bluuebunny/crossref_metadata_2025 huggingface dataset:
To Be Accountable While Showing Care: The Lived Experience of People in a Servant Leadership Organization
Authors: Ragnarsson Sigurdur , Kristjánsdóttir Erla S. , Gunnarsdóttir Sigrún
Published: September 2018

Many organizations attribute their success to the use of servant leadership. However, very few studies have been conducted with the emphasis of understanding what it is like for people to work in servant leadership organizations and how it is practiced. Thus, in-depth interviews were conducted and an observation was performed to explore the lived experience of people, both employees and managers, who work within the business sector where servant leadership has been practiced for decades. Two main themes (and a set of subthemes) emerged from the study: “Accountability as an integral part of the practice of servant leadership” and “People show care and help each other out at work.” During a period with new challenges, the balance between the dimensions of “serving” and “leading” became prominent. The findings indicate that both dimensions are important for the prosperity of the organization, although participants experience the “lead” dimension of servant leadership being practiced more than the “serve” dimension. This is important, as much of current thought considers servant leadership to focus more on the “serve” dimension, and thereby to be soft.
Absenteeism and Delay to Work Due to Sleep Disorders in the Turkish Adult Population: A Questionnaire-Based National Survey
Authors: Firat Hikmet , Yuceege Melike , Kiran Sibel , Akgun Metin , Demir Ahmet Ugur , Aksu Murat , Ardic Sadik , Karadeniz Derya , Ucar Zeynep Zeren , Sevim Serhan , Itil Oya , Yilmaz Hikmet
Published: September 2018

Sleep problems may have negative effects on work–life balance, overall health, and safety. We aimed to investigate the association between sleep disorders and absenteeism and delay to work (being late or tardy) among the working adult population. The study was conducted by using data from a large survey of working adults who participated in the Turkish Adult Population Epidemiology of Sleep Study (TAPES) managed by Turkish Sleep Medicine Society (TSMS). Secondary analyses was employed to examine absenteeism and delay to work and their associations with sleep problems, including sleepiness by Epworth Sleepiness Scale (ESS), parasomnias, sleep apnea (by Berlin Questionnaire), sleep quality (by Pittsburgh Sleep Quality Index), and restless leg. History of any absenteeism and delay to work was observed in 276 (18%) and 443 (29%) out of 1,533 working adults, respectively. In the multivariate analyses, absenteeism was associated with younger age, female gender and poor sleep quality, while delay to work was associated with younger age, poor sleep quality, parasomnia, and sleepiness. In the presence of absenteeism and delay to work, sleep disorders including sleepiness, poor sleep quality, and parasomnia should be considered. Such evaluation may improve worker well-being and provide some additional benefits in terms of increasing productivity and lowering work-related costs.
Ruminators (Unlike Others) Fail to Show Suppression-Induced Forgetting on Indirect Measures of Memory
Authors: Hertel Paula T. , Maydon Amaris , Ogilvie Ashley , Mor Nilly
Published: September 2018

Suppression is a useful everyday skill leading to the clinically important outcome of forgetting. Suppression-induced forgetting, investigated with the think/no-think (TNT) paradigm, is typically demonstrated on direct tests of memory, even though indirect tests are often more ecologically valid. We report results from two TNT experiments terminating in indirect tests—tests that seem not to measure memory. For a subset of the participants in Experiment 1, latencies to rate word valence were delayed by flankers previously learned but not by flankers previously learned and then suppressed on 16 occasions. For a similar subset in Experiment 2, cue meaning denoted by free associations reflected the meaning established during learning, but less so when targets had been suppressed. These subsets showing suppression effects were students who did not describe themselves as ruminators. That ruminators failed to show “forgetting” on either test suggests that ruminative habits cannot be easily overcome by practicing suppression.
Commentary on Hofmann and Hayes: The Water Looks Inviting, but How and When Do We Jump in?
Authors: Teachman Bethany A.
Published: September 2018

In this issue, Hofmann and Hayes (p. 37) shined a light on our field’s lack of progress in reducing the prevalence and burden of mental illness and suggested that a paradigm shift is needed to make more rapid progress. They argued that empirically supported processes of change should guide treatment planning, rather than treatment packages. This approach should allow for greater personalization of treatment and more iterative treatment planning and should increase the scalability of our intervention delivery models. In this commentary, I discuss some of the difficult questions that will arise when trying to make the shift from treatment packages to process-based therapy and highlight some steps that we can take now to facilitate the shift.
Response Rates of Medical Providers to Internet Surveys Regarding Their Adoption of Preexposure Prophylaxis for HIV: Methodological Implications
Authors: Silverman Thomas B. , Schrimshaw Eric W. , Franks Julie , Hirsch-Moverman Yael , Ortega Hugo , El-Sadr Wafaa M. , Colson Paul W.
Published: September 2018

In 2016 to 2017, we surveyed primary care providers (PCPs) in upper Manhattan and the South Bronx, New York, on their knowledge, attitudes, and practices surrounding preexposure prophylaxis (PrEP) for HIV. Despite efforts to promote survey response, we were only able to obtain a meager response rate, limiting our ability to interpret results. In this short communication, we examine our survey’s methodology, as well as the methods used by other similar studies, in order to suggest how certain strategies appear to influence PCP response to PrEP surveys. Administering the survey in a variety of modes, sampling from a professional organization’s listserv, promoting the survey topic’s relevance to potential participants, and offering monetary incentives to each survey respondent all appear to be promising strategies for increasing response rates in PrEP provider surveys.
Photogrammetry of Human Specimens: An Innovation in Anatomy Education
Authors: Petriceks Aldis H , Peterson Ashley S , Angeles Miguel , Brown W Paul , Srivastava Sakti
Published: September 2018

