bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone Block Graft from Calcaneus for Foot and Ankle Reconstruction
Authors: Sanhudo Jose V.
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

The correction of foot and ankle deformities often require the use of a bone block for proper reconstruction. The iliac graft is the most used, but the additional approach in the hip region increases the morbidity, the risk of complications and prevents the execution of the procedure through the peripheral anesthetic block. The objective of the study is to demonstrate the clinical and radiological results of using a bone block graft from calcaneus for reconstruction of the foot and ankle region as an alternative to procedures that require bone lengthening .

Methods:

Between September 2013 and November 2014 eight patients underwent surgery with the use of bone block graft from calcaneus for reconstruction of local bone defects . In four cases the bone graft was used for reconstruction of calcaneal fracture malunion, two cases for ankle fracture reconstruction with shortening of the fibula, one case for hallux arthrodesis after avascular necrosis of the head of the first metatarsal, and one case for lateral column lengthening in a patient with flexible flatfoot. Four patients were male and four were female. The average age of patients at the time of surgery was 44 years.

Results:

After minimum of 13 months and average of 20 months follow-up, patients showed improvement of the AOFAS score from an average of 42 points preoperatively to an average of 83 points after the procedure. Union of both sides of the graft was observed in all patients except one (arthrodesis of the hallux). Despite the radiological failure, this patient remains without pain and satisfied with the her result. All patients were satisfied with the results and would underwent the procedure again under the same circumstances.

Conclusion:

The bone block from the posterior superior calcaneal tuberosity presents the advantages of using highly cancellous autograft with great density; can be removed under sedation and ankle block; dispensing the preparation of the surgical field in another anatomical region and often dispenses additional incision. These preliminary results put this technique as a viable alternative for cases of foot and ankle reconstruction that require a bone block graft.
Beaming in Charcot Arthropathy- Intramedullary Fixation for Complicated Reconstructions
Authors: Fidler Corey M. , Watson Benjamin C. , Reb Christopher W. , Hyer Christopher F.
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

In the modern treatment of Charcot neuroarthropathy, beam screw fixation is an attractive alternative to plate and screw fixation because it minimizes the required exposure for implantation and supports the longitudinal columns of the foot from the inside out as a rigid yet load-sharing construct. Oversized implants risk metatarsal fracture and undersized implants risk implant fracture or impaired healing from mechanical instability. Our review of the scientific literature identified a lack of evidence regarding the aspects of metatarsal intramedullary canal morphology relevant to beam screw fixation. The purpose of the present study was to qualitatively and quantitatively describe metatarsal diaphyseal morphology.

Methods:

Twenty fresh-frozen adult cadaveric below knee specimens were utilized to assess the size and shape of the diaphysis of metatarsals 1-4. There were 10 male and 10 female specimens with a mean age of 75.8 years. No limbs had outward signs of prior injury/surgery, radiographic signs of Charcot neuroarthropathy or previous fracture. Metatarsals 1-4 were excised, cleaned of all soft tissue and then axially transected at the point of most narrow external diameter. The diaphyseal canal shape was categorized as round, oval, triangular, or pear. The widest distance between two endosteal cortical surfaces was measured.

Results:

Triangular endosteal canals were only found in the 1st metatarsal whereas the remainder of metatarsals canals were largely round or oval. The mean diameter of the 1st metatarsal was 9.08 ± 1.26 mm. The mean diameter of the 2nd metatarsal was 4.72 ± 0.82 mm. The mean diameter of the 3rd metatarsal was 4.53 ± 0.88 mm. The mean diameter of the 4th metatarsal was 4.51 ± 1.10 mm.

Conclusion:

Intramedullary fixation by internal beaming of the columns of the foot can provide anatomical alignment with stabile fixation in cases of patients with Charcot arthropathy. Our study has given the smallest average diameter for metatarsals one through 4. This data is helpful when determining what size fixation to choose to achieve the maximum screw-endosteal purchase for column beaming in Charcot reconstructions.
Clinical and Radiographic Outcomes of the Infinity Total Ankle Arthroplasty System
Authors: Asaad Asaad , Kakwani Rajeshkumar , Murty Aradhyula N. , Townshend David
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

We report our early results of the Infinity Total Ankle Arthroplasty (TAA) system, a third generation, constrained implant, recently introduced to the UK market.

Methods:

All ankles were uncemented and standard instrumentation was used. Patients were reviewed at 3, 6 and 12 months for radiological and clinical assessment including Ankle Osteoarthritis Score (AOS), Visual Analogue Scale (VAS) and subjective component of AOFAS Ankle/Hindfoot score.

