bluuebunny/crossref_metadata_2025 huggingface dataset:
Evans Osteotomy with Locked Plate with Wedge Block for Stage IIB Flat Foot
Authors: Araujo Maria Gala Santini , Carrasco Nelly , Sotelano Pablo , Parise Ana Cecilia , Conti Leonardo , Villena Daniel
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

Elongation of the lateral column is indicated only in patients who have a flexible deformity Stage 2B of flat foot. The Evans osteotomy is performed 1.5 or 2 cm from the cuboideal calcaneal joint, and in many publications is maintained by different kind of devices. Our hypothesis is that Evans osteotomy, with blocked plates with a wedge block, without the use of bone graft, maintain the correction obtained at one year after surgery. The primary objective was to evaluate the radiological results at the postoperative year of the osteotomy Secondary objectives were to evaluate the persistence of the correction obtained between the 3 months and the year of the postoperative period and to evaluate the functional outcomes with AOFAS score.

Methods:

We studied a total of 12 patients, 14 feet. with stage 2 B flat foot, in all cases surgery was performed by the same specialist between March of 2011 and March of 2014 in the Service of foot and ankle of our institution. Inclusion criteria were: patients with type 2B flat foot, submitted to external column elongation, with plates blocked with a 6 to 10 mm wedge block, without the use of bone grafting, minimum follow-up of 1 year. Exclusion criteria: revision of previous surgery, another type of material used for elongation of the external column, neurological sequelae. The study was performed retrospectively through clinical records database, data collection and measurements were performed by 2 second-year Foot and ankle fellow trained in the same institution. Statistical analysis was performed with the T-student test.

Results:

A total of 12 patients / 14 feet were evaluated during the study period, with a diagnosis of flatfoot type 2B. The average age was 57 years (32-65 years), 11 (78.5%) were female. No statistically significant difference was observed in any of the radiographic variables measured, at 3 months and at 12 months postoperatively. The preoperative AOFAS score, was 54 points. At the first year was 93 points. Consolidation was achieved at 3 months in all cases. The complications found were 2 superficial infections and 1 wound dehiscence. As a late complication, there was only 1 case of cuboidal calcaneal osteoarthritis that did not require surgical resolution.

Conclusion:

Evans osteotomy for elongation of the external column provides a reproducible and reliable method to restore the normal functional stability of the midfoot and hindfoot. According to the results obtained in our work, we can conclude that the blocked plates with a wedge lock manage to preserve the corrections obtained with the Evans osteotomy in patients with type IIB flat foot. There is no need of autograft with the consequent risk of comorbidities produced by a second approach to the grafting as well as the complications that could happen with the use of allografts.
Implementation and Validation of Anatomic Triplane Hallux Abducto Valgus Classification
Authors: Santrock Robert , Smith W. Bret , Dayton Paul , Hatch Daniel
Published: September 2017

Category:

Bunion

Introduction/Purpose:

The most common classification system for HAV deformity is based on two-dimensional radiographs. This system relies upon measurements taken of the transverse plane. (IMA and HVA) to classify and deploy surgical options based on the severity of these angles [1]. Recently, the understanding of HAV deformity as a three-dimensional problem has been described. A study by Kim et al. [2] utilized WB-CT to describe a frontal plane rotational component in 87% HAV cases. To develop a better understanding of HAV, a unique anatomic classification system (see figure) was proposed. The aims of this study were: (1) To use traditional WB radiographs to confirm the findings of Kim’s WB-CT study. (2)To use inter-observer and intra-observer analysis to validate the classification of HAV into this new system.

Methods:

An Institutional Review Board approved multi-center retrospective study was performed utilizing four view WB radiographs (Anterior-Posterior, Oblique, Lateral and Axial Sesamoid) on patients presenting to the clinic for “bunion,” Hallux Valgus, HAV, Hallux Rigidus or “great toe pain.” The data were analyzed for the presence of frontal/coronal plane rotation of the first metatarsal, subluxation of the sesamoids, metatarsus adductus and degenerative joint disease of the first MTP (metatarsophalangeal) joint (Hallux Rigidus); these findings were compared to Kim’s study. Additionally, these data were used to categorize HAV deformities into a new 3D classification scheme and were tested for inter-observer and intra-observer reliability.

Results:

The results established the presence of frontal/coronal plane rotation and subluxation in similar ratios as reported by Kim et al. thus confirming the utility of a four-view WB radiograph series in recognition of 3D deformity of HAV. The results also confirmed good reliability of the classification from both the inter-observer and intra-observer standpoint.

Conclusion:

These data suggest that new protocols and tools are reliable in helping the surgeon recognize and better identify the three-dimensional components of HAV.
Primary Subtalar Arthrodesis for Acute Intra-articular Displaced Calcaneal Fractures
Authors: Schipper Oliver , Jones Carroll P.
Published: September 2017

Category:

Hindfoot, Trauma

Introduction/Purpose:

Many patients who sustain intra-articular calcaneus fractures have persistent pain and ultimately require subtalar fusion secondary to posttraumatic arthritis. Although often recommended for severe fractures, little evidence exists describing outcomes of primary subtalar arthrodesis for calcaneus fractures. The purpose of this study was to evaluate primary subtalar arthrodesis for the management of acute, displaced, intra-articular calcaneus fractures.

