bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures
Authors: Jones Caleb W. , O’Daly Andres , Smith Kenneth S. , Shah Ashish
Published: October 2016

Category:

Ankle

Introduction/Purpose:

Ankle fractures encompass 9% of all orthopaedic fractures and when they require surgical fixation can use 1/3 rd tubular plates, locking plates, antiglide plates, lagging screws, intramedullary nails which have been made from various metals most commonly stainless steel or titanium alloys. Carbon fiber implants have been used for a number of years more frequently in the humerus, the femur, and the spine. Our hypothesis is that the carbon fiber plates are just as efficacious in fixing ankle fractures as titanium and stainless steel plates.

Methods:

This is retrospective study of one surgeon’s ankle fractures which were fixed by ORIF with carbon fiber plates. All patients from Jan 2013-May 2015 who underwent a ankle orif with carbon fiber plate were collected and assessed for time to fracture consolidation, return to function, and complications and these were compared to historical models of fracture fixation with titanium and stainless steel plates. The results were assessed by ANOVA statistical models.

Results:

We found that the carbon fiber plates are equal in their time to consolidation, wound healing, and return to function, however we found that the carbon fiber plates allow for better fracture site visualization post operatively to determine fracture consolidation

Conclusion:

The carbon fiber plate is a viable alternative to ankle fracture ORIF especially in patients where close follow up of the fracture site is of benefit.
Analysis of Clinical Outcomes and Prognostic Factors in Bosworth Fractures
Authors: Cho Byung-ki , Choi Seung-Myung , Kang Chan , Jeong Jae-Jung , Kim Jun-Beom
Published: October 2016

Category:

Trauma

Introduction/Purpose:

Unlike routine ankle fractures, Bosworth fracture-dislocation lead to devastating complication such as compartment syndrome, neurovascular injury, and subsequent ankle OA more frequently. However, due to the low incidence of this injury, no study have reported clinical outcomes of Bosworth fracture in comparison to which of routine ankle fractures or these prognostic factors. Therefore this study was performed to assess and compare the outcomes of Bosworth fracture- dislocation to that of routine ankle fractures and understand the prognostic factors in order to prevent the irreversible and severe status.

Methods:

Twelve patients were followed for more than 1 years after surgical management for Bosworth fracture-dislocation. The mean age was 39.2 years, and the mean follow-up period was 38.4 months. All patients were treated with ORIF including syndesmosis fixation. The clinical evaluation consisted of the AOFAS ankle-hindfoot score, Olerud & Molander scale. Reduction of tibiofibular syndesmosis and restoration of the ankle mortise were evaluated with plain radiographs and 3-D CT. The clinical and radiological outcomes were compared to those of routine ankle fractures (50 patients). To detect prognostic factors affecting the clinical results, age, fixation methods, interval to operation, existence of post. malleolar fractue, shape of fibular fracture, number of syndesmotic screw, frequency of closed reduction trial were studied.

Results:

Clinical results of Bosworth fracture-dislocation showed improvement including AOFAS score (87.6 on average) and Olerud and Molaner scale (89.7 on average), and corresponded to those results of routine ankle fracture (p = 0.234). All the patients achieved union in 12.6 weeks on average. However, postoperative CT revealed syndesmotic diastasis in 5 of 12 cases As complication, there were two cases of compartment syndrome, 2 cases of posttraumatic OA, 2 cases of ankle stiffness. Interval to operation and frequency of closed reduction trial were foud to be predictive factors of poor outcomes (p = 0.003, 0.011 respectively).

Conclusion:

The results of our study showed that although the clinical results were comparable statistically, Bosworth fracture are more frequently associated with the development of complications than routine ankle fractures. More specifically, prolonged interval between occurrence of fracture and surgical fixation and repeated attempts of closed reduction are at risk for poor outcomes. A prospective study with sufficient power would be needed to further identify risk factors associated with complications.
Anterior Plating with Retention of Nail for Salvage Ankle Arthrodesis After Failed Tibiotalocalcaneal Fusion
Authors: Matson Andrew P. , Hamid Kamran S. , Dekker Travis J. , DeOrio James K.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Tibiotalocalcaneal arthrodesis (TTCA) by retrograde intramedullary nailing (RIMN) is commonly used to treat degenerative disease affecting both the tibiotalar and subtalar joints. In the event of TTCA failure, techniques for salvage arthrodesis are not well-described. The aim of this study is to demonstrate the feasibility of anterior plating with retention of nail as a salvage option for patients who experienced failed TTCA by RIMN.

Methods:

Six patients with failed TTCA following RIMN underwent revision ankle arthrodesis with anterior plating and retention of nail between July 2013 and July 2015. Patient demographics, presentation details, and clinical records were reviewed for clinical and patient-reported outcome measures. Postoperative outcomes consisted of visual analog scale (VAS) pain rating, Coughlin satisfaction scale, Foot & Ankle Activity Measure (FAAM) score, and complications.

