bluuebunny/crossref_metadata_2025 huggingface dataset:
TL 18092 - Hindfoot alignment of adult acquired flatfoot deformity
Authors: Godoy-Santos Alexandre Leme , Cesar Netto Cesar , Roberts Lauren , Lintz Francois , Schon Lew C , Demehri Shadpour
Published: November 2019

Introduction: Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging, and the weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Objective: To compare clinical and WB CBCT assessments of HA in patients with AAFD. Methods: In this prospective study, we included 12 men and 8 women (mean age: 52.2 years, range: 20-88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using Intraclass correlation (ICC). Measurements were compared by paired T-tests, and p-values less than .05 were considered significant. Results: The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5 - 18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9 - 11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3 - 5.0) degrees); Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3 - 7.8) degrees; Tibial axis/Subtalar Joint Angle, 7.0 (CI: 5.3 - 8.8) degrees, and Hindfoot Alignment Angle, 22.8 (CI: 20.4 - 25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87-0.97) and interobserver agreement (ICC range: 0.51-0.88) for all WB CBCT measurements. Conclusion: Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. The different CT measurements were reliable and repeatable, significantly differing from the clinical evaluation of hindfoot valgus alignment.
PO 18217 - Radiographic evaluation of results of percutaneous surgery of Hallux Valgus
Authors: De Schoucair Jambeiro Jorge Eduardo , Cordeiro Neto Antero Tavares , Delmonte Moreira Fernando , Augusto de Oliveira José , Arimatea Cabral Marcela
Published: November 2019

Introduction: There is no consensus regarding the best surgical treatment for Hallux Valgus (HV). The use of percutaneous procedures for HV has been increasingly explored. The present study aims to evaluate and compare the radiographic results of percutaneous surgeries for HV treatment performed at our institution. Methods: A retrospective study was performed on radiographs and medical records of patients undergoing percutaneous surgery for HV treatment from August 2017 to August 2018. Using pre and postoperative radiographs, the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and bone sesamoid deviation measurement and classification were performed according to the AOFAS criteria for angular measurements. Results: We evaluated the radiographs of 19 patients, representing a total of 25 feet, with a minimum segment time of four months, 84.2% females, and a mean age of 58 years. In 13 feet, there was an association of the Chevron and Akin techniques and in 12 of the Reverdin-Isham and Akin techniques. On average, the preoperative IMA was 13.4º, and in the postoperative period, 7.2º HVA had a mean of 26.3º in the preoperative period and in the postoperative period an average value of 11,2º. We observed improvement of the dislocation of the sesamoids in all cases by postoperative radiography. We did not find any serious complications. Discussion: There was a decrease in the postoperative measurements in all evaluated cases, with a mean of 15º in the HVA and 6,2º in the IMA. Chevron osteotomy associated with AKIN obtained a higher degree of correction of the IMA as predicted. The HVA using both techniques provided good correction without significant differences, which could be explained by the association of the Akin osteotomy in the two evaluated techniques.  Conclusion: Percutaneous surgeries with Chevron plus Akin and Riverdin-Isham plus Akin techniques performed at our institution proved to be efficient for HV correction, with a reduction of postoperative HVA and IMA.
PO 18190 - Clinical and functional outcomes of minimally invasive reconstruction of chronic Achilles tendon injuries
Authors: Xavier da Silveira Juliana Doering , Sevá Gomes Guilherme , Carvalho Silva Giulia , Barbachan Mansur Nacime Salomão , De Castro Pochini Alberto
Published: November 2019

Introduction: Chronic Achilles tendon injuries require surgical treatment to improve tendon function. The minimally invasive technique described in this study reduces damage to the fascia and rigid fixation. Objective: To evaluate the clinical and functional outcomes of the reported technique using functional tests, anthropometric measurements and questionnaires. Methods: We evaluated 13 patients who underwent surgical treatment using the minimally invasive technique from 2013 to 2017, after at least 12 months of postoperative follow-up. The patients were subjected to the straight leg raise test to evaluate strength function; we measured the calf circumference and the tibiotarsal angle, and the Achilles Tendon Total Rupture Score (ATRS) and visual analog scale (VAS) were administered. We used parametric tests for statistical analysis. Results: We obtained a 15.4% complication rate (2 patients). We observed differences between healthy and treated limbs when assessing the tibiotarsal angle (a 20% loss of ankle length) and the leg circumference (a 3% decrease in linear measurement). We observed a 36% loss of muscle stretch in functional tests. Conversely, we observed excellent results in the subjective functional assessment using the ATRS (a mean of 82.8 points and a median of 98 points). Conclusion: Surgical treatment of chronic Achilles tendon injuries using the minimally invasive reconstruction technique is associated with an important postoperative objective functional loss. However, this functional loss is not correlated with subjective outcomes assessed using questionnaires in the postoperative follow-up of this technique, which indicates satisfaction and subjective functionality.
PO 18221 - Minimally invasive treatment of acute Achilles tendon injuries with flexor hallucis longus tendon augmentation assisted by posterior ankle arthroscopy
Authors: Coelho Paim Lima Thiago , Gonçalves Pagnano Rodrigo , Eiji Nodu Sato Gustavo , Mattos e Dinato Mauro Cesar
Published: November 2019