Methods:

A retrospective chart review was completed for all primary subtalar arthrodeses of acute displaced, intra-articular calcaneus fractures over a 6 year period. 25 patients were identified. Preoperative CT scans were reviewed for Sanders classification and CT scans obtained at a minimum of 3 months postoperatively were evaluated to quantitate the fusion mass by a blinded reviewer. Subtalar union was defined as greater than 50% bony bridging of the posterior facet based on CT sagittal and coronal views. Patients were contacted to complete the VR-12 mental and physical components, and the Foot and Ankle Ability Measurement (FAAM) score.

Results:

Median patient age at the time of surgery was 49.9 years (41.5-55.9). Mean follow up was 35 months (range 5-80). Four percent (1/25) of patients had a Sanders II calcaneus fracture, 40% had a Sanders III fracture, and 56% (14/25) had a Sanders IV fracture. Median VR-12 mental component was 66.9 (62.9-68.6), median VR-12 physical component was 41.44 (33.0-49.9), median FAAM ADL score was 66.7 (36.9-83.3), and median FAAM sports score was 58.9 (28.6-69.6). One patient had a nonunion of the subtalar joint (4%), 3 patients had 51-75% fusion of the posterior facet, and 21 patients (84%) had greater than 75% union of the posterior facet. One patient required hardware removal after fusion.

Conclusion:

Primary subtalar fusion for acute, displaced, intra-articular calcaneus fractures has a high rate of union and good pain and function outcomes. It should be considered for patients with significant cartilage injury and comminution of the posterior facet.
A Prospective Study
Authors: Shah Ashish , Araoye Ibukunoluwa , Johannesmeyer David , de Cesar Netto Cesar , Jones Caleb , Stavrinos Despina
Published: September 2017

Category:

Post-surgical Lifestyle

Introduction/Purpose:

Gastrocnemius recession is the most common surgical procedure in the foot and ankle orthopaedic community. After surgery, patients ask their surgeons when they can safely resume day-to-day activities such as driving. Most times, the surgeon responds with generalized instructions using pain and patient comfort level as benchmarks for when the patient can return to driving. Several studies have identified safe return times for driving after traumatic injuries. However, a safe return time for gastrocnemius recession patients has never been studied. Given the safety concerns and risk associated with driving after surgery, it is important to have evidence-based advice for patients. The purpose of this study is to determine when a patient can safely return to driving after gastrocnemius recession.

Methods:

IRB approval has already been obtained for this study. 20 patients undergoing right-sided gastrocnemius recession will be identified in the Foot and Ankle clinic. Inclusion criteria will include first time isolated gastrocnemius recession surgery, licensed driver, and age between 18 and 65. Exclusion criteria will include failure to meet inclusion criteria, inability to return for follow-up testing, non-active driver status, medical contraindication to driving, history of any prior foot and ankle surgeries, and performance of any concurrent foot and ankle surgical procedures alongside gastrocnemius recession. Study participants will attend a driving simulator session prior to undergoing their procedure and will follow-up with repeat simulations at 1, 2, and 4 weeks postoperatively. Collected data will include braking reaction time, total braking time, speed stability, and number of traffic violations. A matched healthy control dataset will be used for comparison.

Results:

There was no detailed data available at the time of writing this abstract. We anticipate data availability over the next couple of months.

Conclusion:

We anticipate conclusions on the safe time to resume driving in gastrocnemius recession patients after gathering and processing detailed data. This is the first prospective study to guide counseling for patients undergoing gastrocnemius recession regarding a safe time to resume driving.
Timing of arthroscopy does not impact recurrence rate of ankle instability in patients undergoing lateral ligament repair surgery
Authors: Shah Ashish , Cone Brent , de Cesar Netto Cesar , Hudson Parke , Araoye Ibukunoluwa , Sahranavard Bahman , Pinter Zachariah , Lee Sung , Jones Caleb , Bergstresser Shelby
Published: September 2017

Category:

Ankle, Arthroscopy

Introduction/Purpose:

Ankle sprains are common orthopaedic injuries. Although the initial treatment is conservative, some patients may develop chronic instability requiring surgical repair. Arthroscopy is often performed prior to ligament reconstruction to evaluate concomitant intraarticular and cartilage injuries. Arthroscopic treatment may be performed immediately prior to ligament repair (single stage), or it may be scheduled days/weeks prior to ligament repair (double stage). Concerns of single stage arthroscopic treatment are related to the increased difficulty in dealing with ligaments and soft-tissue injuries hindered by fluid extravasation. Our study compares outcomes between single and double stage arthroscopy in patients undergoing lateral ligament repair surgery.

Methods:

In this retrospective study we reviewed charts of patients with chronic lateral ankle instability who underwent ankle arthroscopy followed by lateral ligament repair from 2011 to through 2015. A total of 102 patients were included in the study, 65 patients in the single stage group, and 37 in the double stage group. Surgical failure was defined as recurrence of ankle instability at any point in the follow up period after the procedure. Demographic data and recurrence rate of instability were compared between the groups using chi-squared test.

