically the result of high energy and are associated with poor outcome. This study reports on the demographics of a series of Type 2 navicular fractures, the operative technique employed and the subsequent outcome.

Methods:

Six patients with a Type 2 navicular fracture were identified from the theatre records. The study period was June 2014 to February 2016. All patients sustained their injuries in either high speed MVAs or motocross accidents. All patients had surgery performed after the soft tissue envelope had settled (mean 7 days after injury). The key component to the surgical procedure was the reduction of the constant large medial fragment. This allowed simple access to the navicular for fracture reduction. The construct was supported with a bridge plate. The bridge plate was removed approximately 9 months post surgery. Final radiological follow up was at 12 months post surgery. Clinical follow up included the AOFAS midfoot score by phone questionnaire at a mean of 15 months’ post injury.

Results:

The study comprised 5 males and one female with a mean age of 22 years. In 5 patients the navicular fracture was an isolated injury, in one there was an associated cuboid fracture. None of the patients experienced any significant complications. All patients returned to work, one as a roofer and two to motocross. AOFAS midfoot scores were obtained from all patients via a telephone conversation at a mean of 15 months’ post injury. The mean score was 70 (range 65 - 80). Radiographs at a mean of 12 months showed no loss of position and maintained alignment.

Conclusion:

Acute fractures of the navicular are uncommon and they typically result in significant long-term morbidity. Our series demonstrate a technique which is reproducible in both maintaining the length of the medial column but also providing good access to the navicular for fracture reduction. It also results in good clinical outcomes in the short term. All our patients returned to their previous occupations with minimal symptoms.
Viscoelastic Properties of the Hindfoot Bones
Authors: Son Michelle , Munroe Brent
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Obtaining and maintaining compression at an arthrodesis site is a key factor in achieving successful bony union. Bones, like other collagen containing tissues, are known to exhibit viscoelastic properties that may lead to stress relaxation at the arthrodesis site. The viscoelastic properties of the hindfoot bones when subjected to compression (as occurs during fusion surgery) are not known. The objective of this study was to quantify the viscoelastic properties of hindfoot bones under compression by measuring the time course of stress relaxation.

Methods:

19 cadaveric human bone cubes 10 mm on each side consisting of trabecular and subchondral bone were cut from the hindfoot bones including the talus, calcaneus, and distal tibia. Each cube was scanned with micro computed tomography (µCT) to quantify bone volume/total volume ratio (BV/TV), trabecular thickness, trabecular separation, trabecular number, and connectivity density. Each specimen was then immersed in a saline bath and compressed 1 mm at a strain rate of 1 mm/s using an MTS machine (Fig 1). This compressed position was then held for 3 hours while the load was recorded. Following the compression test, each specimen was re-scanned with µCT.

Results:

Two distinct patterns of load relaxation were found. The first consisted of a uniform exponential decay. The second had a similar exponential decay but included a plateau occurring between 1-6 minutes. This second pattern was reflected in the average fractional load relaxation graph (Fig 2). The average peak load was 24.14 kg (SD ± 15.07 kg) and average end relaxation was 2.93 kg (SD ± 3.81 kg). The average time to achieve 95% decay in total load was 34.7 min (SD ± 29.1 min) although removing some outliers, it decreased to 24.9 min (SD ± 18.4 min) which is more representative of the overall data. Averages of BV/TV, trabecular thickness, and trabecular separation increased after stress relaxation while average connectivity density and trabecular number decreased.

Conclusion:

These data suggest that, due to the viscoelastic properties of bone, approximately 95% of an applied compressive load generated by a fixed displacement is lost within the first 30 minutes. Applied clinically, these findings may have a significant impact on the optimal surgical technique used for osteosynthesis and arthrodesis. Specifically, these data call into question whether the compression applied during surgery can be maintained throughout the healing phase without the application of continuous compression via an external fixator or internal continuous compression device. At minimum, these data suggest that lag or compression screws should be retightened prior to wound closure.
Modified scarf osteotomy for hallux valgus
Authors: Tao Xu
Published: September 2018

Category:

Bunion

Introduction/Purpose:

To compare the elemental characteristics through a finite element (FE) model with an anatomically realistic geometry and structure of the metatarsophalangeal (MTP) joint. This model will estimate the biomechanical features and correction differences regarding dynamic loading and incidences of troughing.