Results:

Mean age was 66 (range 42-88), 14 females and 21 males. The mean follow-up 12 months (range, 4-18 months), and no patients were lost to follow-up. The diagnosis was post-traumatic in 15 cases, primary osteoarthritis in 15 and inflammatory arthritis in 5 cases. Preoperative coronal alignment deformity was < 10 degrees in 54%, 10-20 degrees in 43% and >20 degrees in 3%. Mean AOS score improved from from 64 to 24, AOFAS score improved from 19/70 to 49/70 and VAS from 7.0 to 2.0. Tibial component subsidence was noted in 1 case (3%), and asymptomatic periprosthetic lucent lines in 6 cases (17%). No ankles were revised. Complications included intraoperative medial malleolar fracture (8.5%), delayed wound healing (14%), tibial osteotomy non-union (3%), and regional pain syndrome (3%). The mean radiographic coronal plane alignment of the tibial component was 1.9 degrees varus (range, 5.3 varus to 1.7 valgus) and its mean sagittal plane alignment 2.8 (range -1.7 to 8.5) degrees dorsiflexion.

Conclusion:

Our early experience has demonstrated good patient outcomes, low complication rate and reproducible alignment with the Infinity implant.
Clinical Comparison of the Two-Stranded Single Krackow and Four-Stranded Double Krackow Techniques for Acute Achilles Tendon Ruptures
Authors: Kim Hak Jun , Lee Tae Hoon , Park Young Hwan , Choi Gi Won
Published: October 2016

Category:

Sports

Introduction/Purpose:

Introduction: Several different configurations of the Krackow stitch have been used for acute achilles tendon rupture repair. Despite there are a few biomechanical studies comparing different Krackow stitch configurations, we could find no studies that have compared the clinical outcome of these different suture methods. This study aims to compare the clinical outcomes and complications of the two-stranded single Krackow and four-stranded double Krackow techniques.

Methods:

Materials and methods: We retrospectively reviewed 48 consecutive patients who underwent an open repair using the two-stranded single Krackow (17 pateints) or four-stranded double Krackow techniques (31 patients) between September 2011 and August 2014. Isokinetic strength of plantar-flexion and dorsiflexion of both ankles was assessed on a Cybex dynamometer at 6 months after surgery. Clinical outcomes were evaluated at 12 months postoperativly.

Results:

Results: There were no significant differences between groups with regard to patient demographics or activity levels prior to treatment. At the time of follow-up at one year, there were no significant differences in the American Orthopaedic Foot and Ankle Society ankle–hindfoot score and four-point Boyden scale. One case of rerupture and one case of superficial wound dehiscence occurred in the double Krackow group, but there was no complication in the single Krackow group. The mean peak torque deficits and work deficits in both plantar flexion and dorsiflexion showed no differences between the groups with any angular velocity.

Conclusion:

Conclusion: The two-stranded single Krackow and four-stranded double Krackow techniques for acute achilles tendon ruptures resulted in similar clinical outcomes and isokinetic strengths. The overall complication rates were low in both suture techniques.
Comparison of MRI and Operative Findings in Peroneal Tendon Disorders in a Military Population
Authors: Boomsma Shawn E.
Published: October 2016

Category:

Sports

Introduction/Purpose:

Peroneal tendon pathology is an overlooked cause of lateral ankle pain and a significant amount of patients are misdiagnosed at their initial visit. Previous studies have compared the magnetic resonance imaging (MRI) findings of peroneal tendon disorders to intraoperative findings with mixed results. The purpose of this study was to compare MRI findings of peroneal tendon pathology to intraoperative findings in an active duty military population.

Methods:

Active duty military servicemembers who underwent peroneal tendon exploration between 2009-2014 with a preoperative MRI were retrospectively reviewed. Studies were reviewed by a board certified radiologist who was blinded to the purpose of the study. MRI findings were then compared to surgical findings from operative reports. The following peroneal tendon pathologies were identified: peroneus brevis tears, peroneus longus tears, tendinopathy of either tendon, tenosynovitis, presence of peroneus brevis low lying muscle belly or peroneus quartus muscle and injury to the superior peroneal retinaculum. Concomitant procedures such as lateral ankle reconstruction, ankle arthroscopy, or osteotomies were also recorded. Comparative statistics were performed to correlate imaging and surgical findings.

Results:

Of 32 patients included, peroneus brevis and longus tears were the most common MRI finding while peroneus brevis tears and tenosynovitis were the most common surgical finding. Peroneus longus tears were found in 4 patients during surgery but seen in 12 patients on MRI. The sensitivity/specificity of MRI for peroneus brevis tears were 69% and 74% compared to 75% and 68% for peroneus longus tears. Tenosynovitis had a sensitivity of 9% and specificity of 95%. Twenty two patients (69%) had a low lying peroneus brevis muscle belly with 9 of those patients having a peroneus brevis tear. Of the 7 patients with peroneus quartus muscles identified in surgery, only 1 was seen on MRI and three had a tear of the peroneus brevis.