Results:

Women comprised 72% (73/102) percent of the total patient population. No significant differences in demographic data were found between the two groups. There was no difference in the recurrence rate of lateral ankle instability between patients who underwent 1-stage versus 2-stage arthroscopic treatment. The rate was similar between the groups: 10.8% (7/65) of patients with the single stage technique and 8.1% (3/37) of patients in the double stage group (p=0.6208).

Conclusion:

In the treatment of chronic lateral ankle instability, the use of single-stage arthroscopy and lateral ligament repair showed similar rates of surgical failure when compared to the double-stage procedure. A single stage approach may be a more efficient use of time and hospital resources, and avoids the need to place the patient under anesthesia multiple times. Arthroscopy may be performed immediately prior to lateral ligament repair without concern for increased risk of recurrence of instability.
A Comparative Study of the Saltzman and the Modified Long-leg Radiograph for Assessing Hindfoot Alignment
Authors: Shah Kalpesh , Dash Kumar Kaushik
Published: September 2017

Category:

Radiology

Introduction/Purpose:

There is growing evidence suggesting that the alignment of the leg (hip-knee-ankle or HKA axis) should be considered when planning an ankle replacement and alignment of the hindfoot (tibio-calcaneal or TC axis) should be considered when planning a knee replacement. The alignment of the HKA axis is assessed from standard long-leg radiographs, while the hindfoot alignment requires special views like Saltzman’s or Coetzee’s or similar. However we have discovered that by making minor adjustments to the way a standard long-leg radiograph is taken, it is possible to measure both the HKA as well as the TC axis from the same radiograph. The aim of our study was to compare the hindfoot alignment between a Saltzman’s view and the modified long-leg view.

Methods:

Approval was obtained for a prospective observational study on 65 consecutive patients referred to our hospital for a knee replacement. Patients with multiple joint arthritis, previous lower-limb surgery, or limb length discrepancy requiring shoe- raise were excluded. All patients had a preoperative modified long-leg view as part of our routine for radiographic assessment of a knee replacement; as well as a Saltzman’s view which served as a standard for hindfoot alignment. The long-leg alignment was measured using the standard HKA (hip-knee-ankle) axis, and the alignment of the hindfoot (tibio-calcaneal angle) was measured using the method described by Van Dijk et all. A difference of 3 degrees between the two observations was agreed to be considered as significant. Results were recorded by two Surgeons independently and analysed using the Bland-Altman Plot. The Intraclass Correlation Coefficient was used for inter-observer variation.

Results:

48 patients were eligible for the study. The hindfoot angle measured in the modified long-leg view (mean 9.29 degrees, SD 4.26 degrees) was similar to that in the Saltzman’s view (mean 8.99 degrees, SD 4.16 degrees). The Scatter Plot showed a linear distribution, with Spearmann Correlation Coefficient of 0.892. Bland Altman Plot showed the differences in the measurements residing within the agreed difference of 3 degrees. Intraclass Correlation Coefficient was 0.94 for the modified long-leg view and 0.87 for the Saltzman’s view, suggesting excellent interobserver agreement.

Conclusion:

Our study shows that the position of the hindfoot can be reliably measured from the modified long-leg view, and this removes the need for additional radiographs for hindfoot alignment. As the entire femur, tibia and the hindfoot is accessible in the same long-leg view, this creates a platform for further research in to the mechanical axis of the entire lower limb as opposed to the HKA axis, and the effects of malalignment of the lower extremity in patients undergoing knee or ankle replacements.
The importance of medial wall stabilization in sinus-tarsi approach to treat Sanders type II and III calcaneus fractures
Authors: Shi Zhongmin
Published: September 2017

Category:

Trauma

Introduction/Purpose:

The aim of this study was to assess the clinical outcomes of medial wall stabilization in sinus-tarsi approach to treat Sanders type II and III calcaneus fractures.

Methods:

In this retrospective study, a total of 38 patients (32 men and 6 women) with 38 displaced intra-articular calcaneal fractures were included. A modified sinus tarsi approach was used to reduce and stabilize the posterior facet using rafting technique with mini-fragment locking plate and multiple sagittal screws were added percutaneously to stabilize the calcaneal body and to control rotation. Preoperative and postoperative Böhler’s and Gissane angle were compared, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and SF-36 scores were used to evaluate the final outcomes, and the complications were also recorded.

Results:

The mean duration of follow-up was 17.4 months. The mean preoperative Böhler’s angle (13.4 ± 3.4°), Gissane angle (88.1 ± 7.6°) were significantly increased (P < 0.05) at final follow-up (25.5 ± 5.6°, 116.2 ± 7.5°, respectively). Complications included 9 cases of moderate subtalar joint stiffness. There were 2 cases with wound edge necrosis, but there was no superficial or deep infection, or nerve injury was observed in these patients.