Introduction: Achilles tendon ruptures cause significant functional limitations. The treatment for acute injury is controversial; conservative or surgical treatment and open or minimally invasive surgery are available options. The objective of this study is to evaluate the clinical and functional outcomes of patients with acute Achilles tendon rupture treated with minimally invasive tendon repair and augmentation with flexor hallucis longus tendon transfer assisted by posterior ankle arthroscopy. Methods: A retrospective, cross-sectional and observational study in which 5 patients with more than 24 months of postoperative follow-up were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, the Victorian Institute of Sport Assessment-Achilles (VISA-A), the Achilles Tendon Total Rupture Score (ATRS), the pain visual analog scale (VAS), and assessments of range of motion and strength. Results: The mean scores on the following instruments were obtained: pain VAS: 0.6; AOFAS: 98; VISA-A: 98.2 and ATRS: 100. The mean dorsiflexion range of motion was smaller (4.8º) than the contralateral range of motion (7.6º). The mean plantar flexion strength was 24.02 kgf on the operated side and 24.64 kgf on the contralateral side. The flexion strength of the hallux interphalangeal joint was weaker on the operated side (13.94 kgf) than on the contralateral side (17.6 kgf), albeit with no complaints from the patients. Conclusion: The proposed surgical treatment method had good clinical and functional outcomes among the patients evaluated in this study. The surgical technique presented herein may be a good alternative for the treatment of uncooperative patients diagnosed with acute Achilles tendon rupture due to tendinosis with important tendon degeneration.
PO 18235 - New tomographic method for measuring metatarsal rotation in hallux valgus
Authors: Rodrigues de Miranda Bruno , Dos Santos Barroco Rui , Prates de Oliveira Leticia Zaccaria , Beerens Abdul Ghani Abdul Ghani Mahmoud , Candido de Paula Neto Antonio , Hideki Ikeuti Douglas
Published: November 2019

Introduction: Hallux valgus is a 3-dimensional deformity involving an increased intermetatarsal I/II angle and a rotational deformity of the first metatarsal bone. Kim et al. developed a method for measuring the tibial sesamoid position relative to the coronal rotation of the first metatarsal bone in computed tomography scans under simulated weight-bearing conditions. Objective: To describe a method for the topographic assessment of the correction of tibial sesamoid and metatarsal pronation using computed tomography scans under simulated weight-bearing and active toe extension. Method: We performed computed tomography under simulated weight-bearing conditions with and without active toe dorsiflexion, observing the degree of metatarsal pronation and sesamoid subluxation. For measurement purposes, we used the classifications of Kim et al. and Smith et al. Results: We observed tomographic correction, both angular and rotational, by measuring the intermetatarsal angle and tibial sesamoid position, which were confirmed by the change in the alpha angle suggested by Kim et al. Discussion: Toe extension was described as a peroneus longus tendon activation test by Klemola et al., who used this maneuver to demonstrate clinical rotational correction of hallux valgus. We described the use of a tomographic technique that followed this principle to preoperatively observe the underlying factors that may affect the rotational correction of the deformity. Conclusion: The method has the capacity for correction in various planes involving derotation of the first metatarsal bone and the relationship between such derotation and the change in sesamoid position in relation to the coronal plane of the foot.
PO 18271 - New method for the radiographic evaluation of metatarsal rotation in hallux valgus
Authors: Dos Santos Barroco Rui , Rodrigues de Miranda Bruno , Prates de Oliveira Leticia Zaccaria , Beerens Abdul Ghani Abdul Ghani Mahmoud , Candido de Paula Neto Antonio , Hideki Ikeuti Douglas
Published: November 2019

Introduction: Hallux valgus involves, in addition to I/II intermetatarsal angle deviation, a rotational deformity of the first metatarsal bone and its sesamoids in relation to the ground. The correction of the rotation is the objective of new and recently developed surgical techniques. Objective: To describe a radiographic method that can help predict changes resulting from metatarsal rotational correction and facilitate surgical planning. Methods: We acquired radiographs in a weight-bearing anteroposterior position in patients with flexible hallux valgus while asking the patient to actively extend the toes. We compared the weight-bearing radiographs with and without the toe extension maneuver. In addition to radiography, we performed computed tomography (CT) of the nonweight-bearing active toe extension maneuver using a support platform. To measure the changes, we used the classification of Coughlin and Smith et al. Results: We observed clinical and radiographic correction, both angular and rotational, by measuring the intermetatarsal angle and sesamoid position. The changes were confirmed by CT, which showed improvement in the intermetatarsal angle, sesamoid position and metatarsophalangeal range. Discussion: The toe extension maneuver was described as a peroneus longus tendon activation test by Klemola et al., who used it to demonstrate rotational clinical correction of hallux valgus. Here, we described a radiographic method based on this principle to observe the correction power of and factors involved in metatarsal derotation using a preoperative radiographic technique. Conclusion: The method clearly demonstrated the capacity for the correction of preoperative hallux derotation in various planes, thus helping to predict the clinical, angular and rotational outcomes of surgical treatment.
TL 18095 - The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safe?
Authors: Godoy-Santos Alexandre Leme , Netto Cesar de Cesar , Roberts Lauren , Cabe Taylor , Deland Jonathan , Drakos Mark
Published: November 2019