Methods:

We retrospectively evaluated 40 patients who had undergone a modified rotational scarf osteotomy to correct for moderate to severe hallux valgus (HV) at our institution between January 2009 and December 2015. To compare the results and the elemental characteristics, we built a finite element model that included an anatomically realistic geometry and structure of the metatarsophalangeal (MTP) joint and estimated the biomechanical features and correction differences on dynamic loading as well as incidences of troughing.

Results:

Although the radiological outcomes remained unchanged within the first three months and moderately worsened over time as measured at the final radiographical assessment, all patients were satisfied with the results, including their visual analysis score (VAS) and American Orthopedic Foot & Ankle Society (AOFAS) score. The rates of troughing and recurrence were remarkably lower in our pilot because of the innate stability of the modified rotated fixation.

Conclusion:

Our pilot findings suggest that the modified rotational scarf osteotomy procedure offers sufficient stability, optimal corrections and variable options.
Increased Foot and Tibial Angles at Footstrike Decrease Vertical Loadrate in Runners
Authors: Tenforde Adam , Borgstrom Haylee Donaghe , Jamison Steve , Davis Irene
Published: September 2018

Category:

Sports

Introduction/Purpose:

It is well established that elevated vertical loadrates on footstrike are a risk factor for developing running injuries. Overstriding, or increased foot and tibial angles at footstrike, has been theorized to increase loading rate. Thus, it is often suggested that runners shorten their stride to reduce their injury risk. However, the relationship between landing alignment and loadrates has not been well established in current literature. Thus, we aimed to investigate the relationship between sagittal plane foot angle (FA) and tibial angle (TA) with vertical loadrates in both healthy and injured forefoot (FFS) and rearfoot strike (RFS) runners. It was hypothesized that as FA and TA increased, loadrate would increase for all runners.

Methods:

This is an ongoing study with 52 healthy runners (35 RFS, 17 FFS) and 24 injured runners (14 RFS, 10 FFS) for a total of 76 runners (51 M, 25 F; age34.3±11.4 yrs). Vertical average loadrate (VALR) and vertical instantaneous loadrate (VILR) were obtained while running at 2.68 m/s on an instrumented treadmill. All runners reported 0/10 pain during the assessment. Sagittal plane FA and TA at footstrike were measured from video recording using an open-source program. Positive FA designated RFS. Positive TA was defined as ankle anterior to the knee. Between-group differences were evaluated using paired two-tailed t-tests. Correlation coefficients (r) were computed for FA and TA with VALR and VILR (p=0.05; trend: p =0.10).

Results:

Healthy RFS - FA and TA were negatively correlated with VALR and VILR. Injured RFS – There was a trend toward negative correlation between TA and both VALR and VILR. Healthy FFS – TA was negatively correlated with both loadrates. Injured FFS – There were no significant correlations. Correlation coefficients, slopes, and p values are presented in Table 1. VALR and VILR were higher in RFS vs FFS runners (56±20 vs 40±10, 69±25 vs 54±12 BW/s, p<0.01), but were not significantly different for healthy vs injured runners (52±19 vs 56±26, 63±21 vs 67±27 BW/s, p=0.4).

Conclusion:

In contrast to current thought, preliminary results suggest that increasing FA and TA at footstrike are associated with decreasing vertical loadrates. This relationship was strongest for FA in the healthy RFS runners and weakest for FA in both the healthy and injured FFS runners. With increased FA, load attenuation may be due to increased eccentric activity of the tibialis anterior as well as increased knee flexion excursion and eccentric quadriceps activity with increased TA.
Whether need to repair deltoid ligament injuries in Supination-external Rotation type Ⅳ ankle fractures
Authors: Yang Yunfeng
Published: September 2018

Category:

Ankle

Introduction/Purpose:

To evaluate the effect of repairing deltoid ligament in patients with supination-external rotation type? ankle fractures.