Cadaver-based anatomical education is supplemented by a wide range of pedagogical tools—from artistic diagrams, to photographs and videos, to 3-dimensional (3D) models. However, many of these supplements either simplify the true anatomy or are limited in their use and distribution. Photogrammetry, which overlaps 2-dimensional (2D) photographs to create digital 3D models, addresses such shortcomings by creating interactive, authentic digital models of cadaveric specimens. In this exploratory pilot study, we used a photogrammetric setup and rendering software developed by an outside group to produce digital 3D models of 8 dissected specimens of regional anatomy. The photogrammetrically produced anatomical models authentically and precisely represented their original specimens. These interactive models were deemed accurate and teachable by faculty at the Stanford University Division of Clinical Anatomy. Photogrammetry is, according to these results, another possible method for rendering cadaveric materials into interactive 3D models, which can be used for anatomical education. These models are more detailed than many computer-generated versions and provide more visuospatial information than 2D images. Future researchers and educators could use such technology to create institutional libraries of digital 3D anatomy for medical education.
Sickness presenteeism as coping behaviour under conditions of high job control
Authors: Gerich Joachim
Published: September 2018

Job control – denoting an employee’s decision authority regarding timing, location or method – plays a key role in occupational research and is typically viewed as a positive resource that helps to buffer negative health effects induced by work demands. Moreover, previous research has suggested that higher job control helps to reduce sickness presenteeism of employees – defined as attending work while ill. Conversely, by considering various theoretical approaches (such as the vitamin model and the ‘entreployee’ concept) it is hypothesized that very high levels of job control may increase sickness presence behaviour of employees as a coping strategy aimed at overcoming a perceived threat of productivity loss due to sickness. As a consequence, a u-shaped curvilinear association between job control and sickness presenteeism is expected – especially for vulnerable individuals. Based on survey data collected from a heterogeneous random sample of 532 employees, a curvilinear association between job control and sickness presenteeism is confirmed, which is amplified for individuals with a higher number of days with sickness. It is concluded that an increase in job control at low or moderate levels is associated with reduced sickness presenteeism, whereas very high levels of job control are related to an increased need for sickness presence.
Improvement in Health-related Quality of Life After Total Ankle Arthroplasty Compares Well to Other Successful Orthopaedic and Non-orthopaedic Procedures
Authors: Lachman James , Adams Samuel , DeOrio James , Easley Mark
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

End-Stage arthritis is one of the leading causes of chronic disability in the United States. Improvement in Health-Related Quality of Life(HRQOL) after total ankle arthroplasty(TAA) has been demonstrated in the literature. This improvement has not been compared to that of other common Orthopaedic and non-Orthopaedic procedures including Anterior Cervical Discectomy and Fusion(ACDF), Total Knee Arthroplasty(TKA), Coronary Artery Bypass Grafting(CABG), and Orthotopic Liver Transplant(OLT). Although TAA is noted to be effective in eliminating symptoms in end-stage arthritis, it is difficult to gauge the impact of TAA relative to other meaningful procedures that have been shown to have great impact on HRQOL improvement. The purpose of this study was to compare changes in HRQOL between TAA and other common procedures with large impacts on this outcomes measure.

Methods:

Five hundred consecutive patients with minimum of two-years follow-up after TAA were prospectively evaluated with the Short Form-36(SF-36) outcome instrument preoperatively, at six months, one year and two years post-operatively. An exhaustive literature review was conducted identifying studies with comparatively sample sizes comparing preoperative and postoperative SF-36 scores after ACDF, TKA, CABG, and OLT. The SF-36 Physical and Mental component scores were included in each cohort and compared for magnitude of improvement and significant differences between them.

Results:

Patients in all cohorts had preoperative SF-36 mental and physical function scores significantly lower than the general population scores. The preoperative physical function scores were lowest in the TKA group (average 31.1 +/-9.7) followed by TAA group (average 40.6 +/-16.3), ACDF group (average 41.5 +/-21.6), OLT group (average 51.9 +/-23.6) and CABG groups (57.8 +/-21.3), respectively. Improvement after surgery was greatest in the ACDF group (Mental +31.5, Physical +22.9), followed by the TAA group (Mental +13.9, Physical +26.8), TKA group (Mental +14.3, Physical +22.4), CABG group (Mental +7.6, Physical +15.4) and OLT group (Mental -4.47, Physical +9.8), respectively. The greatest improvement in physical function score occurred in the TAA group (see attached table).