Conclusion:

In this study of active duty military personnel, we found similar results to previous published studies. MRI had a slightly lower sensitivity and specificity for diagnosing peroneus brevis tears while being slightly better for peroneus longus tears compared to previously published studies. We found significantly higher percentage of patients with a low lying peroneus brevis muscle belly than previous reported, with a 40% correlation to peroneus brevis tears. In patients with an identified low lying peroneus brevis or peroneus quartus on preoperative imaging, we recommend evaluation for associated tendon tears in active duty military servicemembers presenting with lateral ankle pain.
Gravity Stress Radiographs and Effect of Ankle Position on Deltoid Ligament Integrity & Medial Clear Space
Authors: Grimes J. Speight , Ashraf Mohammed A.
Published: October 2016

Category:

Trauma

Introduction/Purpose:

External rotation and gravity stress radiographs have been described to distinguish stable Supination External Rotation-II (SER-II) ankle fractures from unstable SER-IV fractures. It has been previously shown both external rotation and gravity stress views are equivalent in their ability to diagnose deltoid ligament injury. It has also been shown that the position of the ankle influences the external rotation stress radiograph. However, no data of ankle position exists for gravity stress radiographs.

Methods:

8 fresh-frozen cadaveric ankles were dissected and destabilized sequentially according to the SER mechanism of ankle fractures, starting with the anterior inferior tibiofibular ligament, distal fibula osteotomy at the level of the syndesmosis, posterior inferior tibiofibular ligament, superficial deltoid ligament, and finally the deep deltoid ligament. Fluoroscopic radiographs were taken with gravity stress views in both neutral and plantarflexion. Measurements of both dorsal and the medial clear space were taken for each stage. The difference between the dorsal and medial clear space was measured.

Results:

Positive predictive value (PPV) with a medial clear space cut off of 5 mm was 80% in plantar flexion and 72.72% in neutral with a negative predictive value (NPV) of 100% in both positions. Using 6 mm cutoff the PPV improved to 100% and NPV remained 100% for both neutral and plantar flexion. When the difference measurement is used a 1.0 mm difference yielded a PPV of 72% and a NPV of 100% in both neutral and plantarflexion. With a 1.5 mm cutoff the PPV and NPV was 100% for both positions

Conclusion:

The position of the ankle during gravity stress radiographs does not influence the clinical effectiveness of the images. By using larger references for stability, the PPV can be improved.
Intermediate Outcomes of Hydrogel Implant for Hallux Rigidus
Authors: Miniaci-Coxhead Sara Lyn , Glazebrook Mark A. , Younger Alastair S. , Penner Murray J. , Wing Kevin , Pinsker Ellie , Baumhauer Judith F. , Daniels Timothy R.
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus is the most common arthritic condition of the foot. Although a variety of great toe implants have been tried in an attempt to maintain toe motion, the majority have failed. In these cases, salvage to arthrodesis is more complicated and with a prolonged recovery. This prospective study assesses the intermediate efficacy and safety of a small (8/10 mm) hydrogel implant requiring minimal bone resection for moderate to severe hallux rigidus.

Methods:

Patients who underwent 1st MTP hemiarthroplasty with an organic polymer-based biomaterial implant (Cartiva), with at least five-year follow-up were contacted. Patients underwent a physical exam, and completed a pain visual analog scale (VAS) scale, SF-36, patient satisfaction questions, and the Foot and Ankle Ability Measure (FAAM).

Results:

Twenty-nine patients were available, with two lost to follow-up. The average time of follow-up was 5.3±0.5 years. The average age was 55.6±8.4, with 24(80%) females. The average VAS for pain improved from 64.6(±11.8) to 5.2(± 9.4) (p < 0.001). The average FAAM scores were: ADL subscale: 62.1(±16.4) to 95.8%(± 7.2) (p < 0.001); and Sports subscale: 40.2(±15.1) to 91.3%(±11.2) (p < 0.001); The average FAAM scores at follow-up for: Level of function during sports: 91.9%(±10.7); and Current level of function: 92.5%(±10.6). 69.2% of patients reported their level of function as normal, 26.9% nearly normal, and 3.8% abnormal function. Patients had 17.7 degrees of dorsiflexion, with a range of 12.7 to 22.7 degrees. Average peak dorsiflexion was 28.2°(±8.8). 92.3% stated they would undergo the procedure again.

Conclusion:

This study reports the mid-term results of an organic polymer-based biomaterial hemiarthroplasty implant for the management of hallux rigidus. Overall patients were very satisfied with the procedure. At an average of five years, patients are functioning very well, with limited pain and maintained motion of the 1st MTP joint. These results are promising as a viable alternative to fusion of the 1st MTP joint for management of moderate to severe hallux rigidus.
Intra-Osseous Arthrodesis Techniques in the Foot and Ankle
Authors: Haydel Christopher , Eremus Joseph , Lachman James R.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Arthrodesis is considered the standard operative treatment for end-stage arthritis in the foot and ankle. The long-term effects of implant choices for fusions are largely unexplored in the literature. Many companies advertise implants as being "lower profile" and "less painful." The purpose of this study was to perform a clinical and radiographic review to determine outcomes, specifically rates of symptomatic hardware, using four major arthrodesis techniques in joints in the foot and ankle.