Methods:

Between January 2013 and June 2016, 35 patients of supination-external rotation type? ankle fractures associated with deltoid ligament injury had complete medical records and were included in this study. Among all, 30 cases involved pure deltoid ligament injuries while others also included medial malleolus fractures. All fractures were treated by open reduction and internal fixation. Patients were assigned to the repaired group (21 patients) or the non-repaired group (14 patients) according to whether deltoid ligament injuries were treated during the surgery. No significant difference was found in gender, age, injury pattern, time from injury to operation(P>0.05), which was comparable. Medial clear space, visual analogue scale(VAS) score, and American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score(6 months, one year, two years after surgery), Baird-Jackson scoring system and complications were recorded.

Results:

Thirty-five patients were followed up 21-28months.The mean duration of operation in the repaired group was significantly longer than that of the non-repaired group.Baird-Jackson scoring system: the excellent rate of the repaired group was 90.5% while the non-repaired group was 85.7% . The VAS scores and the medial clear space of preoperative and final follow-up were significantly improved. At the last follow-up,2.85 percent of the patients presented with ankle instability while 8.5 percent of them occured traumatic arthritis. The AOFAS scores at 6, 12, and 24 months after operation were (82.1 ± 6.6; 86.2 ± 5.9; 91.5 ± 5.8) and (78.1 ± 6.5; 83.9 ± 5.6; 90.3 ± 5.6). However, none of them showed significant difference between the two groups (P>0.05).

Conclusion:

It’s unnecessary to repair the deltoid ligament in patients with supination-external rotation type? ankle fractures when ankle mortise restores after the fractures are fixed.
Clinical results of capsular interposition arthroplasty for severe hallux rigidus
Authors: Yui Akiyama , Hirano Takaaki , Niki Hisateru
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

There is no established surgical treatment for severe hallux rigidus (HR). Hamilton suggested capsular interposition arthroplasty (CIA), performed using an articular capsule and extensor hallucis brevis as a biologic spacer, as an alternative to metatarsophalangeal (MTP) joint fixation to treat severe HR. CIA is a preservation procedure that relieves pain and maintains joint function. We present the results of CIA performed at our facility to treat severe HR.

Methods:

In the present study, we further divided Hattrup’s grade II HR into two subtypes on the basis of joint space narrowing of 1stMTP. We recorded the severity of patients’ condition using our modified Hattrup’s classification. In this study, we did a follow-up of 8 cases in which CIA was performed to treat severe HR. The cases were followed up for 1 year or longer. The mean age of patients at surgery was 63.8 years, and the mean follow-up period was 7.1 years. Surgery was performed using a modified Hamilton method, which involves making an incision on the dorsal instead of the medial side and a manipulating the articular capsule in a different manner. Clinical outcomes were evaluated using the Japanese Society for Surgery of the Foot standard rating system (JSSF) scale. We investigated the pre- and post-operative ROM of the MTP joints and verified the presence or absence of complications.

Results:

It was observed that pain had reduced significantly in all cases after surgery. Following CIA, the mean ROM at extension was noted to have improved from 27.5° to 48.8° and the mean ROM at flexion had improved from 11.9° to 21.9°. The mean JSSF scale score has improved from 59.5 to 97.5 points. No complications were observed.

Conclusion:

This procedure is beneficial for pain relief and acquisition or maintenance of articular ROM and is a better choice for patients desiring preservation of ROM and articular function. It is imperative that patients follow proper rehabilitation for ROM and muscular strength preservation.
Hiflex Foot Gear improves Quality of life in patients with osteoarthritis of the ankle
Authors: Yui Akiyama , Hirano Takaaki , Niki Hisateru
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

There are few reports describing conservative therapy for ankle osteoarthritis. Hiflex Foot Gear (HFG) is a custom-made polyethylene ankle–foot orthosis developed to permit slight mobility of the ankle while providing adequate ankle support. The purpose of this study was to validate the hypothesis that HFG improves the quality of life (QOL) in patients with ankle osteoarthritis.Subjects and methods.