Conclusion:

The application of minimally invasive rafting technique with medial wall stabilization is an effective option for displaced intra-articular calcaneal fractures.
Can Generalized Ligamentous Laxity be an Obstacle to Perform Minimally Invasive Surgery for Moderate Hallux Valgus?
Authors: Shim Dong-Woo , Hwang Yeokgu , Parsk Yoo Jung , Lee Jin Woo
Published: September 2017

Category:

Bunion

Introduction/Purpose:

Minimally invasive surgical techniques have challenged objectives in hallux valgus surgery, attempting to obtain good clinical outcomes with the least damage to anatomic structures, low complication rates, short time of surgery, cosmetic advantages and an earlier recovery. However, because patients with generalized ligamentous laxity have a major risk for recurrence, arthrodesis of the first tarsometatarsal (TMT) joint is an established method for the surgical treatment of the patients with generalized ligamentous laxity. This study aims to investigate the clinical and radiographic outcomes of joint-preserving minimally invasive distal metatarsal osteotomy in moderate hallux valgus patients with generalized ligamentous laxity.

Methods:

Thirty-two feet from 29 patients were involved prospectively with mean follow-up of 16.8 (range, 10 – 26) months. Generalized ligamentous laxity was assessed in all patients and the patients were divided into two groups (16: 16) with the result. Clinical outcomes were assessed using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Outcome Score (FAOS). Radiographic parameters were evaluated by preoperative and postoperative weight bearing radiographs.

Results:

Mean tourniquet time was 30.4 (range, 19 – 44) minute and additional procedures were required in 6 cases in each group. The mean VAS (p<0.001), AOFAS score (p<0.001) and three FAOS subscales (Pain, Symptoms and Quality-of-Life) (p=0.003, p=0.002 and p<0.001) improved significantly at the last follow-up. Significant corrections in the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and sesamoid reduction were obtained at the last follow-up (p<0.001). Relative first metatarsal length was decreased 2.8% from preoperative length (p<0.001). No other radiographic outcomes showed significant difference between the 2 groups but the mean relative first metatarsal length was shorter in the group without generalized ligamentous laxity (p=0.014, respectively) at the last follow-up.

Conclusion:

Despite the patients without generalized ligamentous laxity tended to have shorter first metatarsal bone postoperatively, minimally invasive distal metatarsal osteotomy yielded substantial clinical and radiological results without any recurrence or fixation failure. This procedure can be a reasonable alternative to first TMT arthrodesis in patients with moderate hallux valgus even with generalized ligamentous laxity.
Mid-term (5-10 year) Results of the Salto Talaris Total Ankle Arthroplasty
Authors: Stewart Matthew , DeOrio James , Adams Samuel , Easley Mark , Nunley James
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

The Salto Talaris total ankle replacement is a modern fixed-bearing implant used to treat symptomatic ankle arthritis with the goals of providing pain relief, restoring mechanical alignment, and allowing motion of the ankle joint. This prosthesis has been used in the United States increasingly over the last 10 years, primarily for older patients with end-stage ankle arthritis but indications are expanding to younger and more active patients. The goal of this study is to report the midterm clinical results of one of the largest cohort of patients in the United States who underwent ankle replacement with this prosthesis.

Methods:

This is a review of patients with a minimum of 5-year up to 10-year follow-up who were prospectively registered within our institutional database prior to proceeding with total ankle arthroplasty using the Salto Talaris prosthesis. Follow-up examinations were scheduled annually after the one-year postoperative mark to evaluate patients both clinically and radiographically. At each annual assessment, patients rated their current level of pain using the visual analog score (VAS) and reported their functional level using the American Orthopaedic Foot and Ankle (AOFAS) ankle-hindfoot scores, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health survey. These scores were analyzed to assess differences between their levels preoperatively, one year postoperatively and at their most recent follow-up. Preoperative and postoperative radiographs were reviewed for component loosening. Criteria for failure was defined as undergoing revision requiring exchange or removal of the metallic components for any reason.

Results:

We identified 106 patients who had a Salto Talaris total ankle replacement between March 2007 and February 2012. Of these, 72 patients (mean age, 61.9 years) met the requirement for a minimum follow-up of 5 years (range 60 to 115 months, mean 81.1 months). Average outcome in the VAS was 7.1 at one year post-op and 11.7 at last follow-up (preop: 70.0). Significant improvements were seen in the SMFA, AOFAS ankle-hindfoot score, and the SF-36 from preoperatively to their final follow-up. Survivorship was 97.2% with two patients undergoing revision arthroplasty for aseptic loosening and a third patient scheduled for revision for a chronic wound infection. 14 patients (19%) with midterm follow-up required a total of 17 additional surgical procedures on the ipsilateral ankle or hindfoot.

Conclusion:

Patients who underwent total ankle arthroplasty with the Salto Talaris prosthesis have continued to show significant improvements in pain and functional outcomes at mid-term follow-up. This has shown to be an effective treatment option with durable results for patients with end-stage ankle arthritis.
Effects of wearing shoes on the feet
Authors: Suh Jin Soo , Choi Jun Young
Published: September 2017

Category:

Midfoot/Forefoot

Introduction/Purpose:

Maasai tribe members either walk barefoot or wearing traditional shoes made from recycled car tires. Despite walking long distances (up to 60 km) daily, they do not generally experience foot ailments. We compared parameters associated with the feet, ankles, and gait of middle-aged partially and regularly shod Maasai women and Koreans.