Methods:

A retrospective study was conducted including one-hundred and twenty-three patients (a total of 197 joints) who underwent arthrodesis of the ankle, or joints in the midfoot or hindfoot. A total of 197 joints underwent arthrodesis in this patient group. Four groups were created based on fixation methods; standard screw fixation, plate and screw fixation, screw-in- post fixation(so-called "intra-osseous" fixation), and a group using a combination of fixation methods. Through chart review and radiographic analysis, outcomes including fusion rate, pain at specific follow-up intervals(6-weeks, 3-months, 6-months, and 1-year), and symptomatic hardware requiring hardware removal were compared across groups.

Results:

No differences were found in fusion rates between the four groups. Non-union rates, hardware loosening, infection, and wound breakdown rates were all comparable across the cohort. Rates of reported pain at 6-weeks and 3-months were similar for all groups but the "plate and screw fixation" group reported significantly more pain at 6 months(p=0.035) and 1 year(p=0.022) than the other three groups and, subsequently, rates of symptomatic hardware requiring removal were significantly higher in this group as well. The patient population had higher rates of diabetes mellitus, human-immunodeficiency virus (HIV) and hepatitis C virus (HCV) than reported in recent studies of comparable design.

Conclusion:

In this high risk patient population, implant choice in arthrodesis of the midfoot, hidfoot or ankle has a significant effect on patient-reported pain during follow-up. In this cohort, the group fused with intra-osseous fixation methods did not demonstrate superiority with regards to rates of patient-reported post-operative pain related to hardware. Clinicians should expect significantly increased rates of symptomatic hardware when using plate fixation in fusions of the ankle, midfoot and hindfoot.
Is There a Role for Preoperative CT Scans in Evaluating the Posterior Malleolus in Ankle Fracture- Dislocations?
Authors: Ketz John , Maceroli Michael , McVicker Zachary
Published: October 2016

Category:

Trauma

Introduction/Purpose:

Ankle fractures are common injuries and have a wide variety of fracture patterns. There is a high incidence of posterior malleolar fragments with ankle fracture-dislocations. There has been increasing interest in the role of the posterior malleolus in the treatment of ankle fractures. Controversies still exist on the operative indications and best method of fixation for these injuries. The current study evaluates the role of preoperative CT scans in evaluating and treating posterior malleolar fractures in this injury pattern.

Methods:

At our institution we initiated a protocol of obtaining post reduction computed tomography (CT) scans for all ankle fracture-dislocations with an associated posterior malleolus (PM) fractures to evaluate the fracture pattern and its role in determining operative treatment. The CT scans were evaluated for number of fragments, loose intra-articular fragments or impacted fragments, and displacement. Displacement was measured as the maximum distance noted on axial, sagittal, or coronal images. Information obtained from the CT scans was compared to the preoperative plain radiographs. Also, the authors evaluated the use of CT scans in preoperative planning with respect to positioning and surgical incisions.

Results:

A total of 51 ankle fracture dislocations with posterior malleolar fractures were evaluated. The size of the PM fracture measured on lateral radiographs was 24.19% compared 25.19%(p=0.75) based on the CT scan. Preoperative CT scans were able to identify loose or impacted intra-articular fragments in 19/51 cases (37%) that were not seen on plain radiographs. Multifragmentary (>2 fragments) PM fractures not appreciated on plain radiographs were found in 18 patients (35%). A total of 20 (39%) fractures were approached using direct posterior surgical exposures. The surgical plan was altered in 31% of patients based on the CT scan. Overall, PM fractures treated with direct reduction had significantly less residual displacement than those treated through indirect reduction techniques (0.4mm v 1.13mm; p=0.04).

Conclusion:

Posterior malleolar fractures in the setting of ankle fracture-dislocations can have complex patterns. While the overall size of posterior fragment was similar on plain radiographs and CT scan, the CT offered improved evaluation of the pattern in terms of multiple or loose intra-articular fragments. This had a direct impact on the surgical technique and approach. Improved reductions were also seen with direct posterior approaches.
Prospective Analysis of Isolated Gastrocnemius Recession for Achilles Tendinopathy; Intermediate Follow-up
Authors: Weisenthal Benjamin M. , Nawoczenski Deborah A. , DiGiovanni Benedict F. , Tome Josh , DiLiberto Frank E.
Published: October 2016

Category:

Ankle

Introduction/Purpose:

Gastrocnemius recession (GR) has emerged as a potential alternative to traditional surgical treatments in patients with recalcitrant Achilles tendinopathy (AT). Recent retrospective studies have shown positive results. However, there is limited long-term prospective data regarding the results of this surgery. We are reporting two-year results of a prospective analysis of isolated GR for Achilles tendinopathy on pain, self reported function, and satisfaction.