Introduction: Treatment of lesser toe metatarsophalangeal joint (MTPJ) arthritis is challenging, and surgical options are scarce. The use of synthetic polyvinyl alcohol hydrogel implants in the treatment of lesser MTPJ arthritis may provide symptomatic relief. An essential technical limitation is that only 8 mm and 10 mm implants are currently available, potentially limiting their use in the lesser metatarsals. Objective: to evaluate the average dimensions of the lesser metatarsal heads using CT scans and anatomical dissections and to perform drilling of the heads, aiming to assess the largest implant that could be safely used. Methods: The height and width of all lesser metatarsals were measured on CT and during anatomic dissection. Sequential reaming of the second to fourth metatarsals was performed. The maximum reaming size, largest implant inserted, and failure of the metatarsal head were recorded. Metatarsal head sizes were compared, and a multiple regression analysis evaluated measurements that influenced maximum drilling and implant size. Results: CT and anatomical measurements demonstrated a significant correlation (ICC range, 0.63 to 0.85). Mean values for the height and width of the metatarsal heads respectively were as follows: second (14.9 mm and 9.9 mm), third (14.8 mm and 8.8 mm), fourth (14.0 mm and 8.7 mm) and fifth (12.3 mm and 9.3 mm). All the second, third and fourth metatarsal heads could be safely drilled up to 7.5 mm, preserving an intact bone rim. During 80% of the time, the heads could be safely drilled up to 8.0 mm. The height of the metatarsal heads was the only factor to significantly influence the size of maximum reaming and the introduced implant. In 20%, 40% and 50% of the second, third, and fourth metatarsal heads, respectively, neither 8 mm nor 10 mm PVAH implants could be used. Conclusion: Our cadaveric study found that even though the majority of the lesser metatarsal heads could be safely drilled up to 8 mm, the smallest PVAH implant size currently available in most countries (8 mm) could be inserted in most of the second but only in about half of the third and fourth metatarsal heads. The remaining bone rim around the inserted implants was considerably thin, usually measuring less than 1 mm. To optimize the use PVAH in lesser metatarsal heads, smaller implant options are needed.
TL 18096 - Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis
Authors: Godoy-Santos Alexandre Leme , Chaudhari Nileshkumar , Rodriguez Ramon , Dun Shouchen , Netto Cesar de Cesar , Shah Ashish
Published: November 2019

Introduction: Arthrodesis of the subtalar joint is performed for various arthritic and instability problems to correct alignment and relieve pain. Use of compression screws is the most common fixation method. Screws may be oriented from dorsal to plantar or plantar to dorsal. Arguments favoring one approach over another are based more on “expert opinion” than on hard data. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3-mm cannulated screws. Randomization was used to assign the screw orientation, such that one foot in each pair was assigned dorsal to the plantar screw orientation (DP group), with the other foot plantar to the dorsal orientation (PD group). The standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD groups using the Student’s T-test, with p = 0.05 used to determine statistical significance.  Results: The statistical analysis demonstrated that the mean torque to failure slightly favored the DP group (37.3 N-m) compared with the PD group (32.2 N-m). However, the difference between the two groups was not statistically significant (p = 0.55). Conclusion: In subtalar arthrodesis, there is no significant difference in construct strength between the dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.
TL 18129 - Surgical treatment of hallux valgus using the percutaneous chevron technique
Authors: Lemos Rodrigues Fábio , Ribeiro Lara Luiz Carlos , Grajales Juan Antônio , Azevedo Torres Filho Lucio Carlos
Published: November 2019

Objective: To clinically and radiographically observe the outcomes of the surgical treatment of moderate and severe hallux valgus using percutaneous distal chevron osteotomy. Methods: A total of 35 feet (33 patients) with moderate and severe hallux valgus were evaluated using the Couhling classification from June 2016 to January 2018. The mean patient age was 53 years, and the mean postoperative follow-up time was 13 months. All patients who underwent chevron osteotomy were evaluated before and after surgery using the American Orthopedic Foot and Ankle Society (AOFAS) scale. We measured the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the distal metatarsal articular angle (DMAA) using radiographic studies. Results: The AOFAS score increased by a mean of 54 points. The HVA decreased by a mean of 19°, the IMA by 7° and the DMAA by 11°. The median decrease in the length of the first metatarsal bone was 0.35 cm. Conclusion: Chevron osteotomy using the percutaneous surgical technique made it possible to correct moderate and severe hallux valgus deformities, with excellent angular correction and a significant increase in the AOFAS score.
TL 18130 - Surgical treatment of hallux valgus using the modified Reverdin-Isham technique
Authors: Ribeiro Lara Luiz Carlos , Lemos Rodrigues Fábio , Grajales Juan Antônio , Azevedo Torres Filho Lucio Carlos
Published: November 2019