Conclusion:

The mental and physical disability associated with end-stage ankle arthritis is as severe as that associated with many other Orthopaedic and non-Orthopaedic conditions. The improvement in HRQOL after TAA is greater than that obtained after TKA, CABG, and OLT but not as great as the improvement seen after ACDF; however, the improvement in physical function score was greatest in the TAA cohort. The HRQOL benefits of TAA are comparable to the benefits achieved after several other relatively common and successful surgical procedures.
The Role of Axial Rotation in Total Ankle Replacement
Authors: Najefi Ali-Asgar , Goldberg Andrew
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

The importance of implant orientation in the axial rotational plane is ill understood. No Total ankle replacement (TAR) implant deals specifically with rotation as part of the surgical technique. Preoperative computed tomography (CT) scan–derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis, TN) have been developed for TAR scanning the knee and ankle for the purposes of patient specific instrumentation. The objectives of this study were to establish the range and relationship between the transtibial axis at the knee, the tibial tuberosity, and the transmalleolar axis using these CT scans in an adult population with ankle arthritis.

Methods:

150 CT Scans of patients with end stage ankle osteoarthritis undergoing Psi, we measured the relationship between the transtibial axis, the tibial tuberosity and the transmalleolar axis (Figure 1). All CT scans were analysed using the Solidworks software (Dassault Systèmes). Varus or valgus arthritis, tibiotalar angle and presence of deformity was also recorded.

Results:

The mean difference in the axial plane between the transmalleolar axis and the tibial tuberosity was 17.9 ± 9.3 degrees externally rotated. There was a large range which was between -5 and 53 degrees of external rotation. The mean foot angle was 15.4 ± 11.1 degrees relative to the implant position. All planned implant positions were mean 1.0 ± 1.8 degrees (range -3.8 – 1.7 degrees) internally rotated to the transmalleolar axis. Varus or valgus ankle arthritis did not correlate with rotation of the tibial axis (p=0.4).

Conclusion:

There is a wide variation in rotational alignment of the tibia, which cannot be accurately assessed clinically or using plain radiographs. Surgical techniques that reference the tibial tuberosity to plan component alignment can be misleading and lead to implant malalignment. We recommend routine preoperative CT scanning prior to ankle replacement surgery and recommend research to assess the effects of axial rotation of implant performance and survival.
Stem Cells Isolated from the Sheath and Core Tissues of Human Plantar Fascia Exhibit Differential Biological Properties
Authors: Zhang Jianying , Nie Daibang , Hogan MaCalus , Wang James
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Plantar fasciitis is a very common ligament disease which affects more than 3 million patients in the United States every year. However, there is no effective treatment in clinics because its pathogenesis is largely unknown. Although PF has been studied quite well from a biomechanical viewpoint, little has been done on PF biology. To better understand the cellular mechanisms of plantar fasciitis, in this study we aimed first to characterize biological properties of stem cells isolated from the sheath and the core of human PF tissues. Their biological responses to mechanical loading are also studied.

Methods:

Two stem cell populations isolated from the sheath (PF-S) and core (PF-C) parts of human PF tissues were investigated by characterizing their colony formation, stem cell marker expression, population doubling time (PDT), multi-differentiation potentials, and biological responses to mechanical loading. One-way ANOVA followed by Fisher’s PLSD for multiple comparisons was used for statistical analysis. A p-value < 0.05 was considered to be statistically significant.

Results:

PF-S grew quicker and formed larger colonies than PF-C cells (Fig. 1). More PF-S expressed nucleostemin (Fig. 2A), Oct- 4 (Fig. 2C), SSEA-4 (Fig. 2E) than PF-C cells (Fig. 2B, 2D, 2F). More PF-S were stained by collagen type IV (Fig. 3D), CD31 (Fig. 3A), and vimentin (Fig. 3B), and less stained by collagen I (Fig. 3C) than those of PF-C cells (Fig. 3E-I). More PF-S were differentiated into adipocytes (Fig. 4A), osteocytes (Fig. 4B), and chondrocytes (Fig. 4C) than PF-C cells (Fig. 4D-F). PF-S and PF-C respond to intensive mechanical stretching differentially in terms of gene expression levels of collagen I (Fig. 5A), IV (Fig. 5B), CD105 (Fig. 5C), non-tenocyte related genes (Fig. 5D-F), MMPs (Fig. 5G-H), and inflammation-related genes, COX-I and COX-II (Fig. 5I-J).

Conclusion:

This study characterized plantar fascia in detail at histological, cellular, and mechanobiological levels. Our results showed that plantar fascia consists of two distinct tissues sheath and core with differential structural and cellular properties. The cells isolated from sheath and core of human PF also differ in their response to mechanical loading. This information may be useful in determining the respective contributions of the sheath and core stem cells to the development of plantar fasciitis and in devising new biologic approaches for effective repair of injured PF in clinics.
Gastrocnemius Recession to Treat Chronic Insertional and Noninsertional Achilles Tendinopathy
Authors: Graham Robert , Innis Collin , Stevens Benjamin
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Small studies on gastrocnemius recession for Achilles tendinopathy with associated contracture of the gastrocnemius muscle are encouraging. The analyses have demonstrated fewer postoperative complications, shortened recovery time, and earlier return to work as compared to traditional surgical management of Achilles debridement and repair. Investigators have reported good patient satisfaction, substantial pain reduction, and restoration of dorsiflexion. However, there have been no large studies specifically looking at the outcomes of gastrocnemius recession for either chronic insertional or noninsertional Achilles tendinopathy. The purpose of this study was to review the efficacy of the gastrocnemius recession in mitigating pain for patients who have chronic Achilles tendinopathy with isolated gastrocnemius contracture and have failed nonoperative management.