Methods:

8 patients (mean age 52± 10.2 years) with chronic unilateral AT (> 6 months duration) and an isolated gastrocnemius contracture participated. All subjects received a GR (Strayer) procedure. Data were collected pre- and post-operatively at 6 months and 2 years. Pain and function were assessed using the Visual Analog Scale(VAS) and the Foot and Ankle Ability Measure(FAAM). Clinical measure of calf endurance was assessed by single limb heel raises and compared to the uninvolved limb. Calf circumference was evaluated and patients were queried regarding satisfaction with the GR procedure and need for further treatment. Descriptive analysis was used to assess changes across the repeated timelines.

Results:

All subjects returned at 6 month follow-up and 7/8 patients participated in the final follow-up (mean 23 +/- 5.5 months). Pain was reduced by 50% at 6 months and 90% at 2 years; with 6 of 7 subjects reporting no pain. Pre-op FAAM ADL subscale was 75%, improving to 90% and 97% at 6 months and 2 years, respectively. Pre-op FAAM Sports subscale was 40%, improving to 69% and 87% at 6 months and 2 years, respectively. There were no side-to-side differences in the number of heel raises performed across time frames; involved mean 26 +/- 7, uninvolved 28 +/-6. Five (of seven) subjects reported complete satisfaction with the procedure and two were satisfied with minor reservations.

Conclusion:

To our knowledge, this is the first study to prospectively evaluate an isolated GR for Achilles tendinopathy and present 6 month and 2-year follow-up data. Pain relief was markedly decreased and maintained at 2 years. FAAM ADL activities were restored to normative values. However, scores for the FAAM sports subscale remained slightly below normative values and may reflect patient reported difficulties with higher-level activities such as jumping and lateral movements. High satisfaction can be expected for the majority of patients, however patients engaged in higher demand activities may have a prolonged recovery period and persistent limitations.
Revision Arthrodesis in the Foot and Ankle
Authors: O’Connor Kathryn , Klein Sandra E. , Johnson Jeffrey E. , McCormick Jeremy J.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Arthrodesis is a common surgical procedure used to manage arthritis and deformity in the foot and ankle. Nonunion or failure of the bone to fuse, is a known possible outcome in any arthrodesis surgery and often presents as persistent pain and swelling after an arthrodesis procedure. Published rates of nonunion in the foot and ankle literature range from 0 to 47 % depending on the patient population and joint involved. Multiple factors can contribute to developing a nonunion including; arthrodesis location, fixation method, tobacco use, diabetes, infection and others.

Methods:

The case logs of three fellowship trained foot and ankle surgeons were reviewed from January 2007 to September 2014. ICD-9 code 733.82 (nonunion fracture), 998.89 (miscellaneous complication), and a word search for nonunion in case logs were used to identify subjects. The clinical charts were reviewed for patient factors incuding: diabetes, inflammatory arthropathy, tobacco use, history of infection, prior nonunion elsewhere in the body, neuropathy, Charcot arthropathy, post-traumatic arthritis, and prior attempt at revision arthrodesis at the same clinical site. Surgical records were reviewed to identify location of the nonunion, type of instrumention, use of structural allograft, use of cancellous autograft (CA), use of iliac crest bone marrow aspirate (ICBMA) and use of orthobiologics such as bone morphogenetic protein (BMP) during the revision arthrodesis. Successful revision was defined as radiographic union in the final x-ray taken during follow-up by the attending orthopaedic surgeon and radiologist.

Results:

Eighty-two cases of revision arthrodesis were identified. The overall nonunion rate during revision arthrodesis was 23%. The average length of follow up was 16 months. Univariate analysis was performed on the patient and surgical factors to determine influence on nonunion rates. Of these factors, statistical analysis identified only neuropathy and prior attempts at revision as significant risks (P< .05) for persistent nonunion. Odds ratio calculated based on previous attempts at revision arthrodesis found a 2.8 fold increase in the risk of failure for each previous attempt at revision. Charcot arthropathy approached significance at p=.051, but was limited by its small sample size (n=2). Smoking, location, use of orthobiologics and other clinical factors did not prove significant. Please see table for further details.

Conclusion:

Revision arthrodesis for nonunion in the foot and ankle can be highly successful (77%) under a variety of patient and surgical conditions. Neuropathy is a significant patient risk factor for persistent nonunions and is important to identify even in the non-diabetic patient. As the number of attempts at revisions increases there is a subsequent 3-fold increase in the risk of persistent nonunion.
Serial CT Evaluation for the Reduction of the Distal Tibiofibular Joint after Open Reduction and Positional Pinning in Ankle Injuries
Authors: Ahn Jiyong , Kim Ju Yeong
Published: October 2016

Category:

Trauma

Introduction/Purpose:

Postoperative malreduction of syndesmotic disruptions in the rotational ankle fractures can make the poor functional outcome. There were many efforts to evaluate the quality of syndesmotic reduction with computed tomography (CT). However, there were few studies to show the acceptable range of syndesmotic reduction with CT. The aim of this study to investigate the reduction of the distal tibiofibular joint after open reduction and positional pinning with anterolateral approach in rotational ankle injuries and show acceptable range of syndesmotic reduction.