Objective: The present study was conducted to clinically and radiographically analyze the outcomes of the surgical treatment of mild and moderate hallux valgus using the modified Reverdin-Isham technique. Methods: We retrospectively studied 46 feet of 39 patients with mild and moderate hallux valgus from June 2010 to July 2017. The mean postoperative follow-up was 36 months, and the mean patient age was 53 years. All patients who underwent the modified Reverdin-Isham technique were clinically and radiologically evaluated before and after surgery using the American Orthopedic Foot and Ankle Society (AOFAS) scale, and radiographs were acquired to calculate the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the distal metatarsal articular angle (DMAA). Results: The AOFAS score increased by a mean of 54 points. Radiologically, the mean HVA decreased by an average of 17.1°, the IMA by 4.2° and the DMAA by 12°. Conclusion: The modified percutaneous Reverdim-Isham technique made it possible to correct mild and moderate hallux valgus deformities with good angular correction and increased stability compared with the classical technique, in addition to providing an increase in the AOFAS score.
TL 18131 - Functional evaluation of hyaluronic acid infiltration in the subtalar joint of patients with posttraumatic osteoarthritis
Authors: Ferreira Gomes Fernanda , Mansur Henrique , Silva Gomes Mariana , Ramalho Daniel Alves , Moreira de Castro Junior Isnar
Published: November 2019

Objective: To assess the efficacy of intra-articular viscosupplementation in patients with symptomatic subtalar osteoarthritis after calcaneal fracture. Methods: Thirty-eight patients with a mean age of 50 years were divided into 3 groups: hyaluronic acid (HA) alone, corticoids alone or hyaluronic acid and corticoids combined. Three consecutive doses of the appropriate medication were administered at one-week intervals. The patients were evaluated for pain and hindfoot function using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the visual analog scale (VAS) at 4 different timepoints (before infiltration and 4, 12 and 24 weeks after infiltration). Results: There was significant improvement in the AOFAS score (from medians of 55 and 73 at baseline to 99 and 100 after 24 weeks; p<0.001) and the VAS score (from medians of 8 and 7 before infiltration to 1 and 2 at 24 weeks after infiltration; p<0.001) scores in the groups with hyaluronic acid alone and in combination with corticoid, respectively. In group 2, the scores improved after only 4 weeks (from 83 to 91.5 and from 7 to 5), returning to near-baseline values at the end of the follow-up (from 83 to 82.5 and from 7 to 7). Conclusion: Infiltration with hyaluronic acid was effective and safe and should be included in the therapeutic arsenal of conservative treatments for symptomatic posttraumatic subtalar osteoarthritis.
TL 18136 - Short-term results for acute instability of the syndesmosis treated with arthroscopic reduction and percutaneous fixation
Authors: Cândido Nishikawa Danilo Ryuko , Honda Saito Guilherme , Devito Letícia , Moreira Mendes Alberto Abussamra , Pires Prado Marcelo
Published: November 2019

Introduction: Acute syndesmotic sprain is rarely associated with instability in the absence of fracture. The surgical treatment of these injuries is usually performed as an open procedure with direct visualization of the anatomical reduction of the joint. However, direct visualization of the reduction can be achieved by arthroscopy with minor incisions avoiding damage to the soft tissues. The aim of this study is to present the short-term outcomes of a series of patients with acute unstable syndesmotic injuries who were surgically treated through an arthroscopic reduction and percutaneous fixation with a suture button. Methods: We report a series of 8 patients with a mean age of 25,62 years with acute instability of the syndesmosis without fracture who were treated through arthroscopic reduction of the syndesmosis followed by percutaneous fixation using a suture button, between October 2014 and May 2018. Medical records, the visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pre and postoperative radiological results (stress radiographs, computed tomography and magnetic resonance imaging) and complications were retrospectively reviewed. Results: After a mean follow-up of 13,4 months, the mean VAS was 0 and the mean AOFAS was 100. All patients were able to return to their preinjury activities and were completely satisfied with the treatment outcomes. Two patients had an associated deltoid ligament rupture and were treated by open repair at the same time. Two complications were observed. One patient developed an aseptic cyst over the distal knot, and one evolved with complex regional pain syndrome. The last one required a reoperation to remove the anterior button. Conclusion: Arthroscopic treatment represents an effective approach for acute syndesmotic instability. In the short-term, it provides satisfactory clinical and functional results, allowing patients to return to their previous activities. It is reliable regarding anatomic reduction of the syndesmotic joint and percutaneous fixation with a suture button without aggression toward the soft tissue of the ankle.
TL 18142 - The Ponseti method in children with clubfoot after walking age
Authors: Stéfani Kelly Cristina , Ferraz Ferreira Gabriel , Podestá Haje Davi , Paschoal Nogueira Mônica
Published: November 2019