Methods:

Ten ankles from eight patients (one man, seven women) diagnosed with ankle osteoarthritis at this hospital, prescribed an HFG, and observed for follow-up for at least 3 months were included in this study. The patients’ mean age was 69.9 (range: 46?85) years. Patients were classified as Takakura–Tanaka stage IIIa (2 ankles), stage IIIb (2 ankles), stage IV (6 ankles), with a mean observation period of 8.9 (range: 3?13) months. Clinical evaluations were made before and 3 months after wearing the orthosis. The ankle/hindfoot scale of the Japanese Society for Surgery of the Foot (JSSF) Standard Rating System and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) subscale of the Japanese Orthopaedic Association/Japanese Society for Surgery of the Foot, respectively, were used for making evaluations. Scores were compared using a paired t-test.

Results:

JSSF scores improved from 55.1 points at baseline to 71.4 points after wearing the HFG (p < 0.001). According to the SAFE-Q subscales, changes after wearing the HFG were as follows: 28.9 to 61.9 points for items related to pain (p < 0.001), 36.9 to 53.7 points for those related to physical function and daily life (p = 0.001), 31.3 to 58.9 points for those related to social functions (p = 0.002), and from 31.3 to 65.0 points for those related to overall perception of health (p < 0.001); items related to shoes showed no substantial change (from 52.1 to 53.6 points).

Conclusion:

Our results revealed that wearing the HFG improved pain in patients with severe ankle osteoarthritis. Retained flexibility in the ankle range of motion was believed to be the factor underlying improvements in physical function and daily life, social functions, and overall perception of health. HFG is a potential option for conservative therapy in patients who cannot obtain sufficient pain control during the preoperative waiting period or in those who do not wish to undergo surgery.
Treatment outcomes of buttress plating for posterior pilon fractures
Authors: Zhang Ming-Zhu , Yu Guang-rong
Published: September 2018

Category:

Ankle

Introduction/Purpose:

The purpose of current study was to retrospectively analyze the clinical outcomes of buttress plate treatment of posterior pilon fractures.

Methods:

Between January 2005 and December 2016, 58 patients with posterior pilon fractures underwent buttress plate fixation. There were 32 males and 26 females and the mean age was 40.2years (range, 23 to 73 years). Preoperative radiographs, CT scans and three dimensional reconstructions were used to evaluate the fracture patterns. On the basis of the extension of the fracture lines presented on the CT scans, a posterolateral approach or a combination of both posterolateral and posteromedial approaches were used to reduce and fixate the posterior malleolar fragments. Clinical and radiographic examinations were used for postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Visual Analogue Scale (VAS) were used to evaluate the functional outcomes.

Results:

According to the CT scan images, the posterior pilon fractures were classified into 3 types. 51 patients were available for follow-up. The mean time of follow-up was 44.8 months. The mean AOFAS score was 84.3 points, and the mean VAS score was 1.6 points. One patient was found with ankle joint swelling and long term walking discomfort at 2-year follow-up. Other patients received favorable functional outcomes. No hardware failure occurred.

Conclusion:

The clinical outcomes of buttress plate treatment of posterior pilon fractures were satisfactory. Buttress plating availed the patients to return to earlier weight-bearing and functional exercises.
All-arthroscopic anatomical reconstruction of anterior talofibular ligament using semitendinosus autografts
Authors: Zhou Yunfeng , Song Bin
Published: September 2018

Category:

Arthroscopy

Introduction/Purpose:

We introduced a new technique of all-arthroscopic anatomical anterior talofibular ligament (ATFL) reconstruction using semitendinosus autografts.

Methods:

From June 2012 to June 2013, 28 patients with chronic ATFL rupture underwent arthroscopic anatomic reconstruction of the ATFL. They were divided into the Broström group (n = 16) and reconstruction group (n = 12). The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) was recorded before the operation, 12 months after the operation and 30 months after the operation. Physical examination and radiographs were performed in follow-ups.