Methods:

The records of patients with isolated gastrocnemius contracture were retrospectively reviewed who underwent an isolated gastrocnemius recession to treat insertional or noninsertional Achilles tendinopathy as performed by a single surgeon spanning from 2011 to 2017. Minimum follow-up time required was 6 months with an average of 25.5 months follow-up among all responders with a range from 6 to 63 months. Patients were excluded by the criteria of any other concomitant foot deformities, diagnoses, or surgical procedures performed. Clinical outcome was evaluated using a mail-in patient satisfaction questionnaire. One hundred and thirty-nine patients were identified to have underwent an isolated gastrocnemius recession to treat chronic insertional or noninsertional Achilles tendinopathy that was refractory to conservative management for a minimum of six months. Sixty-six patients (76 legs) of those eligible responded.

Results:

Sixty-three out of 66 patients (95.5%) were satisfied with the results of the procedure overall. Sixty-two out of 66 patients (93.9%) would elect to repeat the surgery if they knew their results in advance. Sixty-one out of 66 patients (92.4%) would recommend the surgery to a family or friend with the same diagnosis. The most frequently reported postoperative complication was 9 accounts of swelling (out of 76 legs; 11.8%). There were no reports of sural nerve injury. Responses for Visual Analogue scale (VAS) for pain were only eligible if they had reported a preoperative VAS score on their preoperative intake form. This made 23 patients eligible with an average preoperative pain of 8.43/10 and an average postoperative pain of 0.91/10.

Conclusion:

Gastrocnemius recession for treating chronic Achilles tendinopathy was found to be an effective procedure to mitigate pain in patients with isolated equinus contracture. To our knowledge, this is the largest study assessing gastrocnemius recession for treatment of chronic Achilles tendinopathy.
Analysis of Gait and Footprint in Patients with Hallux Valgus
Authors: Ito Naoya , Nishimura Akinobu
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux valgus (HV) is one of the most common forefoot problems. HV is defined as a hallux valgus angle of more than twenty degrees. HV can lead to alterations of the plantar pressure pattern and clinical gait. This study examined the relationship between gait alterations and HV deformities.

Methods:

We examined 500 residents (161 men and 339 women; >50 years of age) of Miyagawa village in Mie, Japan in 2009, 2011 and 2013. They performed a 6-meter walk test at normal and maximum speed. We examined gait speed, the number of steps, and footprint between patients with normal (HV angle <20; n=350) and HV (HV angle >20; n=150), and between normal-to-mild (HV angle <30; n=436) and moderate-to-severe (HV angle >30; n=64). Their plantar pressure patterns were measured using a gait analyzer (Walk Way MW 1000; Anima, Tokyo, Japan, Figure.1). Statistical analyses were performed using the chi-square test according to sex and use of the hallux ball; the t-test according to age, height, and weight; and logistic regression analysis adjusted for age, sex, and height according to gait speed and the number of steps. P value less than 0.05 was considered significant.

Results:

With regard to the plantar pressure pattern, the percentage of subjects in the HV group who left a footprint of the hallux ball was significantly lower than that in the normal group. The percentage of subjects in the moderate-to-severe group who left a footprint of the hallux ball was even lower. Analysis of the footprint revealed that the HV group used the hallux ball significantly less during toe-off than the normal group. At both normal and maximum speed, the number of steps and gait speed did not differ significantly between the normal and HV groups. However, when we compared normal-to-mild and moderate-to-severe groups, the number of steps in the moderate-to-severe group was significantly greater than in the normal-to-mild group at maximum walking speed.

Conclusion:

Analysis of the footprint revealed that the percentage of subjects in the HV group who was able to use the hallux ball during toe-off was significantly less than that in the normal group. The percentage of subjects in the moderate-to-severe group who could use the hallux ball in toe-off was even lower. HV can cause footprint alterations. Moderate-to-severe HV can cause not only footprint alterations but also gait alterations, especially when walking at maximum speed.
Sinus tarsi approach vs. extensile lateral approach for intra-articular calcaneal fracture
Authors: Khongphaophong Methee
Published: September 2018

Category:

Trauma

Introduction/Purpose:

The options of operative treatment for intra-articular calcaneal fracture still remains controversial. Extensile lateral approach allow excellent exposure to fracture, but bring high rate of wound complications. The aim of this study was to compare the outcome of intra-articular calcaneal fracture treated with open reduction and internal fixation via an extensile lateral versus. Sinus tarsi approach

Methods:

Prospective study of 62 intra-articular calcaneal fractures treated by open reduction and internal fixation between 2014, October to 2017, June. 29 were treated with extensile lateral approach with calcaneal locking plate(Wright medical, Tennessee), 33 sinus tarsi approach(4 cases need additional mini medial incision approaches for SanderIII AC, BC) with mini-calcaneal locking plate(Normed, Florida). Durations until operation, operative time, foot functional index(total score), visual analog scale, SF-36, Bohler’s angle, angle of Gissane, wound complications and duration of hospital stay were recorded post-operatively and minimal 6 months follow up.