Introduction: The prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an interventional option for older, untreated children.  Methods: A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.  Results: Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82-0.94, p < 0.01) relative to the total analyzed. The recurrence rate was 18% (95% CI = 0.14-0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03-0.15, p = 0.19).  Conclusion: Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures that are likely to cause complications. The obtained results exhibited considerable heterogeneity
TL 18144 - Percutaneous chevron/akin (PECA) versus open scarf/akin (SA) osteotomy treatment in hallux valgus
Authors: Cristina Stéfani Kelly , Ferraz Ferreira Gabriel , Quadros Borges Vinícius , De Matos Moraes Leonardo Vinicius
Published: November 2019

Introduction: The surgical treatment of hallux valgus presents several techniques described in the literature. Recently, the percutaneous technique has appeared as a less invasive option in the correction of the deformity and is increasingly used by surgeons.  Methods: A meta-analysis was performed using studies discovered by the systematic review of articles included in electronic databases (Medline, Scopus, Embase and the Cochrane Library) until June 2018 (Systematic Review Registry PROSPERO: CRD42018096613). A pooling analysis was synthesized from clinical outcomes such as the visual analogue scale of pain (VAS) and AOFAS score, radiographic outcomes and evaluation of complications.  Results: Two studies, including 137 feet with a hallux valgus diagnosis were added to the analysis, comparing open surgery using the Scarf and Akin (SA) technique versus percutaneous Chevron and Akin (PECA). In the synthesis of the results, pain in the perioperative period was lower in the PECA group, with a reduction of 1.68 points in the fixed effect model (95% CI = -2.09 a -1.27, p < 0.01, i2 = 87%, t2 = 0.60). There were no differences between techniques in the radiographic results or in the risk of complications. The PECA technique demonstrated a longer radioscopy time compared with SA. Conclusion: Use of the PECA method to correct hallux valgus compared with the open SA technique demonstrated less pain in the perioperative period, a similar potential for radiographic correction and an equal risk of complications, with a longer radioscopy time.
TL 18147 - Single-nucleotide polymorphisms in the P2x7 receptor gene are associated with bone mineral density and ankle fractures
Authors: Stéfani Kelly Cristina , Martinhago Ciro Dresh , Fernandes Túlio Diniz
Published: November 2019

Objective: The objective of this study is to determine the associations among genetic variations in the P2X7 receptor gene, decreased bone mineral density (BMD), and the risk of osteoporosis in patients aged older than 50 years with ankle fractures. Methods: Patients were genotyped for 15 nonsynonymous single-nucleotide polymorphisms (SNPs) in the P2X7 gene. The sample was divided into two groups according to the bone densitometry results: an intervention group with osteopenia (T scores between –1.0 and –2.5) or osteoporosis (T scores ≤ –2.5) and a control group with values within the normal range (T scores ≥ –1). A total of 121 patients were evaluated: 65 in the intervention group and 56 in the control group. Results: The results suggested that SNPs 1, 4, 11, 13, 14, and 15 were loss-of-function (LOF) variants. SNP 12 was also associated with LOF in our population, but its RNA expression has not been analyzed to date. Conclusions: In conclusion, we demonstrate that functional polymorphisms in P2X7 are associated with BMD and with an increased risk of ankle fractures. The limitations of our study are its focus on nonsynonymous polymorphisms, which do not cover all genetic variations in P2X7, and its small sample size compared with the international literature. A strength of this study is that it is the first to evaluate P2X7 in the Brazilian population.
TL 18161 - Evaluation of Achilles tendon oxygen saturation in patients with tendon rupture
Authors: De Faria Freitas Márcio , Matos e Dinato Mauro César , Viana Pereira Filho Miguel , Ferreira dos Santos Tatiana , Dias dos Santos Filho Raul , Zerati Antônio Eduardo
Published: November 2019

Introduction: Histopathological analyses of ruptured tendons show hypoxia-related tissue degeneration. Intrinsic factors that may cause tissue hypoxia, especially during physical exercise, may be related to Achilles tendon ruptures. Thus, the objective of the present study is to compare the resting oximetry of patients who had a ruptured Achilles tendon with that of a control group after exercise and after muscle ischemia. Methods: This was a single-center, comparative, cross-sectional observational study approved by the research ethics committee. The study assessed the Achilles tendon oxygen saturation of 2 groups: patients with a history of total Achilles tendon rupture (R: n=12) and control individuals without a history of tendon rupture (C: n=11). Oxygen saturation was measured by infrared spectroscopy on a near-infrared spectroscopy (NIRS) device (PortaMon, Artinis Medical Systems). Data were collected after the patient had rested at least 10 minutes in the supine position at the following times: test, after controlled contractions of the triceps surae muscle, and after 5 minutes of leg ischemia. The NIRS sensor was placed on the contralateral Achilles tendon in group R or on a randomized limb in group C. Data normality was confirmed using the Shapiro-Wilk test, and the groups were compared using the independent samples t test, with a significance level of p<0.05. Results: The oximetry levels of group R were similar to those of group C at rest (R: 72 ± 9% vs. C: 74 ± 6%, P=0.598), after exercise (R: 74 ± 5% vs. C: 77 ± 4%, p=0.199), and after 5 minutes of ischemia (R: 79 ± 3% vs. C: 80 ± 5, p=0.856). Conclusion: No differences in Achilles tendon oxygen saturation were identified between individuals with a history of rupture and control individuals
TL 18196 - The lapidus procedure for severe hallux valgus deformity
Authors: Prado Marcelo Pires , Amodio Daniel , Devito Leticia , Mendes Alberto Abussamra Moreira , Saito Guilherme Honda
Published: November 2019