Methods:

Foot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were compared among 20 middle-aged bush-living partially shod (PS) Maasai women, urban-living regularly shod (RS) Maasai women and Korean. Static and dynamic Harris mat footprints were taken to determine forefoot pressure distribution during walking. We also compared standing foot and ankle radiographic parameters.

Results:

The mean ratios of foot length to the width were not significantly different among three groups. Claw toe deformity was showed highly in PS (80%) and RS (95%) Maasai women. There were no significant differences in walking velocity and Harris mat findings among the three groups. On comparing PS and RS Maasai groups radiographically, talonavicular coverage angle, talo-first metatarsal angle and naviculo-cuboidal overlap were significantly greater in the PS Maasai group, whereas hallux valgus angle, the first and second intermetatarsal angle Meary angle and the medial cuneiform height were greater in the RS Maasai group.

Conclusion:

Regularly wearing shoes can protect the feet from fallen medial longitudinal arches with everted hindfeet and abducted midfeet. It could also cause hallux valgus deformity. Claw toe deformity was seen frequently in the Maasai tribe regardless of shoe wearing habits.
Arthroscopic autologous-matrix induced chondrogenesis in association with microfractures and autologous bone graft for the treatment of osteochondral talar lesions in young patients
Authors: Usuelli Federico Giuseppe , Maccario Camilla , D’Ambrosi Riccardo
Published: September 2017

Category:

Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics

Introduction/Purpose:

The purpose is to evaluate the clinical and radiological outcomes of patients younger than 20 years, treated with the arthroscopic-talus autogolous matrix-induced chondrogenesis (AT-AMIC®) technique and autologous bone graft for osteochondral lesion of the talus (OLT) at a follow-up of 24 months.

Methods:

13 patients under 20 years (range 13.2 – 19.85) underwent the AT-AMIC® procedure and autologous bone graft for OLTs. Patients were evaluated pre-operatively (T0) and at 6 (T1), 12 (T2) and 24 (T3) months postoperatively, using the AOFAS score, the VAS and the SF-12 respectively in its Mental (MCS) and Physical component (PCS). Radiological assessment included CT-scan, MRI and intraoperative measurement of the lesion. A multivariate statistical analysis was performed.

Results:

Mean size lesion measured during surgery was 1.1102 cm3 ± 0.518 cm3. We found a significant difference in clinical and radiological parameters with ANOVA for repeated measures (p<0.001). All clinical scores significantly improved (p<0.05) from T0 to T3. Lesion area significantly reduced from 120.12 ± 29.58 mm2 pre-operatively to 75.78 ± 15.00 mm2 (p<0.05) at final follow- up as assessed by CT, and from 133.32 ± 32.42 mm2 to 83.45 ± 15.54 mm2 (p<0.05) as assessed by MRI. Moreover we noted an important correlation between intra-operative size measurement of the lesion and BMI (p=0.0114).

Conclusion:

The technique can be considered safe and effective, reporting early good results in young patients. Moreover we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life.
Functional Return to Play after Surgical Treatment of Lower-Extremity Injuries using Global Positioning System Profiles in Elite College Football Players
Authors: Waldrop Norman , Cain Lyle , Emblom Benton , Ryan Michael
Published: September 2017

Category:

Sports

Introduction/Purpose:

Return to sport criteria after surgical treatment of lower extremity injuries are highly variable and without consensus. Thigh measurements assessing atrophy, single-leg hop testing and isokinetic strength measurements are commonly used metrics when considering return to sport after surgical treatment of lower-extremity injuries. Yet, these modalities are limited in scope, as they do not fully or accurately evaluate functional movements required in elite athletics. Alternatively, using new Global Positioning System (GPS) technology, a wide breadth of functional movements can be tracked for each athlete, which can be used as a comparative self-control in the event of an injury. This data proposes a more comprehensive, dynamic and longitudinal comparison of athlete performance, which may more accurately reflect functional return to sport in elite athletes after surgery.

Methods:

Over a three-year period, GPS data was collected on thirteen elite American College Football players at a single FBS Subdivision University. A total of 300 data points per athlete were collected for every practice, scrimmage and game starting in spring prep and extending through regular season, and post-season play. A total of 5.7 million data points including total distance traveled, average and maximum velocity, acceleration profiles, and explosive change of direction through inertial movement analysis were prospectively collected and analyzed. Individual pre-injury GPS functional profiles for each of the thirteen athletes were used as baseline, healthy comparisons, and functional recovery was determined prospectively during return to play progression after lower extremity surgery. Return to sport was allowed when post-operative GPS profiles demonstrated equivalence or superiority of all parameters compared to pre-injury measurements.

Results:

All thirteen players returned to sport after all measured parameters were equal to or greater than pre-injury levels.