Results:

Compared 2 groups with demographic datas.Average duration until operation; extensile group was 13.32 days, sinus tarsi group was 6.08 days, p <0.001. Operative time; extensile group was 123.41minutes vs. sinus tarsi group was 91.20 minutes, p <0.001. Wound complications was 24.13% in extensile group vs. 6.06% in sinus tarsi group, p =0.045, Duration of post-operative admission was 6.68 days in extensile group vs. 3.10 days in sinus tarsi group p <0.001 FFI last visits was 25.36 in extensile group vs. 25.65 in sinus tarsi group, p =0.969, VAS activity was 29.68 in extensile group vs. 28.54 in sinus tarsi group, p=0.271.

Conclusion:

Sinus tarsi approach with mini-calcaneal locking plate was a great option for treatment of intra-articular calcaneal fracture. This approach brought lower rate of wound complications, earlier operations, shorter operation times and shorter hospital stay compared to extensile lateral approach.
Arthroscopic Treatment of Flexor Hallucis Longus Tenosynovitis
Authors: Labrum Joseph , Harris Thomas , Shymon Stephen , Maiyuran Harinee
Published: September 2018

Category:

Arthroscopy

Introduction/Purpose:

Flexor Hallucis Longus (FHL) tenosynovitis is a common cause of posterior ankle pain, typically associated with repetitive plantar flexion activities. The purpose of this study was to report the results of patients with FHL tenosynovitis treated with posterior ankle arthroscopy using validated outcome measures and develop a zone-based classification of FHL tenosynovitis that demonstrates well correlated preoperative imaging and intraoperative findings.

Methods:

Posterior ankle arthroscopy was performed in 11 patients (12 ankles) with a diagnosis of FHL tenosynovitis, with patients followed for a minimum of two years (mean 44 months). Outcomes were evaluated using validated scoring measures, including visual analog scales (VAS) for pain, 12-Item Short Form Health Survey (SF-12), and the Foot and Ankle Ability Measure (FAAM).

Results:

A zonal classification scheme based on anatomic location was developed, divided into three zones: proximal to the ankle joint, posterior to the ankle joint, and from the fibro-osseous tunnel underneath the sustentaculum tali to the FHL insertion. Agreement between preoperative MRI and arthroscopic zonal involvement at time of surgery was present in ten feet (83%), and differed in two feet (17%). VAS scores improved significantly from 7.1 ± 1.4 preoperatively to 1.3 ± 1.3 postoperatively (p <0.001). Mean values for ADL and sports subscales of the FAAM at time of follow up were 87.1 ± 16.2 and 76.5 ± 28.8, respectively. Physical component summary (PCS) and mental component summary (MCS) of the SF-12 yielded means of 51.3 ±12.8 and 52.7 ± 5.0, respectively.

Conclusion:

FHL pathology can be classified using a zone-based classification scheme, which is highly correlative between preoperative MRI and intraoperative findings. Posterior ankle arthroscopy is an effective treatment option for FHL tenosynovitis, as evaluated using validated outcome measures.
Learning Curve in the Posterior Endoscopy of the Ankle
Authors: Pagnano Rodrigo , Dinato Mauro Cesar Mattos E. , Filho Miguel Pereira
Published: September 2018

Category:

Arthroscopy

Introduction/Purpose:

The Posterior Ankle Impingement Syndrome (PAIS) can be treated by the endoscopic technique with posterior portals and patient in prone position. There is discussion whether this would be the best method, given the possible difficulty in learning and applying this technique, risks of complications and prolonged time of surgery. We conducted this retrospective study to assess the time spent to perform the posterior endoscopy along the learning curve and the relationship of the duration of the procedure to the presence of complications.

Methods:

We evaluated 39 patients undergoing endoscopic treatment through posterior ankle portals technique and prone position, operated by a single surgeon between 2005 and 2014. We divided the patients into four groups of ten subjects according to the chronological sequence of the surgeries. We used the Jonckheere-Terpstra test to compare the surgery time between the four analyzed groups. We used the Mann-Whitney test to compare operative time and the occurrence of complications, and the relationship between surgical procedure time and presence of intraoperative fibrosis. We used the Wilcoxon signed-rank test to compare preoperative and postoperative AOFAS Ankle-Hindfoot Score. For all statistical analysis, p-values <0.05 were considered to be significant.

Results:

We found a significant decreasing of the surgery duration over time (p=0.0273) (Figure). Figure: Representing surgery time (in minutes) to groups of patients (Groups 1 to 4, being Group 1 patients 1-10, Group 2 patients 11-20, Group 3 patients 21- 30 and Group 4 patients 31-39).There were three complications not related to the duration of the surgery (p=0.6909). The presence of extensive fibrosis had an impact on the operative time (p=0.0387). The AOFAS Score evolved from 64.0±16.9 preoperatively to 93.7±8.9 postoperatively (p<0.0001).

Conclusion:

The time of the procedure decreased as the surgeon’s experience increased, and our complications showed no relationship with the surgery time.
Investigation of the Effect of Initial Graft Tension During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In-situ Force
Authors: Sakakibara Yuzuru , Teramoto Atsushi , Kamiya Tomoaki , Watanabe Kota , Yamashita Toshihiko
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Ankle sprains are the most common sports injuries, and anterior talofibular ligament (ATFL) injury comprised 85% of all ankle sprains. Most patients recover with conservative treatment, but 20% of them progress to chronic ankle instability. Some studies have reported that anatomic reconstruction using a tendon graft is one of the best procedures to restore the ankle to its condition before symptom development. However, the effect of initial graft tension during ATFL reconstruction is still unclear. Therefore, the objective of this study was to investigate the effect of the initial graft tension during ATFL reconstruction.