Introduction: Surgical techniques for hallux valgus correction are constantly evolving. However, there is little data in the literature comparing the different techniques and methods of fixation. The aim of this study was to compare two variations of the Lapidus procedure with respect to the rate of complications, radiographic and functional outcomes. Methods: A retrospective review of 94 consecutive patients treated with a Lapidus fusion for hallux valgus correction between 2006 and 2017 was performed. In the first group, 33 patients underwent modeling arthrodesis between the first metatarsal base and the medial cuneiform, and between the base of the first and second metatarsals. In the second group, 61 patients underwent a fusion between the base of the first metatarsal and the medial cuneiform only. Results: In group 1, the rate of complications was 18% compared with 13% in group 2; of these, 10,5% required a revision procedure in group 1 versus 7,5% in group 2. The most common complications were nonhealing, partial recurrence of the deformity and loosened screws. In group 1, the first intermetatarsal angle and the hallux valgus angle were improved from an average of 18,3 degrees to 14 degrees and from 29 to 9,7 degrees, respectively. In group 2, the angles were improved from 16,1 to 9,1 degrees and from 31,1 to 9,1 degrees, respectively. The AOFAS score was improved from 44,5 to 94,9 in group 1 and from 35,8 to 91,32 in group 2. Conclusion: The Lapidus procedure with fusion of only the first metatarsal base and the medial cuneiform is safe, with a low rate of complications. In this modified procedure, the surgeon is required to optimize the congruency between the base of the first metatarsal and the medial cuneiform prior to fixation, which may conceivably explain the good results observed in this group.
TL - 18173 - The effect of low-level laser therapy in the management of plantar fasciitis
Authors: De Souza Guimarães Janice , Arcanjo de Jesus Fabio Luciano , De Oliveira Lomelino Soares Gustavo Leporace , Fossati Metsavaht Leonardo , Marçal Vieira Túlio Eduardo , Gomes Neto Mansueto
Published: November 2019

Introduction: Plantar fasciitis (PF) is one of the common reasons for foot pain and is associated with substantial health and economic burden. PF often responds to a wide range of therapies that are predominantly conservative. We performed a meta-analysis to investigate the effects of low-level laser therapy on pain and disability in patients with PF. Methods: Studies were comprehensively searched in Pubmed MEDLINE, the PEDro database, the Scientific Electronic Library Online, and the Cochrane Central Register of Controlled Trials, from the earliest date available to January 2019. Randomized controlled trials that evaluated the effects of low-level laser therapy versus control or another intervention for patients with PF were included. Mean differences (MD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Calculations were performed using a random effects model, with two comparisons: low-level laser therapy compared with the control (no intervention); low-level laser therapy compared with extracorporeal shock wave therapy. Results: Eight trials met the study criteria, including 473 PF patients. The main outcomes included changes from baseline in the Visual Analogue Scale Score (pain) and Foot Function Index (disability). Low-level laser therapy resulted in improvement in pain MD (-2.27 95% CI: -2.72 to -1.82 N=184) compared with the control. No significant difference in disability MD (-1.81 95% CI: -7.4 to 3.8 N=110) was found in participants in the low-level laser therapy group compared with the control group. Compared with extracorporeal shock wave therapy, low-level laser therapy did not achieve a significant reduction in pain intensity MD (0.45 95% CI: -2.4 to 3.3 N=141). In addition, no serious adverse events were reported.  Conclusion: Low-level laser therapy may improve pain and should be considered as a component of care for PF patients. However, this superiority disappeared when it was compared to extracorporeal shock wave therapy.
TL 18183 - Total ankle arthroplasty
Authors: Kerber Cavalcanti Lemos André Vitor , De Souza Nery Caio Augusto , Soares Baumfeld Daniel
Published: November 2019