Results:

Anterior plating was performed at a mean of 15.8 months (range, 6.3-25.7) after primary TTCA by RIMN. All patients achieved bony fusion at an average of 9.3 weeks (range, 5.4-16.1) postoperatively. Postoperative outcomes at 1 year follow-up demonstrated an average VAS score improvement from 7.8 to 5.3 (p = 0.019) and an average postoperative FAAM score of 50.9 (range, 37.5-75.0). One major complication occurred in a patient who had a posterior tibial nerve neuroma from the initial TTCA procedure. Despite achieving union following anterior plating, the patient had several subsequent procedures to manage the neuroma but eventually required amputation. There was one minor complication consisting of postoperative swelling requiring a compressive stocking.

Conclusion:

Anterior plating with retention of nail is a viable option for salvage arthrodesis in patients with failed TTCA after RIMN. Given the complex presentation of most patients with this problem, detailed preoperative counseling regarding the potential risks of surgery should be performed.
Assessing the Utilization of Total Ankle Replacement in the US
Authors: Koenig Lane , Demiralp Berna , Nguyen Jennifer , Zhang Qian , Reddy Sudheer C.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

While total ankle arthroplasty has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis, implant costs and complications have the potential to increase the overall financial burden of performing TAR. The purpose of this investigation is to analyze the overall cost and utilization of total ankle arthroplasty.

Methods:

Our analytical sample consisted of Inpatient Prospective Payment System hospitals from 2011 and 2012 Medicare claims data and the 2011-2012 Medicare Inpatient Limited Data Sets. Outcome variables of interest were the likelihood of a hospital performing TAR and the volume of TAR cases, conditional on a hospital having performed at least 1 TAR in a year. Data from the 2010 Cost Report and from Medicare inpatient claims were utilized to compute average margins for TAR cases and overall hospital margins. TAR cost was calculated based upon the all payer cost-to-charge ratio for each hospital provided by the Healthcare Cost and Utilization Project. The FY2015 Impact File was used to gather data on hospital-level characteristics, such as bed size, census region, teaching status, and urban/rural location. Hospital ownership data were obtained from the CMS Hospital Compare Database. Nationwide Inpatient Sample (NIS) data was used to generate descriptive statistics on all TAR patients.

Results:

Medicare participants accounted for 47.5% of the overall population of patients. Orthopaedic specialty hospitals are four times more likely to perform TAR than a non-orthopedic specialty hospital. Average implant cost was $13,034, which accounted for approximately 70% of the total all-payer cost. With respect to teaching versus non-teaching hospitals, the average cost per case is $18,331 and $19,303 respectively. Compared to nonprofitable hospitals, profitable hospitals performing TAR in 2011 had lower total costs ($14,425 vs. $19,884) and higher payments ($19,631 vs. $13,640), leading to a difference in profit of approximately $11,000 from TAR surgeries between profitable and nonprofitable hospitals. Approximately, one-third of hospitals were profitable with respect to TAR. No difference was noted with respect to length of stay or number of cases performed between profitable and nonprofitable hospitals.

Conclusion:

There is an overall significant financial burden associated with performing total ankle replacement with many health systems failing to demonstrate profitability despite its increased utilization. Profitable hospitals are more likely to have lower cost per day and prosthesis costs and higher payments compared to nonprofitable hospitals. While additional factors such as improved patient outcomes are driving utilization of TAR, financial barriers exist that can affect utilization of TAR across health systems.
Assessment Inter- and Intraobserver Agreement in Two Radiological Indexes in True Lateral X-Rays View for Syndesmotic Reduction in Ankle Fractures
Authors: Briceno Jorge A. , Filippi Jorge , Abarca Mario C. , Mery Pablo , Villa Andres , Garcia Ignacio , Bernal Jaime
Published: October 2016

Category:

Trauma

Introduction/Purpose:

Malreduction of distal tibio-fibular syndesmosis in ankle fractures has been reported from 20% to 52% in surgically treated patients. Current intraoperative methods, fluoroscopy and intraoperative CT, have not improved consistently this results. Recently, new indexes to determine the normal anatomy of the syndesmosis have been published using a true lateral view of the ankle to evaluate the relation of the fibula with the tibia in the sagittal plane. These studies have been made in non- injured ankles. If these measurements could be performed intra operatively, they may improve the evaluation of syndesmotic reduction. To our knowledge this indexes have been not tested in injured ankles. The purpose of this study is to assess intra- observer and inter-observer agreement in two radiological indexes by evaluating true lateral x-ray view in surgically treated patients for ankle fractures with syndesmotic injury.

Methods:

Retrospective study of case series. Forty-three consecutive patients who underwent open reduction and internal fixation for ankle fractures with syndesmotic screw were evaluated. The inclusion criteria were syndesmotic injury fixed with one or two screws, and having a true lateral postoperative ankle x-ray view. Two measurements were performed: Anteroposterior Tibiofibular Ratio (APTF) and Anterior Tibiofibular Ratio (ATFR). Three independent evaluators performed the measurements. The intra-class correlation was used to determine inter- and intra-observer agreement, through statistical package SPSS 20.

Results:

The intra-observer and inter-observer agreement in the APTF was good to very good, with intra-class correlation values between 0.77 and 0.81; The reproducibility of the ATFR was also good to very good, but with lower intra-class correlation values between 0.62 and 0.79.