Results:

The patients had higher AOFAS score after the operation in both the Broströmgroup and the reconstruction group. 12 months after operation, the patients in the reconstruction group showed significantly higher AOFAS score and lower VAS score than those in the Broström group (P = 0.003 and 0.001, respectively), while the difference between the two groups was not statistically significant 30 months later (P = 0.425 and 0.323, respectively). Contemporary numbness of the lateral dorsal part of the foot appeared in one (8.3%) patient in the reconstruction group and two (12.5%) patients in the Broström group, and the symptoms diminished after neurotrophic treatment. No other complications, including recurrent instability, were encountered. No donor-side morbidity such as infection or delayed wound healing was observed.

Conclusion:

The novel surgical technique enhanced postoperative rehabilitation by providing better ankle joint function than modified Broström procedure at 12 months after operation, while the advantage was not statistically significant 30 months later. The long-term outcome requires further investigation. The technique of all-arthroscopic anatomical ATFL reconstruction using semitendinosus autografts proved to be a viable option for ATFL injuries.
Transcriptomic but not genomic variability confers phenotype of breast cancer stem cells
Authors: Tong Mengying , Deng Ziqian , Yang Mengying , Xu Chang , Zhang Xiaolong , Zhang Qingzheng , Liao Yuwei , Deng Xiaodi , Lv Dekang , Zhang Xuehong , Zhang Yu , Li Peiying , Song Luyao , Wang Bicheng , Al‐Dherasi Aisha , Li Zhiguang , Liu Quentin
Published: September 2018

Background

Breast cancer stem cells (BCSCs) are considered responsible for cancer relapse and drug resistance. Understanding the identity of BCSCs may open new avenues in breast cancer therapy. Although several discoveries have been made on BCSC characterization, the factors critical to the origination of BCSCs are largely unclear. This study aimed to determine whether genomic mutations contribute to the acquisition of cancer stem‐like phenotype and to investigate the genetic and transcriptional features of BCSCs.

Methods

We detected potential BCSC phenotype‐associated mutation hotspot regions by using whole‐genome sequencing on parental cancer cells and derived serial‐generation spheres in increasing order of BCSC frequency, and then performed target deep DNA sequencing at bulk‐cell and single‐cell levels. To identify the transcriptional program associated with BCSCs, bulk‐cell and single‐cell RNA sequencing was performed.

Results

By using whole‐genome sequencing of bulk cells, potential BCSC phenotype‐associated mutation hotspot regions were detected. Validation by target deep DNA sequencing, at both bulk‐cell and single‐cell levels, revealed no genetic changes specifically associated with BCSC phenotype. Moreover, single‐cell RNA sequencing showed profound transcriptomic variability in cancer cells at the single‐cell level that predicted BCSC features. Notably, this transcriptomic variability was enriched during the transcription of 74 genes, revealed as BCSC markers. Breast cancer patients with a high risk of relapse exhibited higher expression levels of these BCSC markers than those with a low risk of relapse, thereby highlighting the clinical significance of predicting breast cancer prognosis with these BCSC markers.

Conclusions

Transcriptomic variability, not genetic mutations, distinguishes BCSCs from non‐BCSCs. The identified 74 BCSC markers have the potential of becoming novel targets for breast cancer therapy.
Single-cell murine genetic fate mapping reveals bipotential hepatoblasts and novel multi-organ endoderm progenitors
Authors: El Sebae Gabriel K. , Malatos Joseph M. , Cone Mary-Kate E. , Rhee Siyeon , Angelo Jesse R. , Mager Jesse , Tremblay Kimberly D.
Published: September 2018