Introduction: Total ankle arthroplasty (TAA) is an alternative for the treatment of end-stage ankle arthrosis that is still in the implementation phase in Brazil. The objective of this study is to present the clinical and radiographic outcomes of the INBONE II prosthesis assessed by the Ankle and Foot Groups of the Department of Orthopedics and Traumatology of the Paulista School of Medicine at Federal University of São Paulo and Federal University of Minas Gerais. Methods: From November 2016 to December 2018, 13 TAAs were performed in 13 patients (4 females: 31%; 9 males: 69%) with ages ranging from 41 to 84 years (mean: 58 years) using INBONE II implants (Wright Medical Technology, USA). Parametric data on arthrosis etiology, clinical status (visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores), implant positioning and bone cut adequacy (lateral tibial slope (LTS), alpha, beta and theta angles and distances "a" and "b") were collected, in addition to short-term qualitative bone properties (periprosthetic bone cysts and tibial and talar component sinking and wear). We also collected immediate and early postoperative data on associated surgeries, complications and reinterventions. All data were subjected to statistical analysis at the 5% significance level. Results: The VAS (pre 8; post 2) and AOFAS (pre 37; post 80) scores significantly improved at the end of a mean follow-up period of 10 months (min 1 month: max 2 years, 2 months). The immediate and early postoperative tibial and talar component alignment was within 2 degrees of deviation from the ideal in the sagittal plane in 84% patients and in the coronal plane in 92% patients, with an LTS below 5 mm in 100% of patients and good correction of radiographic parameters, even in cases of arthroplasty revision. Conclusion: Total ankle replacement is a good alternative for the treatment of advanced arthrosis of the ankle, and the INBONE II prosthesis is seems to be a good option for cases of arthroplasty failure due to loosening or malalignment. Longer follow-up is needed to evaluate intermediate and long-term outcomes.
TL 18192 - Perspective on the Ponseti method for the treatment of clubfoot associated with amniotic band constriction syndrome
Authors: Bergamasco Jordanna Maria Pereira , Chakkour Marcelo , Madeiro Raoni , Costa Marco Tulio , Ferreira Ricardo Cardenuto , Marchi Neto Noé De
Published: November 2019

Introduction: Amniotic band constriction syndrome is a rare anomaly with an incidence of approximately 1:15,000 live births. It manifests as fibrous amniotic bands involving the deep fascia and, depending on its depth, can compromise the venous and lymphatic system. The presence of fibrous amniotic bands in the lower limbs is strongly associated with foot malformations, and the prevalence of clubfoot under such conditions ranges from 12 to 56%. Clubfoot associated with amniotic band constriction syndrome is characterized by rigidity and edema and tends to respond poorly to conservative treatment. We present a series of cases of clubfoot associated with amniotic band constriction syndrome that were treated with manipulation and plaster casting using the Ponseti method. Methods: Over the past 10 years, we followed 19 patients with amniotic band constriction syndrome affecting the lower limbs. Of these patients, 6 had clubfoot, including 2 who were bilaterally affected. The 6 children in this series had constriction bands in Hennigan and Kuo zone 2. The 8 affected feet were rigid, with a mean Pirani score of 5.5 and Dimeglio III classification. Four extremities with complete constriction bands initially underwent z-plasty for band release, followed by manipulation and plaster casting. The other four extremities had incomplete bands, which were initially subjected to manipulation using the Ponseti method, followed by band release at the time of the Achilles tenotomy. Results: Over a mean follow-up time of 5 years, 7 of the study feet were plantigrade and painless, with no limitations of activities of daily living; only one foot showed limited dorsiflexion, and that patient is awaiting corrective surgery. This limb showed a double band in zone 2 that was both complete and deep. Conclusion: Despite the rigidity, clubfoot secondary to amniotic band constriction syndrome showed good outcomes when treated using the Ponseti method.
TL 18206 - Foot and ankle insufficiency fractures among postmenopausal sedentary women
Authors: Viana Pereira Filho Miguel , Cristina Stéfani Kelly , Paschoal Nogueira Mônica
Published: November 2019

Introduction: Insufficiency fractures occur in bones with decreased elastic strength. In contrast to fatigue or stress fractures, which affect normal bones and have been extensively studied in the literature, foot and ankle insufficiency fractures have been poorly researched to date. The objective of this study was to identify behavioral, biomechanical and metabolic factors associated with the development of foot and ankle insufficiency fractures. Methods: In total, 53 sedentary postmenopausal female patients who had foot and ankle insufficiency fractures and who were treated at the São Paulo State Civil Servant Hospital (Hospital do Servidor Público do Estado de São Paulo) were included in the treatment group, and 53 individuals were included in the control group. Data were collected on fracture site, body mass index (BMI), corticoid use, femoral and lumbar T-score measured by bone densitometry, and serum 25-hydroxyvitamin D level. The calcaneal angle, the angle between the first metatarsal and the talus and the metatarsus adductus angle were measured in radiographs. Results: The fractures affected the metatarsal bones in 47 patients. Other fracture sites included the lateral malleolus, lateral cuneiform bone, cuboid bone, tibia and calcaneus. All metatarsal bones were affected, most frequently the 5th. The most common fracture was a 5th metatarsal base fracture in zone II. There was no significant difference in mean BMI, serum 25-hydroxyvitamin D levels, alcohol consumption or smoking between the groups. The development of fractures was significantly associated with corticoid use (p<0.0001), low femur (p=0.028) and lumbar spine (p=0.002) bone mineral density and metatarsus adductus angle (p=0.02). When analyzed separately, 4th and 5th metatarsal fractures were associated with smaller angles between the talus and the first metatarsal (p=0.01). Conclusion: Foot and ankle insufficiency fractures among sedentary postmenopausal women are associated with corticoid use, low bone mineral density and biomechanical characteristics, such as pes cavus and metatarsus adductus. The presence of such fractures may be the first sign of bone fragility and should be used as criteria for initiating adequate treatment to prevent other fractures.
TL 18209 - Relationship between the knee and hindfoot axes among patients with advanced gonarthrosis
Authors: Mansur Henrique , Almeida Rocha Felipe , Moreira de Castro Junior Isnar
Published: November 2019