Conclusion:

Intra- and inter-observer concordance in APTF and ATFR in operated ankle fractures with syndesmotic injury was similar to that reported in healthy ankles. This study validates, in terms of intra and inter-observer agreement, the use of these indexes in surgically treated ankle fractures with syndesmotic repair. The next step is to compare these measurements made intra-operatively with a CT scan.
Biomechanical Comparison of the Holding Strength of a PEEK Locking Dorsal Plate Versus Lag Screw Fixation for Triple Arthrodesis
Authors: Sabatini Jefferson , Smith Kenneth S. , Eberhardt Alan , Kirchner John S.
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

Hindfoot arthrodesis is often the treatment of choice for hindfoot pain due to arthritis or advanced deformity. Good results are dependent on secure fixation while avoiding hardware related side effects. A small radiolucent locking dorsal circular plate placed into the talonavicular and calcaneocuboid joints may provide a low-profile solution for secure fixation of these joints. The goal of this study is to compare the fixation strength of a locking dorsal circular plate to that of the current gold standard technique of screw fixation.

Methods:

Eight matched fresh-frozen cadaveric foot-ankle pairs were obtained for comparison of the two fixation methods. One side of each matched pair was plated with a locking dorsal circular plate and the contralateral foot was fixed with partially threaded 4.5 mm cannulated screws. All subtalar joints were fixed with two 7.3 mm cannulated screws. Translational forces through a mechanical testing system (MTS) were applied to the constructs cyclically for 40 cycles followed by loading to failure. Displacement was recorded using two high-speed infrared cameras, following sets of orthogonal marker systems attached to each bone.

Results:

Cyclical loading trials found there to be no significant difference in resistance to motion between the two methods. However, specimens instrumented with plates had an approximately 400% higher load to failure (513.3 N vs 127.7 N) than specimens instrumented with screws.

Conclusion:

Locking dorsal circular plates are a viable option that provide equivalent and possibly better fixation strength than screw fixation for the talonavicular and calcaneocuboid components of a triple arthrodesis of the hindfoot. These plates are radiolucent allowing easy assessment of the fusion site. In addition, these plates have the theoretical benefit of being low profile to decrease tendon irritation and wound healing problems.
Bone-Block Arthrodesis Procedure in Failures of First Metatarsophalangeal Joint Replacement
Authors: Maccario Camilla , Grassi Miriam , Usuelli Federico G. , Manzi Luigi
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

The treatment of the failure of the first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding treatments options. The main issue is the available bone stock.The aim of the study was to report on clinical and radiographic results for MTP1 arthrodesis with autologous bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure.

Methods:

We enrolled 12 patients who underwent MTP1 prosthesis failures and retrospectively collected data. All the patient underwent removal of the prosthetic implant and simultaneous MTp1 arthrodesis with autologous bone graft, harvested from the ipsilateral calcaneus (minimum follow-up of 24 months). The minimum time period elapsed between the surgical procedure of prosthetic implant and the revision surgery has been 18 months. Patients were evaluated preoperatively with a weight-bearing radiograph of the foot and CT-scan and at 24 months after surgery with Foot Ankle Disability Index (FADI).

Results:

The reasons for implant-failures were: 8 mobilization and 4 malalignment. The average defect filled with bone-block was 12.2 mm. The fusion was performed with a plate and locking-screws. We had 3 cases of asymptomatic nonunion at the falangeal side of the fusion, none on the other side. Mean average rate of consolidation in other patients was 10 weeks. All patients returned to common activities’ of daily living. Average FADI was foun1d to be 84.6 at final follow-up.

Conclusion:

The management of this pathology is still controversial. Bone-block MTP1 arthrodesis The main limitation of the study is the small sample. seems to be a viable option.
Clinical Analysis of the Conservative Treatment for Treating Diabetic Foot Osteomyelitis
Authors: Chun Dong Il , Cho Jaeho , Park Chul hyun , Choi Hongjoon
Published: October 2016

Category:

Diabetes

Introduction/Purpose:

The question of surgical versus non-surgical treatment for diabetic foot osteomyelitis remains subject to debate. The aims of this study were to analyze the outcome of conservative treatment (antibiotics treatment and conservative surgery) for diabetic foot osteomyelitis and identify the predictive factors of remission in conservative treatment of diabetic foot osteomyelitis.

Methods:

77 patients with diabetic foot osteomyelitis who were initially treated by conservative treatment from January 2004 to July 2013 were identified, and their medical records were reviewed. We defined diabetic foot osteomyelitis by imaging studies or histological evidence. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 12 months after the end of treatment. The demographic, clinical and therapeutic factors were analyzed.

Results:

The mean age of the patients was 62.6 years(SD=12.20), and 47(61.0%) of these patients were male. The median diabetes duration was 15.6 years(SD=11.20) and mean HbA1c was 8.7%(SD=2.40). Forty-eight (62.3%) patients healed with conservative treatment (antibiotics treatment and conservative surgery). Twenty-five(32.5%) patients underwentamputation. Inthe multivariate analysis, concomitant peripheral artery diseaseand inadequate antibiotics therapywere associated with failure of conservative treatment.