Conclusion:

Modern GPS technology employed during preseason, regular season and post-season establishes an individualized, baseline, profile of lower-extremity function which allows for postoperative comparison and prospective assessment of safe return to play in elite football players.
Short Term Clinical and Radiographic Results of the Salto Mobile Version Ankle Prosthesis
Authors: Wan Dong Dong , Shim Dong-Woo , Hwang Yeokgu , Park Yoo Jung , Lee Jin Woo
Published: September 2017

Category:

Ankle, Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) has become an increasingly attractive option for advanced tibiotalar arthritis treatment. The Salto prosthesis (Tornier SA, Saint Ismier, France) was reported to have midterm and long term promising outcomes. However, to date, the clinical reports of this prosthesis are few and most of the papers were published by the inventors and disclosed consultants. The published areas are also limited to Europe, and no results were documented from other region.

Methods:

We retrospectively reviewed 62 patients in total. All of underwent unilateral Salto TAA. The average clinical follow-up was 34.3 months. Clinical and radiologic results were evaluated and enrolled. Clinical follow-up included medical records review, visual analogue scale (VAS) pain score, American Orthopeadic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS) pain and disability score and range of motion (ROM). Apart from these, subsequent surgeries and perioperative events that occurred at the first 3 months after the operation were recorded simultaneously. In the radiographic evaluation, we measured the tibial angle (TA), talar angle (TAL), tibial slope, and talocalcaneal angle (TCA) described by Bonnin. Distributive regions of osteolysis and radiolucency were reviewed. In addition, heterotopic ossification also be observed and graded. Endpoint of the follow-up was either any component removal or reoperation for any reason.

Results:

Date to last follow-up, the survival rate with any reoperation as the endpoint was 88.7% (7/62). Using any component removal as the endpoint of followup, the survival rate was 95.2% (3/62). The mean VAS score, AOFAS ankle-hindfoot score, and AOS pain and disability score were improved postoperatively (p < 0.001). Postoperative ROM of ankle was also improved (p = 0.003). Within 6 weeks of postoperation, radiolucent line arose around tibial implant in 39 cases and disappeared at mean 5.5 ± 2.6 months. 28 patients with postoperative mean 8.5 ± 4.5 months appeared radiolucent area. Osteolysis was found in 28 patients with mean 18.1 ± 8.2 months postoperatively. 13 patients suffered heterotopic ossification which appeared 9.4 ± 4.3 months after operation.

Conclusion:

At the last followup, obvious pain relief and satisfactory results were achieved in most of the patients. Different from previous studies on Salto prosthesis, we considered that the early radiolucent line around the tibial implant is likely due to the tiny gap between the implant and bone contacted interface, and it would disappear at the time of osseous integration. The lucent area and osteolysis occurred frequently around the tibial keel and tray due to the stress shielding of the tibial component. However, longer follow-up is necessary to determine the durability of this implant.
Biomechanical study of screw fixation and plate fixation of a posterior malleolar fracture in a simulation of the normal gait cycle
Authors: Wang Xu
Published: September 2017

Category:

Ankle

Introduction/Purpose:

Fixation of the posterior malleolar fracture with plate or screws is under debating. A fatigue loading system and a spatial motion capture system will provide a theoretical basis for the selection.

Methods:

Thirty-six below-knee specimens with Haraguchi I type posterior malleolar fracture model was obtained. The specimens were randomly divided into two groups, Group A used two parallel-placed 3.5 mm semi-threaded hollow titanium alloy screws to fix the fracture from back to front; group B used an anatomical plate to fix the posterior malleolus. According to the ratio S of the area of the sagittal fracture over the total area of the distal tibial articular surface, each group was subdivided into three groups recorded as A1, B1; A2, B2; and A3, B3. In group A1 and B1, S=1/4; in A2 and B2, S=1/3; in A3 and B3, S=1/2. In the simulations of gait cycle, 4 kinds of ankle joints were subjected to mechanical loading. A fatigue loading system was used for repeated loading. The spatial motion capture system was used to measure the displacement X (mm) in the final stage of loading.

Results:

At different locations and different loading conditions, the posterior malleolar fracture displacement X in the three groups of posterior malleolar fracture showed no statistically significant difference.

Conclusion:

here is no biomechanical difference between the internal fixation of two parallel 3.5-mm hollow screws and anatomical plate for Haraguchi I type posterior malleolar fractures with an average fracture block height of 19.27 mm.
The Significance of MRI in Process Change of Osteochondral Lesion of Talus
Authors: Wang Xu
Published: September 2017

Category:

Sports

Introduction/Purpose:

To evalute if the MRI Signals can be the predictor of osteochondral lesion of talus

Methods:

From Jul. 2012 to Oct. 2014, 3.0 T MRI scanning was performed in 20 cases of ankle sprain. MRI scanning was performed every 3 monthes and the followed-up time of each case was 12 months. The signal of cartilage, subchondral bone and marrow edema were recorded and analyzed comparatively.

Results:

The signal of marrow edema in talus body of 14 cases were decreased step by step and disappeared eventually. The time from injury to the marrow edema disappear was more than 9 months. 4 cases became III° osteochondral lesion and 2 cases have subchondral bone cyst formation.