Introduction: The relationship between knee and hindfoot alignment is intuitive, but the number of studies on associated deformities remains limited. The objective of this study is to assess the correlation between the femorotibial joint axis and the hindfoot axis in patients with advanced gonarthrosis. Methods: The knee and hindfoot axes were assessed in 72 patients with indications for total knee replacement. Knee radiographs and long axial view radiographs of the hindfoot were acquired from all patients. The hindfoot/ankle function of the patients was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Statistical analysis was performed at a maximum significance level of 5%. Results: The sample included 24 (33.3%) men and 48 (66.7%) women with a mean age of 58.7 years. The results showed that 79.2% subjects had genu varum (mean: 15º±7.69), and 20.8% had genu valgum (mean: 15.9º) (p>0.05); 46 (63.89%) patients had hindfoot varus (mean: 8.5º±6.07), and 26 (36.11%) had hindfoot valgus (mean: 3.9º±3.92). We observed a significant association between the knee and hindfoot axes (p<0.05). There was no significant correlation only between genu valgum–hindfoot varus (p<0.05). The mean AOFAS score was 74.26 points, with significantly higher scores among patients with hindfoot varus. The AOFAS score was correlated with the hindfoot and knee axes (P<0.05). Conclusion: The knee and hindfoot axes were associated in patients with advanced gonarthrosis. In addition, the patients with hindfoot varus showed better ankle function according to the AOFAS score.
TL 18237 - First metatarsophalangeal joint arthrodesis using a minimally invasive technique
Authors: Ribeiro Lara Luiz Carlos , Carlos Torres Lúcio , Cervone Gabriel , Grajales Juan Antonio , Lemos Rodrigues Fabio
Published: November 2019

Introduction: Metatarsophalangeal joint arthrodesis (MTPA) is a surgical technique indicated for the treatment of hallux rigidus with advanced arthrosis and for rheumatic diseases. This classic surgery is widely used and effective; however, the use of a minimally invasive technique remains mostly unknown.

Objective: To present the outcome of MTPA performed using a percutaneous technique. Methods: Hallux MTPA was performed in 8 feet from 4 patients with hallux rigidus and 4 with rheumatoid arthritis, with a higher prevalence of women than men (5 vs. 3) and a mean postoperative follow-up time of 1.5 years. The outcomes were evaluated using a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and the union time. Results: All patients who underwent surgery showed improvements in pain and arthrodesis union at approximately 8 weeks. The mean AOFAS score increased to 85 points (of a total of 90 possible points). There were no complications, such as infection, nonunion or persistent pain. Conclusion: The percutaneous technique of hallux MTPA was effective, with satisfactory outcomes, reduced surgical invasiveness, immediate walking, rapid union with “arthrodesis take” and significant improvement in pain. However, a larger sample is required to confirm the outcomes.
TL 18241 - Preliminary results of the correction of metatarsus adductus associated with severe hallux valgus
Authors: Barbachan Mansur Nacime Salomão , Furtado da Fonseca Lucas , Fernandez Maringolo Leonardo , Souza Maciel Eduardo , Oliveira Danilo , Pereira Vinicius Felipe
Published: November 2019

Objective: To evaluate the preliminary results of angular corrections from a series of cases of surgical treatment of severe hallux valgus associated with metatarsal adduction. Methods: Data were retrospectively collected from the medical records and pre- and postoperative radiographs of patients undergoing Lapidus arthrodesis combined with lateral rotation osteotomy at the bases of the second and third metatarsals. The following angle measurements were performed before and after surgery: hallux valgus angle, intermetatarsal angle, and the degree of adduction of metatarsal bones (measured using Sgarlato’s and Engel’s angles). The mean follow-up period was 18 months (16-24 months). Results: The mean hallux valgus correction angle was 31° (19-53°), and the mean intermetatarsal correction angle was 5.771° (2-9°). Regarding forefoot adduction, the mean correction angle measured was 15.57° (12-21°) when the Sgarlato technique was used and 15.71° (10-22°) when the Engel technique was used. All measured angles decreased significantly in the postoperative evaluation. Conclusion: Rotational osteotomy at the bases of the second and third metatarsals was effective for correcting metatarsal adduction, allowing the alignment of the first metatarsal and therefore the correction of the deformity.