Conclusion:

Antibiotics alone, or with conservative surgery, were successful in treating diabetic foot osteomyelitis in 62.3% of the patients. Concomitant peripheral artery diseaseand inadequate antimicrobial therapy were risk factors for remission in diabetic foot osteomyelitis treated conservatively.
Clinical and Radiographic Evaluation of Total Ankle Arthroplasty with Custom Image Measurement Software
Authors: Kosugi Shinichi , Takakura Yoshinori , Tanaka Yasuhito , Matsumoto Yuki , Koeda Masanao
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Ceramic 2-component total ankle prosthesis, TNK-Ankle, has been used clinically as standard prosthesis in severe ankle osteoarthritis or rheumatoid arthritis for long years in Japan. Two-component prosthesis would require more precise replacing because of more constraint than mobile type. We would report the outcomes of total ankle arthroplasty (TAA) with TNK-Ankle investigated radiographically using custom image measurement software and compared with clinical scores.

Methods:

Twenty four cases of total ankle arthroplasty with TNK-Ankle for osteoarthritis in stage 3b and 4 operated by an expert surgeon from 2009 to 2013 have investigated on X-rays of preoperative unaffected and postoperative affected ankles. Clinical outcomes by JSSF score based on AOFAS score and SAFE-Q, patient-based questionnaire, were compared with radiographic measurements. Image analysis performed with custom OpenCV software programmed for this study. This could match translucent X-ray images, an unaffected lateral ankle image and an implanted lateral ankle image with TNK-Ankle, and measure differences in geometry of ankle joint for tibia and talus between two images.

Results:

Postoperative clinical outcomes were improved from preoperative on JSSF (from 57 to 90) and generally affirmative on each item of SAFE-Q at forty-six months follow-up. But three ankles had some subsidence and loosening of prostheses, two ankles needed revision surgeries. Their ankles were classified for revision and loosening group, and the other ankles were classified for non-loosening group. X-ray image measurements with the custom software had elucidated two dimensional geometry of postoperative implanted ankle compared to preoperative unaffected ankle joint and its differences between two groups. In Revision and loosening group, the top of tibial plafond of tibial component of TNK-Ankle was placed 7 mm anterior to the top of unaffected tibial plafond and more than 4 mm anterior in non-loosening group. Inclination of component in loosening and revision group was a little more than in non-loosening group.

Conclusion:

In this study it was indicated that a few case may have loosening and revision after TAA even if it was performed on correct indication and by an expert surgeon, and clinical results may be concerned in geometry of implanted ankle. Precise replacing of total ankle prostheses by means of navigation and image-guided surgery may produce better results means. Data accumulation by more radiographic measurements with digital tools must become useful for future navigation system. Custom- made software development suitable to research demand like this study would be more efficient.
Comparative Study of Mobility and Perceived Exertion for the Wheeled Knee Walker and Axillary Crutches in Healthy Participants
Authors: Kirk Kevin L. , Kocher Benjamin K. , Lopez Donna M.
Published: October 2016

Category:

Other

Introduction/Purpose:

Functional limitations are common after lower extremity surgery and often require the use of an assistive device for ambulation during rehabilitation and recovery. There is no known data evaluating the wheeled knee walker (WKW) as an assistive device for postoperative protected ambulation. The purpose of this study is to compare mobility and perceived exertion in the WKW and the axillary crutch (AC) in healthy volunteers.

Methods:

This is a cross sectional study of the WKW and the AC that was performed on 24 healthy volunteers utilizing the Six- Minute Walk Test (6MWT). The participants were randomized into two separate arms, one starting with the AC (N=12) and one starting with the WKW (N=12). A modified version of the American Thoracic Society (ATS) Guidelines for the 6MWT was performed for both assistive devices on all subjects. Pre-activity and post-activity heart rates were recorded for both events. From the 6MWT data the values for the Self Selected Walking Velocity (SSWV) were calculated and the subjects rating of perceived exertion was recorded using the OMNI Rating of Perceived Exertion (OMNI-RPE). Patient's preference for assistive device was identified.

Results:

The 6MWT, SSWV and the Omni-RPE were evaluated using paired T-tests and was determined to be statistically significant for the WKW when compared to the AC (p < 0.001). The confounding effect of the sequences were measured utilizing a mixed-model 2x2 ANOVA and was determined to have no significant 3 way (time x device x sequence) interaction (p = 0.968). Factorial 2 x 2 repeated measures ANOVA was used to evaluate the pre-activity and post-activity heart rates and demonstrated a statistically significant difference for the WKW when compared to the AC (p < 0.001). 87.5% of subjects preferred the WKW to the AC.

Conclusion:

The WKW provided increased mobility and had a lower rating of perceived exertion than the AC on level surfaces in healthy participants
Comparison of Weil Osteotomy and Cheilectomy for Second Metatarsophalangeal Joint Osteoarthritis
Authors: Kim Ji-Beom , Lee Woo-Chun , Yi Young , Kim Jae-Young
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Second metatarsophalangeal (MTP) joint osteoarthritis (OA) was newly introduced at 2013. However, treatment of second MTP joint OA was not reported yet. The purpose of this study was to investigate the difference in clinical and radiographic outcomes between a chilectomy and an Weil osteotomy for treatment of second MTP joint OA.