Methods:

This study included axial CT images of 104 patients (104 ankles) with rotational ankle fractures which were obtained in both ankles including uninjured ankle between 2012 February and 2014 June. At 10 mm proximal to the tibial plafond, anterior, middle, posterior shortest distances (aTFD, mTFD, pTFD) between fibula and tibia were measured and compared with those of uninjured ankles preoperatively, immediate postoperatively and at the followup after removal of syndesmotic fixation. The shortest distance from the anterior border of the fibula to the connecting line between most prominent point of anterior tibia and most prominent point of lateral fibula (ATF) were measured and compared in both ankles preoperatively, immediate postoperatively and at the followup after removal of syndesmotic fixation. The clinical outcomes were evaluated with AOFAS hindfoot score and visual analogue scale for pain.

Results:

Mean preoperative aTFD, mTFD, pTFD were 3.4±0.5 mm, 6.2±2.4 mm, 10.3±2.9 mm respectively. Mean immediate aTFD, mTFD, pTFD were 1.4±0.3 mm, 2.9±0.5 mm, 5.1±2.0 mm respectively. Mean postoperative aTFD, mTFD, pTFD at the followup after pin removal were 2.4±0.5 mm, 3.6±1.0 mm, 6.3±2.9 mm respectively. Mean ATF were 0.5±0.1 postoperatively. Both aTFD and mTFD significantly improved immediate postoperatively and at the followup after removal of syndesmotic fixation. However mean pTFD was widened compared to uninjured ankle. All postoperative clinical outcomes were improved significantly.

Conclusion:

Open reduction and positional pinning with anterolateral approach in rotational ankle injuries could show the good clinical outcomes and posterior tibiofibular diastasis could be allowed in terms of syndesmotic reduction if there is no anterior translation of fibula with improved anterior and middle tibiofibular distance at the axial CT images.
Subject-Specific Orientations of the Talocrural Joint Axes Estimated from the Morphology of the Talar Trochlea
Authors: Nozaki Shuhei , Watanabe Kota , Katayose Masaki
Published: October 2016

Category:

Ankle

Introduction/Purpose:

The individual morphology variations in the talar trochlea influence subject-specific kinematics of the talocrural joint. In particular, it is suggested that the medial to lateral radius ratios of the anterior and posterior talar trochlea determine the orientations of the dorsiflexion and plantarflexion axes of the talocrural joint, respectively. However, the characteristics of the orientations of these axes of the talocrural joint have not been elucidated. The aims of this study were to assess the variations in the medial to lateral radius ratios of the anterior and posterior talar trochlea and to estimate the subject- specific orientations of the dorsiflexion and plantarflexion rotational axes of the talocrural joint.

Methods:

Computed tomography (CT) images of forty-nine unilateral adult human male tali were enrolled in this study. The three-dimensional bone models of the talus were reconstructed from the CT images. Four circles were fitted to medial and lateral edges of each anterior and posterior trochlea, respectively. Then, the radii of curvatures of these circles were measured. The medial to lateral radius ratios of the anterior and posterior trochlea were also calculated, respectively. In addition, the line connecting the centers of the medial and lateral circles fitted to anterior trochlea was defined as a dorsiflexion axis of the talocrural joint, and that of posterior trochlea was also defined as a plantarflexion counterpart. The coronal and transverse angles of these axes were calculated.

Results:

At the anterior trochlea, the medial to lateral radius ratio was ranged from 0.43 to 0.92. This result of the calculated values meant that the all of the lateral curvature of radius was larger than medial counterpart. On the other hand, at the posterior trochlea, the medial to lateral radius ratio was ranged from 0.58 to 1.63. The coronal and transverse angles of dorsiflexion axis were on average 19.6 ± 7.3° (range, -3.9° to 38.9°) and 10.3 ± 4.6° (range, -0.9° to 23.2°), respectively. The coronal and transverse angles of plantarflexion axis were on average -1.5 ± 12.8° (range, -31.8° to 31.0°) and 7.5 ± 4.5° (range, -3.4° to 17.4°).