Methods:

Eight fresh-frozen cadaveric ankle specimens were subjected to passive plantarflexion (PF)-dorsiflexion (DF) movement from 15° DF to 30° PF using the 6-degree-freedom robotic system. In addition, 60 N of anterior-posterior load, 1.7 Nm of inversion-eversion (IV-EV) torque, and 1.7 Nm of internal-external rotation (IR-ER) torque were applied to the ankle. During testing, 3-dimensional paths of the ankle were recorded simultaneously. Furthermore, in-situ forces of the ATFL and reconstructed graft were calculated using the principle of superposition. A repeated experiment was designed with the intact condition (intact), ATFL transection, and ATFL reconstruction with four different initial graft tensions (10 N, 30 N, 50 N, and 70 N).

Results:

AP laxity, IV-EV laxity and IR-ER laxity with ATFL transection was significantly greater than those with intact. In ATFL transection, the talus was significantly translated anteriorly with inversion and internal rotations under passive PF-DF motion compared with intact. Kinematic patterns and laxity in ATFL reconstruction with initial tension of 10 N and 30 N almost imitated intact, but in ATFL reconstruction with initial tension 70 N, the talus was significantly translated with external rotation compared with intact. As the initial graft tension during ATFL reconstruction increased, in-situ force of the reconstructed graft tended to increase during PF-DF motion. In-situ force of the reconstructed graft tension was significantly greater with initial tensions of 50 N, and 70 N than with intact during PF-DF motion (Figure 1).

Conclusion:

ATFL deficiency altered ankle kinematics and laxity. Although the optimal initial graft tension during ATFL reconstruction might restore ankle kinematics and laxity, excessive initial graft tension caused abnormal kinematics and laxity. Furthermore, the reconstructed graft tension increased as the initial tension increased. Initial tension during ATFL reconstruction has the important effect of imitating the normal ankle condition. We suggest that over-tensioning during ATFL reconstruction should be avoided in order to imitate the conditions of a normal ankle.
Mid-term Outcomes of Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus
Authors: Shimozono Yoshiharu , Hurley Eoghan , Kennedy John
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Autologous osteochondral transplantation (AOT) is an established treatment for large-sized OLT, typically greater than 107mm2. Several studies have demonstrated favourable outcomes following AOT at short- and mid-term follow-up. However, the majority of the literature on AOT has short-term follow-up and little evidence exists on the mid-term and longer-term follow-up. Additionally, few studies include a large number of patients or have a high level of evidence, limiting the ability to draw broad and meaningful conclusions about the effectiveness of the AOT procedure for the treatment of OLT beyond short-term follow-up. The purpose of the current systematic review was to evaluate the clinical outcomes analysing level and quality of evidence of the AOT procedure in the treatment of OLT at mid-term and long-term follow-up.

Methods:

A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in October 2017 based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Clinical outcomes, and complications were also evaluated.

Results:

Eleven studies, with 500 ankles were included at a mean 62.8 months follow-up. There were 3 studies of LOE III, and 8 studies of LOE IV. There were 3 studies of fair quality and 8 studies of poor quality. The weighted mean preoperative AOFAS score was 55.1 ± 6.1, and the postoperative score was 86.2 ± 4.5, with 87.4% of patients being reported as excellent or good results. In total, 54 of the 500 patients (10.8%) had complications. The most common complication was donor site morbidity with 18 patients (3.6%) at final follow-up. Thirty-one patients (6.2%) underwent reoperations, and the authors deemed a total of 5 ankles (1.0%) failures. Only 5 studies (45.5%) used MRI for follow-up evaluation.

Conclusion:

The current systematic review demonstrated that good clinical and functional outcomes can be expected following AOT procedure for the treatment of OLT, with a failure rate of only 1.0% at 63 months follow-up. MRI and radiographs showed restoration of articular surface as well as a minimal presence of osteoarthritis at mid-term follow-up. However, there is still lack of data from high LOE and QOE studies, and further high quality studies are necessary.
Increasing female authorship of foot and ankle academic literature over 24 years
Authors: Sing David , Vora Molly , Kuripla Casey , Ouyang David
Published: September 2018

Category:

Other

Introduction/Purpose:

Under-representation of women in surgery is commonly attributed to lacking mentorship and exposure in medical school, societal perceptions regarding career priorities, and concerns of “fitting in” in a work culture predominantly comprised of men. Furthermore, this disparity is also reflected in research productivity across academic medicine with male faculty being more likely to publish research compared to female colleagues. In this study we aim to describe the representation and longevity of female investigators among the authors of three foot and ankle research journals from 1993 to 2017.

Methods:

In this retrospective bibliometric analysis, authors of original research from three prominent foot and ankle research journals (Foot and Ankle International, The Journal of Foot and Ankle Surgery, Foot and Ankle Clinics) were extracted from PubMed. For authors with a complete first name listed, gender was determined by matching first name using an online database containing 216,286 distinct names across 79 countries and 89 languages. Proportion of female first, middle, and senior authors were determined over time, as well as total publication count per author. A sub-analysis of authors first publishing between 2007-2012 was followed for 5 years to identify how often authors continued to publish after first publication. Student t-test, chi-square analysis, and Cochran-Armitage trend tests were used to determine significance between groups.