Methods:

From August 2007 to January 2015, 61 feet of 51 patients who had been operated for second MTP joint OA by were retrospectively reviewed. The cheilectomy involved removal of bone spur on the second MTP joint. And the Weil osteotomy involved shortening of second metatarsal bone and removal of the bone spur (Fig.1). The average age was 60 years (95% CI: 57-62 years), the mean duration of follow up was 15 months (95% CI: 12-17months). The 61 feet were divided into two groups, the cheilectomy-group (36 feet) and the Weil-osteotomy-group(25 feet). The preoperative and the last follow-up radiological values and clinical values were measured. Length of the second metatarsal relative to the fourth (2-4 MT length ratio), second MTP joint OA grade, and Visual Analogue Scale (VAS) of pain were measured to evaluate clinical and radiological outcomes. Further, prevalence of second MTP joint disturbance at the time of last follow-up was measured.

Results:

There were no significant differences of age (P=0.83), gender (P=0.08), BMI (P=0.09), the preoperative 2-4 MT length ratio (P=0.68) and the second MTP joint OA grade (P=0.21) between the chilectomy-group and the Weil-osteotomy-group. In the cheilectomy-group, the last follow-up 2-4 MT length ratio and second MTP joint OA grade were not statistically different from the preoperative values. In the Weil-osteotomy-group, there was a significant decreasing of the 2-4 MT length ratio and a significant improvement of the second MTP joint OA grade between the preoperative values and the last follow-up values. For both the cheilectomy-group and the Weil-osteotomy-group, there was a significant improvement of the VAS of pain after treatment. However, the cheilectomy-group showed the statistically higher prevalence of second MTP joint disturbance than the Weil- osteotomy-group (Table.1).

Conclusion:

The Weil-osteotomy group showed superior result than the cheilectomy group clinically and radiologically in this study. Because shortening of second metatarsal bone could reduce a pressure of second MTP joint, joint space widening and joint disturbance decreasing could be achieved after the Weil osteotomy. We therefore recommend the Weil osteotomy as a treatment of second MTP joint OA.
Cost Comparison of Operatively Treated Ankle Fractures Managed in an Inpatient versus Outpatient Setting
Authors: Bettin Clayton C. , Lyman Mikayla , Barg Alexej , Saltzman Charles L. , Rothberg David , Nelson Richard
Published: October 2016

Category:

Trauma

Introduction/Purpose:

Although choices physicians make profoundly impact the cost of healthcare, few surgeons know actual costs. Without valid cost information, surgeons cannot understand how their choices impact the total cost of care. We leveraged a validated value analytics framework to efficiently allocate clinical care costs to individual patient encounters in an effort to understand the sources and variation of cost of care for a putatively straightforward and common orthopaedic problem.

Methods:

We conducted a retrospective cost analysis on all isolated, operatively treated ankle fractures from a Level 1 trauma hospital and affiliated outpatient surgery center between 2013 and 2015. Patients were categorized based on whether they were treated on an inpatient or outpatient basis, and records were reviewed to determine the presence of confounding variables as well as readmission and emergency department (ED) visits within 90 days after surgery. Actual costs were determined using a validated episode of care costing system and analyzed using multivariate regression analysis.

Results:

148 patients (61 inpatients, 87 outpatients) with isolated, operatively treated ankle fractures were included. After controlling for confounding variables, outpatient care was associated with 31.6% (95% CI: 19.8% - 41.8%) lower costs compared to inpatient care. Obese patients had 21.6% (95% CI: 5.8% - 39.8%) higher costs compared to patients who were not obese. There was no difference in reoperation, readmission or return visits to the ED for patients treated on an inpatient or outpatient basis.

Conclusion:

Inpatient surgical care is clearly more expensive than outpatient care primarily due to higher facility and labor costs without a clear advantage relative to lower readmission or ER visit rates. Where medically appropriate, this analysis suggests ankle fracture surgery should be provided in an outpatient surgical facility to provide the greatest value to the patient and society.
Does the Learning Curve of Minimally Invasive Chevron and Akin Osteotomies Affect Outcome of Hallux Valgus Correction?
Authors: Asaad Asaad , Kakwani Rajeshkumar , Townshend David , Hutt Nicholas J. , Grey W
Published: October 2016

Category:

Bunion

Introduction/Purpose:

Minimally invasive chevron and akin osteotomy (MICA) has become increasingly popular in the correction of hallux valgus deformity. This study compared the radiological outcomes of the first cases performed by 2 surgeons using this technique with open scarf and akin osteotomy

Methods:

A retrospective review of hallux valgus corrections performed in Northumbria Healthcare NHS Trust between March and September 2014. Consecutive patients who underwent MICA correction by 2 surgeons trained on a cadaveric course were compared with a group of patients with mild to moderate deformity that underwent open scarf correction. Pre and post radiographic assessment was performed measuring the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and medial sesamoid position (MTS) using Hardy and Clapham classification. Radiographic measurements where statistically compared for difference and complications were recorded.

Results:

14 MICA procedures were identified and compared with 14 scarf procedures. Average age of the MICA group was 46 vs. 55 for the scarf group. Pre operative radiographic measurements showed no statistical difference between MICA vs. scarf: Mean HVA 26.9 vs. 28.2 degrees (p 0.698), mean IMA 14.7 vs. 15.3 degrees (p 0.512) and mean MTS grade 5 vs. 5.5 (p 0.251). Change in these parameters between MICA vs. scarf also did not show any statistical difference: Mean HVA change 17.2 vs. 19.2 degrees (p 0.396), mean IMA change 8.5 vs. 8.1 degrees (p 0.680) and mean MTS grade change 2.6 vs.3.2 (p 0.149). In the MICA group, 1 procedure was converted to open and post operatively 1 screw was removed due to length. In the scarf group 1 patient developed a superficial infection that resolved with antibiotics and 1 prominent screw for akin osteotomy required removal.