Conclusion:

This study found different features between orientations of the dorsiflexion and plantarflexion axes of the talocrural joint. Concretely, in all the talus specimens, the dorsiflexion axis of the talocrural joint is inclined downwards and laterally on the coronal plane, and inclined backwards and laterally on the transverse plane. On the other hand, there were two types of the plantarflexion axis, one was a type whose axis inclined as the same direction as dorsiflexion axis, and the other was a type whose axis inclined downwards and medially on the coronal plane and inclined backwards and laterally on the transverse plane.
Excellent T-cell reconstitution and survival depend on low ATG exposure after pediatric cord blood transplantation
Authors: Admiraal Rick , Lindemans Caroline A. , van Kesteren Charlotte , Bierings Marc B. , Versluijs A. Birgitta , Nierkens Stefan , Boelens Jaap Jan
Published: October 2016

Key Points

Immune reconstitution after CBT is excellent provided ATG exposure is low or absent. Individualized dosing, or omission of ATG in selected patients, may increase the chance of survival after CBT.
RETRACTED ARTICLE: The effect of n-3/n-6 polyunsaturated fatty acids on acute reflux esophagitis in rats
Authors: Zhuang Ze-Hao , Xie Jing-Jing , Wei Jing-Jing , Tang Du-Peng , Yang Li-Yong
Published: October 2016

Background

Polyunsaturated fatty acids (PUFAs) play various roles in inflammation. However, the effect of PUFAs in the development of reflux esophagitis (RE) is unclear. This study is to investigate the potential effect of n-3/n-6 PUFAs on acute RE in rats along with the underlying protective mechanisms.

Methods

Forty Sprague Dawley rats were randomly divided into four groups (n = 10 in each group). RE model was established by pyloric clip and section ligation. Fish oil- and soybean oil-based fatty emulsion (n-3 and n-6 groups), or normal saline (control and sham operation groups) was injected intraperitoneally 2 h prior to surgery and 24 h postoperatively (2 mL/kg, respectively). The expressions of interleukin (IL)-1β, IL-8, IL-6 and myeloid differentiation primary response gene 88 (MyD88) in esophageal tissues were evaluated by Western blot and immunohistochemistry after 72 h. The malondialdehyde (MDA) and superoxide dismutase (SOD) expression in the esophageal tissues were determined to assess the oxidative stress.

Results

The mildest macroscopic/microscopic esophagitis was found in the n-3 group (P < 0.05). The expression of IL-1β, IL-8, IL-6 and MyD88 were increased in all RE groups, while the lowest and highest expression were found in n-3 and n-6 group, respectively (P < 0.05). The MDA levels were increased in all groups (P < 0.05), in an ascending trend from n-3, n-6 groups to control group. The lowest and highest SOD levels were found in the control and n-3 group, respectively (P < 0.05).

Conclusion

n-3 PUFAs may reduce acute RE in rats, which may be due to inhibition of the MyD88-NF-kB pathway and limit oxidative damage.
How to Integrate Elotuzumab and Daratumumab Into Therapy for Multiple Myeloma
Authors: Hofmeister Craig C. , Lonial Sagar
Published: October 2016

Purpose

Treatment options and outcomes for patients with multiple myeloma have dramatically improved over the past decade with new agents and drug targets for patients at all stages of disease. Incorporation of newly approved monoclonal antibodies is a clinical challenge because the trials used to gain approval are relatively limited in scope and may be less helpful for patients treated in the United States. This article will review data on the use of elotuzumab and daratumumab and provide a foundation for their use in current clinical practice.

Methods

We performed a review of current published articles and abstract data from clinical trials as well as data on managing adverse events.

Results

Single-agent activity was seen when using daratumumab in refractory myeloma, and trials for both elotuzumab and daratumumab have demonstrated significant activity when combined with proteasome inhibitors and immunomodulatory agents. Unique antibody-related adverse events and challenges are reviewed and discussed.

Conclusion

These antibodies already have had and will continue to have a dramatic impact on myeloma treatment. Combination therapy likely represents the best approach for their use, and trials that evaluate optimal timing and duration of therapy are in progress as part of induction, salvage, and maintenance therapy.
Complex cis-regulatory landscape of the insulin receptor gene underlies the broad expression of a central signaling regulator
Authors: Wei Yiliang , Gokhale Rewatee H. , Sonnenschein Anne , Montgomery Kelly Mone't , Ingersoll Andrew , Arnosti David N.
Published: October 2016

Insulin signaling plays key roles in development, growth and metabolism through dynamic control of glucose uptake, global protein translation and transcriptional regulation. Altered levels of insulin signaling are known to play key roles in development and disease, yet the molecular basis of such differential signaling remains obscure. Expression of the insulin receptor (InR) gene itself appears to play an important role, but the nature of the molecular wiring controlling InR transcription has not been elucidated. We characterized the regulatory elements driving Drosophila InR expression and found that the generally broad expression of this gene is belied by complex individual switch elements, the dynamic regulation of which reflects direct and indirect contributions of FOXO, EcR, Rbf and additional transcription factors through redundant elements dispersed throughout ∼40 kb of non-coding regions. The control of InR transcription in response to nutritional and tissue-specific inputs represents an integration of multiple cis-regulatory elements, the structure and function of which may have been sculpted by evolutionary selection to provide a highly tailored set of signaling responses on developmental and tissue-specific levels.
A network of conserved formins, regulated by the guanine exchange factor EXC-5 and the GTPase CDC-42, modulates tubulogenesis in vivo
Authors: Shaye Daniel D. , Greenwald Iva
Published: October 2016