Results:

From 1993 to 2017, 8,132 original articles were published in three foot and ankle research journals. A total of 6,597 (81.1%) had first names listed, identifying 25,329 total authors, of which 22,961 (90.7%) were successfully matched to a gender. 9,273 unique authors were identified (female: 19.2%). Female representation increased for first and senior authors from 6.5% and 5.9% (1993-1997) to 16.9% and 13.1% (2013-2017, p<0.001). Compared with male authors, female authors published fewer articles (mean: 1.7 vs 2.4, p<0.001). Of 2,691 authors who first published during 2006 to 2011, 369 authors (13.0%; female: 8.1% vs male 15.0%, p<0.001) continued to publish 5 years after their first publication. Female authors were more likely to only publish one article (75.6% vs 69.4%, p=0.016).

Conclusion:

Female representation in academic foot and ankle research has increased over two-fold over the past 2 decades. Despite these advances, compared to male authors, female authors are less likely to continue publishing 5 years after initial publication, and on average publish fewer articles. Although women are increasingly supported in the surgical workforce, our findings suggest that disparities in academic productivity exist in foot and ankle surgery. Further analysis of barriers to research amongst women may result in more equitable academic advancement and promotion for female foot and ankle surgeons.
An Accuracy of Syndesmotic Reduction by Direct Visualization Technique
Authors: Sripanich Yantarat , Rungprai Chamnanni
Published: September 2018

Category:

Trauma

Introduction/Purpose:

Syndesmotic injury is commonly seen associated with acute ankle fracture. Syndesmotic malreduction was proven be a poor prognostic factor. Many methods have been purposed to assess the quality of reduction such as direct visualization, comparing radiographic parameters to contralateral ankle fluoroscopy, and intra-operative computed tomography. In this study, we demonstrated syndesmotic malreduction rate using bilateral CT after using direct visualization technique for syndesmotic fixation.

Methods:

A prospective case series of 34 patients (13 left and 21 right sides) with an average age of 42 years who had rotational ankle fractures with syndesmotic injury confirmed by arthroscopic examination. All patients were treated with an open reduction and internal fixation of distal fibula using either 1/3 tubular plate or distal anatomical locking plate. Syndesmosis was fixed by one or two of 3.5-mm cortical screw with three or four cortices. Before syndesmotic fixation, syndesmotic reduction is made by using a large point reduction clamp and quality of the reduction was checked by direct visualization at anterior tibiofibular line. The accuracy of syndesmotic reduction is then evaluated by post-operative bilateral CT. A widening of distance between anterior tibia and fibular at 1-cm above the ankle joint more than 2 mm compared to uninjured sides considered a malreduction of syndesmosis.

Results:

The accuracy of syndesmotic reduction was 97.1 percent (33/34) compare to contralateral ankle. An average of BMI was 27.2 and an average of operative time was 98.2 minutes. One malreduction, was diagnosed on the criteria of a 2 mm difference from the contralateral side occurred due to a small fragment interposition at the syndemosis. This patient underwent revision surgery to remove the fragment and then fixation of syndesmosis with same manner to achieve anatomical reduction. In all cases, the screws are removed at 12 weeks. Neither breakage nor migration of screws is observed and no wound or nerve complications following this technique.

Conclusion:

A syndesmotic fixation using direct visualization technique demonstrate lower rate of malreduction as demonstrated by poster-operative bilateral CT scan and no complications. This technique is effective, safe, and should be considered for treatment of syndesmotic injury associated ankle fracture.
Prevalence of Vitamin D Deficiency in Patients with Talar Osteochondral Lesions
Authors: Telleria Jessica J.M. , Ready Lauren V. , Bluman Eric M. , Chiodo Christopher P. , Smith Jeremy T.
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Vitamin D deficiency affects over 1 billion people worldwide and is common in foot and ankle patients. The prevalence in those with osteochondral lesions of the talus (OLTs) is unknown. This study identified the prevalence and risk factors for hypovitaminosis D in patients with an OLT.

Methods:

Serum 25(OH)D levels were obtained from patients presenting with an OLT from May to November during 2007 to 2016. Hypovitaminosis D was defined as 25(OH)D less than 30 ng/mL (75 nmol/L). Patients presenting with an acute ankle sprain (AS) during the same months served as a control group. Specific medical risk factors for hypovitaminosis D were recorded. The final OLT population included 46 patients (31 women [67.4%]; mean [SD] age 43.6 [14.8] years). The comparison AS group had 40 patients (32 women [80.0%]; mean [SD] age 56.2 [13.0] years).

Results:

The mean (SD) 25(OH)D in the OLT and AS cohorts were 31.2 (12.6) ng/mL and 37.1 (13.5) ng/mL, respectively (P =.039). Hypovitaminosis D was identified in 54% of the OLT population and 28% of the AS population (P = .012).