Conclusion:

Early experience of MICA resulted in similar outcomes and complications compared with open scarf and akin osteotomy.
Five to Sixteen Year Follow-Up of the STAR Total Ankle Replacement
Authors: Sanders Thomas H. , Walling Arthur K. , Loewy Evan M.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Limited intermediate and long-term follow-up data has been published for total ankle arthroplasty in the United States (U.S.). This is a report of clinical follow-up data of a prospective, consecutive cohort of patients that underwent total ankle arthroplasty by a single surgeon at a single institution from 1999 to 2009 with the Scandinavian Total Ankle Replacement (STAR) prosthesis.

Methods:

Patients undergoing total ankle arthroplasty at a single U.S. institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination and radiographs; American Academy of Orthopaedic Foot and Ankle Surgeons (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Implant survival was defined as retention of both initial tibial and talar components at final follow up. Patients undergoing the surgical procedure from 1999 to 2009 were selected for inclusion.

Results:

Between 1999 and 2009, eighty-five STAR total ankle arthroplasties were performed in eighty-one patients; fifty patients were female. The mean age at surgery was 59.8 ± 12.8 years (range, 30-88 years). Thirteen patients died with implants in place and one patient with bilateral arthroplasties was lost to follow up. The mean duration of follow up for living patients that retained both initial components at final follow up was 11.3 ± 3.3 years (range, 5.5-16.75 years). The mean change in AOFAS Ankle-Hindfoot scores from baseline to final follow up was 34.4 ± 16.3 (range, -5-67). There were fifteen (17.6%) implant failures that occurred at a mean 5.2 ± 3.9 years postoperative. Eight glidecores (9.4%) required replacement for fracture at an average 8.6 years postoperative.

Conclusion:

This cohort of patients with true intermediate to long-term follow-up after total ankle arthroplasty with the STAR prosthesis demonstrates maintained acceptable revision rates, maintained improved patient reported outcomes scores and low major complication rates. Further intermediate and long-term outcome studies with follow up over 15-20 years on total ankle arthroplasty are needed to further understand the survivability of these implants.
Functional Outcomes of Gastrocnemius Recession for Isolated Gastrocnemius and Gastrocnemius-Soleus Contractures
Authors: Gross Christopher E. , Messerschmidt Cory A. , Netto Anuj P. , Barfield William R. , McKibbin William K.
Published: October 2016

Category:

Ankle

Introduction/Purpose:

Contracture of the gastrocnemius muscle with or without involvement of the soleus muscle has long been proposed as an etiologic factor in the development of chronic pathology of the foot and ankle including among others plantar fasciitis, hallux valgus, metatarsalgia, and symptomatic pes planovalgus deformity. Very few studies have analyzed the effect on strength and function of the gastrocnemius recession and those that have, are limited by sample size and functional outcome tools utilized. This prospective study reports on strength and functional effect of the gastrocnemius recession utilizing a validated outcome measure on the largest sample size yet reported.

Methods:

We developed two treatment arms to achieve our aims. Twenty-four patients (25 extremities) underwent a gastrocnemius recession for isolated gastrocnemius and gastrocnemius-soleus contracture. In one arm, eight patients (8 extremities) prospectively underwent range of motion, isokinetic and isometric testing pre-operatively and at 3 and 6 months post-operatively. Validated functional outcomes were also assessed using the Foot Function Index (FFI). In the second arm, an additional sixteen patients (17 extremities) prospectively completed the validated functional outcomes using the FFI. Variables were compared across three time intervals with repeated measure ANOVA with Bonferroni post hoc testing and t testing between control and operative sides was with IBM SPSS Statistics-Version 22.

Results:

The average age in the 24 patients (25 extremities) was 58.4 ± 15.2 years-old. Treatment for symptomatic pes planovalgus was the most common reason for surgery (10, 40%). Significant improvement in functional outcomes were observed across all three time points (p < 0.001) based on a multivariate repeated measures ANOVA for all 3 subscales (pain, disability, activity limitation) of the FFI. The improvement was significantly greater between pre-operative and 6 months post-operative intervals (p < 0.001) although significant improvements were observed between pre-operative and 3 months post-operative intervals (p=0.001). Range of motion significantly improved between pre-operative and 6 months post-operative intervals (p=0.023) and between 3 and 6 months post-operative intervals (p=0.012). No differences were observed in isokinetic and isometric testing.

Conclusion:

Analysis of results demonstrates improved range of motion and functional outcomes of the gastrocnemius recession between pre-operative and 6 months post-operative intervals for isolated gastrocnemius and gastrocnemius-soleus contracture.
Gait Analysis of Patients Suffering From Hallux Valgus
Authors: Ito Naoya , Nishimura Akinobu , Nakazora Shigeto , Kato Ko , Sudo Akihiro
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux valgus that is defined as HVA (hallux valgus angle) >20 is one of the most common forefoot problems and can lead to alterations of the plantar pressure pattern. In addition, it can cause clinically gait alterations. Hence, we investigated the plantar pressure pattern and the gait-related factors using the gait analyzer. The purpose of this study was to examine the relationship between gait alterations or motor function and hallux valgus deformity.