The definitive endoderm (DE) is the embryonic germ layer that forms the gut tube and associated organs including thymus, lungs, liver and pancreas. To understand how individual DE cells furnish gut organs, genetic fate mapping was performed using the Rosa26LacZ Cre-reporter paired with a tamoxifen inducible DE-specific Cre-expressing transgene. We established a low tamoxifen dose that infrequently induced heritable LacZ-expression in a single cell of individual E8.5 embryos to identify clonal cell descendants at E16.5. As expected, only a fraction of the E16.5 embryos contained LacZ-positive clonal descendants and a subset of these contained descendants in multiple organs, revealing novel ontogeny. Furthermore, immunohistochemical analysis was used to identify LacZ-positive hepatocytes and biliary epithelial cells, the cholangiocyte precursor, in each clonally populated liver. Together these data not only uncover novel and suspected lineage relationships between DE-derived organs but also illustrate the bipotential nature of individual hepatoblasts, by demonstrating that single hepatoblasts contribute to both the hepatocyte and the cholangiocyte lineage in vivo.
Comparison of the Abbott Architect BRAHMS and the Biomérieux Vidas BRAHMS Procalcitonin Assays
Authors: Wang Dan , Caddell Brittany , Nolte Frederick S , Babic Nikolina
Published: September 2018

Background

Procalcitonin (PCT) is a well-established marker for bacterial infection. Recently the US Food and Drug Administration approved the expanded use of this biomarker to guide clinical decisions for antibiotic treatment in patients with lower respiratory tract infections. Both the Architect BRAHMS PCT (PCT-A) and Vidas BRAHMS PCT (PCT-V) are approved for this indication. The aim of this study is to evaluate analytical performance of PCT-A in comparison to PCT-V.

Methods

PCT-A and PCT-V were evaluated for intra- and interassay precision and functional sensitivity. To assess the accuracy of PCT-A, 108 residual plasma specimens were randomly selected from routine hospital orders, and PCT was measured concurrently with PCT-A and PCT-V.

Results

Both assays demonstrated excellent precision, with intraassay precision ranging from 2.2% to 4.0% CV and interassay precision ranging from 2.5% to 3.6% CV. The functional sensitivity was verified at 0.01 ng/mL for PCT-A and at 0.05 ng/mL for PCT-V. The Passing–Bablok regression revealed approximately 20% negative bias of PCT-A compared to PCT-V (PCT-A = 0.042 + 0.79 × PCT-V, r = 0.995). The concordance of the 2 methods at diagnostically important cutoffs (0.10, 0.25, 0.50, and 2.0 ng/mL) was excellent, with overall agreement >93% at each threshold.

Conclusion

The results of our study show improved sensitivity and equivalent clinical performance of PCT-A compared to PCT-V. The availability of this test on common clinical immunoassay analyzers may help accelerate its adoption into antimicrobial stewardship programs and thereby improve antibiotic use and patient outcomes.
The industrial network and the role of the professional illustrator in Spain
Authors: Berroya Elosua Alfonso , Echevarria Aguirre Maitane
Published: September 2018

The crisis of the publishing industry shows the precarious situation of the professional illustrator in Spain, which does not seem to improve in recent years. Job opportunities are hindered by competition at the international level after the appearance of the Internet, and the decrease of commissions, which are mostly assumed by highly experienced professionals. This situation makes it difficult to access the labor market, where the absence of official rate charts makes it complicate to budget jobs for the less experienced ones. Contrasting with this reality, the booming industries of video games and animation movies demand new professionals, but the lack of academic professionalization in traditional training system limits the possibilities of finding work due to the lack of preparation, forcing future professionals to depend on self-taught education or training in specialized private centers, being these economically less accessible
A la sombra de la producción: Aproximaciones y puesta en valor de la catábasis, extensión oculta del proceso creativo
Authors: Gómez Vázquez Rakel
Published: September 2018

Este artículo tiene como objetivo principal la puesta en valor y defensa del fracaso, la duda, las contradicciones y las paradojas inherentes a los procesos de producción e investigación artística, y su puesta en escena como método de construcción de saberes. Partiremos en esta reflexión de la presentación del caso de “El club Fénix” como ejemplo de la puesta en práctica, en espacios experimentales y abiertos, de metodologías artísticas que abren espacio a la discusión acerca de los problemas que atraviesa la creación artística en los procesos de producción. A partir de la presentación de este caso se revisarán las problemáticas a las que el arte se enfrenta desde la concepción académica del saber y de la construcción de conocimiento, así también como las consecuencias y posibilidades para la comunicabilidad de este saber.