Conclusion:

Hypovitaminosis D is intimately related to decreased bone mineral density. This study identified a significantly higher rate of hypovitaminosis D in patients with an OLT compared to a cohort of AS patients. These findings suggest that when patients present with an OLT, health care providers should consider evaluating for and treating hypovitaminosis D.
A Virtual Clinic and a One Stop Acute Tendo-achilles Clinic
Authors: Thomson Calum , Singh Anjani
Published: September 2018

Category:

Trauma

Introduction/Purpose:

Patients with acute tendo-achilles (TA) rupture require prompt diagnosis, investigation and treatment in order to ensure optimum outcomes. This can be prevented by delay in review of patients within secondary care. We present our experience of treating such injuries by establishing a “virtual” fracture clinic (VFC) and a one stop dedicated TA specialist clinic. Patients are referred to the service via the emergency department (ED) and are triaged remotely by the VFC, at which all orthopaedic cases including suspected TA injuries are reviewed by a consultant orthopaedic surgeon using all available medical records and imaging. Suitable patients are then diverted directly to the specialist TA clinic for definitive treatment. We wished to establish the speed and efficiency of this care pathway.

Methods:

Using our institutions prospectively maintained database, we identified patients treated in the specialist TA clinic between September 2016 and August 2017. We recorded demographic details, injury mechanism, time from injury to diagnosis, ultrasound scan findings, and the speed of progress of the patient along the agreed rehabilitation pathway.

Results:

Sixty two patients were referred to the VFC with suspected TA injury. Mean age was 49 years, M: F (44:18 female). Mean time to triage in the VFC was 3.5 days (with 42% of patients triaged in the VFC on the same day as initial ED presentation). Mean time from ED consultation to assessment in our TA clinic was 11.7 days. Patients were assessed by a specialist foot and ankle surgeon, supported by a same day musculoskeletal ultrasound service. 45 patients (74%) were diagnosed with TA rupture, of which 69% were acute complete ruptures. Eight patients fulfilled criteria for surgical repair. Mean time from ED consultation to surgery was 13.25 days. Three further patients treated non-operatively developed secondary ruptures requiring delayed operative intervention.

Conclusion:

We recommend the use of a virtual triage service and a one stop TA clinic led by a dedicated specialist team to improve the accuracy of diagnosis and efficacy of treatment of acute TA rupture. This service provides a robust system for avoiding mis-diagnoses and delays in treatment, as well as ensuring effective implementation of our local care pathway under specialist supervision in a one stop clinic. This also establishes an effective system for monitoring as well as maintaining a research database for further prospective studies.
The Role of Lateral Soft Tissue Release for the Treatment of Hallux Valgus with Distal Chevron Osteotomy
Authors: Wang Zhijian , Zhong Tao
Published: September 2018

Category:

Bunion

Introduction/Purpose:

To define the effect of distal chevron osteotomy with and without lateral soft tissue release for the correction of mild and moderate hallux valgus.

Methods:

24 consecutive patients were enrolled in this prospective study. In Group A, 12 patients underwent a chevron osteotomy only. In Group B, 12 patients underwent a chevron osteotomy with lateral soft tissue release. The hallux valgus angle (HVA) and intermetatarsalangle (IMA), and AOFAS score were measured preoperatively, and 6-month follow up postoperatively and complications were evaluated. Results and complications were evaluated.

Results:

The change in HVA, IMA and AOFAS score were insignificant (p > 0.05) between Group A and Group B. Complications of digital neuritis and cosmetically dissatisfied scarring of the dorsal web space were seen only in Group B. No cases had avascular necrosis of the metatarsal head, malunion or nonunion.

Conclusion:

Lateral soft tissue release may not be needed for mild or moderate hallux valgus deformities which may prevent neuritis of dorsal or plantar lateral digital nerve and cosmetic dissatisfaction of adorsal scar.
Pediatric Psoriatic Arthritis
Authors: Brandon Timothy G. , Manos Cynthia K. , Xiao Rui , Ogdie Alexis , Weiss Pamela F.
Published: September 2018

Background:

Relatively little is known about the epidemiology of juvenile psoriatic arthritis (PsA), including clinical features associated with the development of arthritis among children with psoriasis and subsequent risk of inflammatory comorbidities.

Objective:

To identify the overall risk of arthritis among children with psoriasis and subsequent risk of inflammatory comorbidities.

Methods:

Using Clinformatics DataMart (OptumInsight) deidentified US administrative claims data from 2000 to 2013, we identified children aged 0 to 16 years with an incident diagnosis of psoriasis or PsA using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic, procedure, and pharmacy billing codes. Cox proportional hazard regression was performed to assess clinical features associated with development of arthritis in children with psoriasis. Incidence rate ratios were used to compare the relative frequency of comorbid diagnoses.

Results:

We identified 212 children with PsA, 4312 with psoriasis only, and 45 240 controls. Approximately 33% of children with PsA received a diagnostic code for psoriasis before arthritis. Median time to index code for arthritis after index code for psoriasis was 17.6 months (interquartile range: 4.1-38.1). Older age and uveitis were associated with a significantly increased risk of developing arthritis in children with psoriasis. Children with PsA had a significantly increased risk of uveitis, diabetes, and depressive disorder when compared to patients with psoriasis and inflammatory bowel disease, uveitis, diabetes, and depressive disorder when compared to controls.

Conclusion:

Most children with PsA developed arthritis first. Older age and uveitis were risk factors for arthritis among children with psoriasis. Psoriatic arthritis was associated with an increased risk of several clinically relevant inflammatory comorbidities.