Methods:

In 2009, we examined 309 inhabitants (male, 105; female, 204; age, >65 years) of Miyagawa village in Mie, Japan and compared the plantar pressure pattern between the subjects who has hallux valgus (HVA, >20; n=88) and those who does not have hallux valgus (HVA, < 20; n = 221). Furthermore, we compared gait-related factors among mild group (20< HVA < 30; n=88), moderate group (30< HVA < 40; n=24), and severe group (HVA, >40; n=9). If the right and left hallux valgus varied in severity, we selected severe side. The plantar pressure pattern and the gait-related factors such as stride, step width, foot angle (Figure 1), and gait speed were measured using the gait analyzer (Walk way MW 1000; Anima, Tokyo, Japan). Statistical analyses were performed using t-test, Chi-Square test, or logistic analysis adjusted age, gender and height. P < 0.05 was considered significant.

Results:

The average weight and height of hallux valgus group were significantly lower, and age of hallux valgus group were significantly higher than those of normal group. About the plantar pressure pattern, ratio of the subjects in hallux valgus group who can use the hallux ball in toe off were significantly less than those of normal group. However, the gait-related factors were not significantly different between 2 groups. On the other hand, when we compared by severity, step width tended to increase with progression of hallux valgus. Moreover, stride, gait speed, and foot angle of severe group were the lowest among 4 groups (normal, mild, moderate, and severe). Especially stride of severe group was significantly lower than those of other 3 groups.

Conclusion:

Mild hallux valgus can cause alterations of the plantar pressure pattern, but didn’t cause motor functional decline. However, when hallux valgus become severe, hallux valgus can cause not only gait alterations but also motor functional decline.
Gender Differences in End-Stage Ankle Arthritis
Authors: Dodd Andrew , Pinsker Ellie , Khan Ryan M. , Daniels Timothy R.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

End-stage ankle arthritis (ESAA) is a debilitating disease that does not affect all individuals equally. Gender differences have been identified in patients with end-stage hip and knee arthritis and have stimulated research to explain these findings. The present study was undertaken to examine if gender has a significant effect on pre-operative disability and post- operative outcomes in patients with ESAA.

Methods:

Patients undergoing ankle arthrodesis (AA) or total ankle replacement (TAR) with minimum 2-year follow-up were identified in the Canadian Orthopedic Foot and Ankle Society prospective ankle reconstruction database. Demographic data, revision data, patient satisfaction questionnaires, and outcome data using the Ankle Osteoarthritis Scale (AOS) and Short-form 36 (SF-36) health survey were collected.

Results:

TAR: 384 patients were included, with 198 females and 186 males. Preoperatively females had higher rates of pain and disability, demonstrated by lower SF-36 physical component scores (PCS) (31.0 vs 34.5, p < 0.001), and higher AOS pain (54.7 vs 51.1, p=0.05) and AOS disability scores (66.5 vs 59.6, p < 0.001). Postoperatively, both groups had significant improvement in PCS, AOS pain, and AOS disability scores. Females continued to demonstrate lower PCS scores (38.3 vs 41.9, p < 0.001) and higher AOS disability scores (31.0 vs 25.8, p=0.02) than males. Preoperative PCS, gender, age, and arthritis etiology all had a significant impact on postoperative PCS scores, with preoperative PCS scores having the largest impact. Gender had no significant impact on AOS pain and disability scores postoperatively. AA: Results Pending

Conclusion:

In patients with ESAA, females tend to have higher pre-operative levels of pain and disability compared to males, which persists post-operatively. This is consistent with the hip and knee arthroplasty literature. This finding may be due to females undergoing surgery at more advanced disease states, arthritis etiology, referral bias, or treatment bias. Both males and females have significant and similar degrees of improvement in pain and disability scores after TAR, and reoperation rates and patient satisfaction rates are similar despite the apparent disparity in outcomes.
Gravity Reduction View
Authors: Gonzalez Tyler A. , Ehrlichman Lauren K. , Macaulay Alec , Ghorbanhoseini Mohammad , Kwon John
Published: October 2016

Category:

Trauma

Introduction/Purpose:

The determination of stability and ultimate need for operative stabilization of Weber B fibula fractures largely depends on the presence of a competent deltoid ligament. While various radiographic parameters and the application of manual or gravity stress have been proposed to elucidate instability, the prognostic capability of these modalities remains unclear. Given that a recent study found no difference between operative and nonoperative treatment for stress-positive Weber B ankle fractures, the value of stress views is questionable; what may be ultimately more important is the determination of anatomic positioning of the mortise. We propose a novel view, the Gravity Reduction View (GRV), which helps elucidate non-anatomic positioning and reducibility of the mortise. We also propose a treatment algorithm based on the use of the GRV.