Conclusion:

The reason of OLT and pain were under discussion. After sprain, what changes occured in the talus body and cartilage were under debate. How the subchondral bone cyst formation was unknown. Continuous MRI scanning may have some value in evaluation of the OLT. From the results of our study, we can see that the edema signal in most case can disappear in about 9 months. The OLT and cyst formation may resulted from violent force and no-standard conservative treatment. MRI scanning can help the surgeon decide when to perform operation and choice the operative procedure.
Radiologic and Clinical Outcomes of Ollier Approach with Screw Fixation for Displaced Intra-Articular Calcaneal Fractures – Comparative Study with Extensile Lateral Approach with Lateral Plating
Authors: Woo Seunghun , Bae Su-Young , Chung Hyung Jin , Goh Tae Sik
Published: September 2017

Category:

Trauma

Introduction/Purpose:

This study aims to assess the detailed radiologic outcomes which used uninjured side weight-bearing radiograph as a template as well as clinical results to compare the Ollier approach with screw fixation and the extensile lateral approach with lateral plating.

Methods:

We performed a retrospective review of intra-articular calcaneal fractures treated operatively in our hospital from January 2009 to November 2014. Radiologic outcomes were assessed using radiologic parameters such as Böhler angle, calcaneal height, and talar sagittal angles represent calcaneal deformation by the comparison of the final follow-up bilateral weight-bearing lateral radiograph. Functional outcome was assessed through the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) pain scores. Postoperative complications were investigated.

Results:

Ninety-seven unilateral fractures were appeared to match our inclusion criteria: forty-six fractures were treated by using the extensile lateral approach with lateral plating (the ELP group), and fifty-one fractures were treated with the Ollier approach and screw fixation (the OS group). The operation time was significantly shorter in the OA group (p<0.05). There were no significant difference of the final follow-up radiologic parameters between two groups. The mean AOFAS scores were significantly higher in the OS group (p = 0.020) and both groups showed similarity in the VAS pain scores (p = 0.175). Overall soft-tissue complications were 28.3% in the ELP group and 9.8% in the OS group (p = 0.034).

Conclusion:

No difference could be shown in the postoperative and final follow-up radiological outcomes between the Ollier approach and the extensile lateral approach, but the Ollier approach had better functional score and lower soft tissue complication rate with shorter operative time.
Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for StageⅡB Adult- acquired Flatfoot Deformity
Authors: Yang Yunfeng , Zhou Haichao , Zhang Yun
Published: September 2017

Category:

Basic Sciences/Biologics

Introduction/Purpose:

To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage? B adult-acquired flatfoot deformity in cadaver.

Methods:

Six cadaver specimens were compressively loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm).

Results:

Compared with the flatfoot model, the 2-,3-,4-, and 5-mm LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs. As the graft increased in size incrementally, lateral forefoot pressure increased consistently, and medial pressure decreased significantly except for the 2-mm LCL. Compared with the intact foot, the above angles of the LCLs showed no significant difference except for the 2- mm LCL. In terms of forefoot pressure, medial pressure of the 2-mm LCL and lateral pressure of the 3-, 4- and 5-mm LCLs showed statistical differences, but lateral pressure of the 3-mm LCL was not much more than the intact foot as compared to the 4- and 5-mm LCLs, which was still less than medial pressure.

Conclusion:

Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage? B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.
Thromboembolic Events In Elective vs Non-Elective Foot & Ankle Surgery
Authors: Yohe Nicholas , Choueka David , Moore Amy , Iannariello Cassidy , Kolker D
Published: September 2017

Category:

Ankle, Arthroscopy, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma

Introduction/Purpose:

The occurrence of venous thromboembolisms (VTE) in the management of foot and ankle conditions can lead to serious and sometimes fatal complications. The reported incidence range of symptomatic deep venous thrombosis (DVT) following various foot and ankle procedures is wide, ranging from 0.01% to 23.4%. The incidence of asymptomatic DVT is likely higher and has been reported to be up to 34% in patients with Achilles ruptures. In line with the wide variability in incidence data, there remains a lack of consensus in determining the necessity to implement DVT prophylaxis after foot and ankle surgery. The purpose of this study was to examine the National Surgical Quality Improvement Program (NSQIP) database to assess the 30- day risk of VTE in foot and ankle surgery.

Methods:

The ACS-NSQIP database for the years 2011-2014 was queried for patients undergoing elective versus non-elective foot and ankle surgery with a total of 72 Current Procedural Terminology (CPT) codes included. Those undergoing procedures for an infectious process or oncologic procedures were excluded. A total of 18,632 cases were included for analysis in our study with 11,744 being elective and 6,888 non-elective surgeries. A univariate analysis of thromboembolic parameters included in the database was conducted to measure the difference between the two cohorts.

Results:

There were a total of 6,888 non-elective (36.97%) and 11,744 elective surgeries (63.03%). The incidence of DVT was 32 (0.33%) for elective and 39 (0.46%) for non-elective surgery with no statistical significance (P=0.37). The incidence of pulmonary embolisms (PE) was 24 (0.35%) for the non-elective and 20 (0.17%) for the elective group with the non-elective group having a statistically significant increase (P = 0.0156). The incidence of cerebral vascular accidents (CVA) was 8 (0.06%) for males and 1 (0.009%) for females with males having a statistically significant higher incidence of CVA (P = 0.0318). Patients under age 65 had a statistically higher risk (P = 0.0194) of a CVA occurrence with an odds ratio of 0.132 times greater than those over the age of 65.