Methods:

To obtain the GRV, the patient is positioned in lateral decubitus with the injured fibula directed upward and elevated with a leg holder. The x-ray cassette is placed posterior to the heel, with the beam angled at 15˚ of internal rotation to obtain a mortise view. Our treatment algorithm is based upon the measurement of the medial clear space (MCS) on the GRV versus the static mortise view. If the MCS on GRV remains wide or decreases, surgery is recommended as the GRV confirms a non- anatomic mortise. If the MCS remains within normal limits on the static and GRV views, a trial of nonoperative treatment with immobilization and repeat radiographs in 1-2 weeks is undertaken. If the MCS is normal on repeat weightbearing x-rays, the patient is treated conservatively; if increased, surgery is recommended. To further assess mortise stability, the MCS is compared to the superior clear space (SCS).

Results:

23 patients with Weber B distal fibula fractures were managed according to this treatment algorithm. The mean age was 49.1 years old (range: 18-74). Of these patients, 15 underwent operative treatment and 10 patients were initially treated nonoperatively, although 2 patients demonstrated late displacement and were treated surgically. Using this algorithm, all patients had a final MCS that was less than the SCS (final mean MCS for patients treated operatively or nonoperatively 2.85 mm vs. mean SCS of 3.34), indicating effectiveness of the treatment algorithm.

Conclusion:

The Gravity Reduction View is a novel radiographic view in which deltoid competency, reducibility and initial anatomic positioning of the mortise are assessed by comparing a static mortise view with the appearance of the mortise on the reduction view (GRV). We have developed a treatment algorithm based on the GRV and have found it to be predictive of mortise alignment and useful in guiding treatment.
Higher In-Hospital Complications in Ankle Fusion Than Ankle Arthroplasty
Authors: Anderson Robert B. , Davis W. Hodges , Odum Susan M. , Van Doren Bryce
Published: October 2016

Category:

Ankle

Introduction/Purpose:

Ankle fusion and total ankle arthroplasty (TAA) are common surgical procedures used to treat ankle morbidity. Little is known about the comparative rates of in-hospital complications between patients treated with ankle fusion and TAA.

Methods:

Data from the 2002-2013 Nationwide Inpatient Sample releases were analyzed. 4,451 TAA patients and 16,277 ankle fusion patients were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 81.11 and 81.56 procedure codes, respectively. ICD-9-CM diagnosis codes were utilized to classify major or minor in-hospital complications. Fusion and TAA patients were exact matched on age, gender, race, hospital type, geographical region, comorbidities, and diabetes status. Minor and major in-hospital complications, including mortality were compared using chi-square and multivariate logistic regression.

Results:

Exact matches were identified for 4,174 (93.8%) TAA patients, with a mean age of 62.2 years. The major in-hospital complication rate for ankle fusion patients was 14.7% (615 of 4,174) versus 6.4% (269 of 4,174) for TAA patients (p< .01). The minor complication rate for ankle fusion was 3.9% (169 of 4,174) compared to 4.6% (167 of 4,174) for TAA (p=0.91). Fewer than 10 patients in either group died (p=0.59). After adjusting for case-mix, ankle fusion patients were 2.46 times more likely to experience major complications (OR: 2.46, 95% CI 2.11-2.88) than TAA patients.

Conclusion:

Compared to a matched cohort of ankle fusion patients, TAA patients are less likely to experience major in-hospital complications. These findings suggest that TAA may be a safer surgery than ankle fusion.
Medializing Calcaneal Osteotomy (MCO) and FDL Transfer as Therapy for Acquired Flat Foot
Authors: Bock Peter , Krenn Sabine , Chraim Michel , Trnka Hans-Jorg
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

MCO and FDL Transfer is established for grade II PTTD. The study shows a comparison of one-year and intermediate-term results.

Methods:

Thirty-eight patients (40 feet) with an average age of 58 years (36-75) were operated for a grade II tibialis posterior tendon insuffiency between january 2005 and december 2008. The patients were seen pre-operatively, one year and an average of 98 months (84 -120) post-operatively to assess the following parameters: AOFAS Score, VAS Score for pain (0-10), FAOS Score. Foot x-rays in full weightbearing position (dorsoplantar and lateral) were done at every visit in order to assess the following parameters: tarsometatarsal I angle on the dorsoplantar and lateral view, talo-navicular coverage angle on the dorsoplantar view, talo-calcaneal angle, calcaneal pitch angle and medial cuneiforme height on the lateral view.

Results:

The AOFAS hindfoot score improved from 46.4 to 89.5 points 1-year postoperatively und decreased to 87.8 points at the last follow-up. VAS for pain decreased from 6.6 pre-operatively to 1.1 at the one year follow-up and increased to 1.5 at the last follow-up. The FAOS with its subscores showed following results (pre-op, one-year post-op, final follow-up): pain subscore: 64.1, 94.3, 92.1; symptoms subscore: 80.5, 96.7, 97.3; ADL(function daily living): 67.1, 89.4, 85.3; Quality of life: 25.0, 83.6, 84.1. All clinical Scores showed a significant improvement from pre-operatively to one year post-operatively and no further significant change from one year post-operatively to final follow-up.All radiologic parameters except for the talo-navicular coverage angle improved and stayed without significant changes over time. Following complications were seen: one recurrence, two patients with irritation of the sural nerve, one patient with hypesthesia of the big toe. In ten patients the screws had to be removed.

Conclusion:

Flexor digitorum longus transfer together with medializing calcaneal osteotomy provides excellent results for the therapy of acquired flat foot deformity. The clinical and radiologic results improved from pre-operatively to one-year post- operatively and did not worsen over time.