Conclusion:

Non-elective Foot & Ankle surgery is an independent risk factor for pulmonary embolism. Males under the age of 65 years old are more likely to experience CVAs with residual deficits. However, the overall incidence of PE and CVA are exceedingly low in our study with an incidence of under half a percent. The incidence of DVT was also low, under 0.5% for the non-elective group and 0.33% for the elective group. Therefore, surgeons should weigh the risks and benefits of anticoagulation, especially in elective foot and ankle surgery, prior to the initiation of anticoagulation therapy.
Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis
Authors: Zhang Mingzhu , Yu Guang-Rong , Yang Yunfeng
Published: September 2017

Category:

Midfoot/Forefoot

Introduction/Purpose:

The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages.

Methods:

The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13–72) years. The average follow up period was 17 (range 14–24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up.

Results:

Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33± 2.07 mm at follow-up. The bone union required an average of 8.4±0.8 weeks. The average ROM of dorsal flexion improved from 37.2±5.3° before surgery to 73.6±9.9° at latest follow-up (p<0.0001). The average ROM of plantar flexion improved from 16.0±10.1° before surgery to 19.5±8.6° at latest follow-up (p=0.35). The average VAS significantly improved from 75.3±8.5 before surgery to 4.9±4.2 at latest follow-up (p<0.0001). The average JSSF score significantly improved from 67.3±9.4 points before surgery to 98.8±3.0 points at the latest follow-up (p<0.0001).

Conclusion:

Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.
Hepatic veno-occlusive disease due to tacrolimus in a single-lung transplant patient
Authors: Shah S. , Budev M. , Blazey H. , Fairbanks K. , Mehta A.
Published: September 2017

Hepatic veno-occlusive disease is defined as nonthrombotic fibrous obliterative endophlebitis of small centrilobular hepatic venules.

Clinically, patients present with elevated liver enzymes and a triad of jaundice, hepatomegaly and ascites. Although reported as a complication of other solid organ and stem cell transplantation, there have been no reported cases to date of veno-occlusive disease following lung transplantation.

The present authors report a case of veno-occlusive disease following single-lung transplantation in a patient on a triple-drug immunosuppressive regimen composed of tacrolimus, mycophenolate mofetil and prednisone.

The diagnosis was established by transjugular liver biopsy and by discontinuing tacrolimus; there was clinical regression of symptoms and serological return to baseline.
Airway calibre variation is a major determinant of exhaled nitric oxide's ability to capture asthma control
Authors: Michils Alain , Haccuria Amaryllis , Michiels Sebastien , Van Muylem Alain
Published: September 2017

Changes in airway calibre have the potential to modify exhaled nitric oxide fraction (FENO) values and could hamper howFENOcaptures changes in asthma control. Here, our objective was to assess whether forced expiratory volume in 1 s (FEV1) variations alter the ability ofFENOto reflect asthma control.

FENO, asthma control (Asthma Control Questionnaire (ACQ)) and FEV1were measured at least two times in 527 patients during 1819 pairs of visits. Determinants ofFENO–ACQ discordance probability were evaluated through a logistic regression analysis. The effectiveness ofFENOat capturing either asthma control worsening or improvement between two visits was then assessed by undertaking a stratified receiver operating characteristic curves analysis.

When FEV1andFENOchange in the same direction, the odds ofFENO–ACQ being discordant are multiplied by 3 (p<0.001). The area under the curve values were 0.765 (95% CI 0.713–0.805) (improvement; p<0.001) and 0.769 (95% 0.706–0.810) (worsening; p<0.001) or 0.590 (95% 0.531–0.653) (improvement; p=0.001) and 0.498 (95% 0.416–0.567) (worsening; p=0.482) when FEV1andFENOchanged in the opposite or same direction, respectively.

The manner in whichFENOand FEV1vary concomitantly when asthma control changes determines the ability ofFENOto capture this change: parallel or opposite changes in FEV1andFENOeither decrease or increase this ability to capture asthma control changes.
SensDeploy: efficient sensor deployment strategy for real-time localization
Authors: Lee Jin-Hee , Shin Byeong-Seok
Published: September 2017

In order to estimate the location of the user, the previous studies introduced many sensor deployment methods applying the sensor network. The important issues to consider when placing the sensors are a configuration cost and detection area of a sensor network. In other words, the sensors consisting the network should be optimally deployed by taking into account the coverage and connectivity of them. In this paper, a sensor signal is modeled as the Gaussian distribution based signal points group, and signal points in overlapping region between two different sensors are classified by e-SVM (support vector machine) method as each sensor group. In addition, a trilateration technique is used for estimating the position of a moving object. At this time, we efficiently deploy the sensors with f-Apriori method to maintain the connectivity between the sensors as well as to apply the trilateration. The proposed method can be utilized for optimal placement of sensors if we know a detection range of one sensor. In this paper, we introduce more effective and adaptive deployment method to consist the sensor network as taking into account the cost and the situation.