The C. elegans excretory cell (EC) is a powerful model for tubulogenesis, a conserved process that requires precise cytoskeletal regulation. EXC-6, an ortholog of the disease-associated formin INF2, coordinates cell outgrowth and lumen formation during EC tubulogenesis by regulating F-actin at the tip of the growing canal and the dynamics of basolateral microtubules. EXC-6 functions in parallel with EXC-5/FGD, a predicted activator of the Rho GTPase Cdc42. Here, we identify the parallel pathway: EXC-5 functions through CDC-42 to regulate two other formins: INFT-2, another INF2 ortholog, and CYK-1, the sole ortholog of the mammalian diaphanous (mDia) family of formins. We show that INFT-2 promotes F-actin accumulation in the EC, and that CYK-1 inhibits INFT-2 to regulate F-actin levels and EXC-6-promoted outgrowth. As INF2 and mDia physically interact and cross-regulate in cultured cells, our work indicates that a conserved EXC-5−CDC-42 pathway modulates this regulatory interaction and that it is functionally important in vivo during tubulogenesis.
ECONOMIC AND TARGET DETERMINATION IN THE ORGANIZATION OF REPRODUCING SYSTEMS
Authors: Таранов Алексей , Taranov Aleksey , Политикова Наталья , Politikova Natalya
Published: October 2016

The article presents the theoretical and methodological approaches to the forming modern concept of nature-use based on adaptive management of the natural environment. In this case natural environment is considered as a complex self-organizing system with a high degree of uncertainty reaction (response) to an external managing influence. Based on the interpretation of the Godel´s applied theorem, we can conclude that it is necessary to develop a multivariate optimal environmental management mechanism with the dominance of adaptive management mechanisms and minimizing the extreme and, a fortiori, robust control techniques.

The territorial development concept, based on the primacy of environmental acceptability of projects, is dominant in the modern civilized world. It is based on the need to include the assimilative capacity of the natural environment in the processes of economic activity as a mandatory resource with relevant financial and economic parameters. The approach presented in the article allows to ensure optimization of economic activity on the basis of taking into account the rent component in the value of produced effect of socio-economic activities.

Technocratic paradigm of economic activities objectively creates the conditions for increasing environment load. Under the climatic conditions of most of the regions, specified load is critical, creating a threat of loss by the natural environment of its assimilative capacity, which leads to environmentally dangerous and sometimes disastrous consequences: the depopulation of the biotic environment, mutagenic effects, and growth the risk of endemic pathologies. Methodology outlined in the article allows to use it as content in the simulation models development and physical modeling of economic processes related to the intensive nature-use.

The article may be useful in the development of territory organization projects, regional planning and the target complex programs of regional development.
Summary 19(3)
Authors: Gonçalves Sergio Eduardo de Paiva
Published: October 2016

Summary Brazilian Dental ScienceIssue 19Volume 3July, August and September
Short term secular change in body size and physical fitness of youth 7–15 years in Southwestern Poland: 2001–2002 and 2010–2011
Authors: Ignasiak Zofia , Sławińska Teresa , Malina Robert M.
Published: October 2016

Short term secular change in body size and physical fitness of Polish youth 7-15 years of age resident in an industrial region of Lower Silesia in southwestern Poland was considered across two surveys, 2001-2002 and 2010-2011. Subjects were students in the same schools in both surveys 1892 boys and 1992 girls in the first and 1237 boys and 1236 girls in the second. In addition to height and weight, performances in six fitness tests were measured in each survey. Height, weight and BMI increased significantly across surveys. Statistically controlling for secular gains in height and weight, only static strength (hand grip) and running speed - agility (shuttle run) improved significantly between surveys in three age groups (7-9, 10-12, 13-15 years), while explosive power (standing long jump) showed negligible changes except in girls 13-15 years among whom performances declined significantly. Speed of upper limb movement (plate tapping), flexibility (sit and reach) and trunk strength (sit-ups) declined between surveys, except for trunk strength in boys 13-15 years which did not change. In conclusion, after statistically controlling for secular gains in body size, physical fitness items changed variably over the decade.
The semi-Lagrangian method on curvilinear grids
Authors: Hamiaz Adnane , Mehrenberger Michel , Sellama Hocine , Sonnendrücker Eric
Published: October 2016

We study the semi-Lagrangian method on curvilinear grids. The classical backward semi-Lagrangian method [1] preserves constant states but is not mass conservative. Natural reconstruction of the field permits nevertheless to have at least first order in time conservation of mass, even if the spatial error is large. Interpolation is performed with classical cubic splines and also cubic Hermite interpolation with arbitrary reconstruction order of the derivatives. High odd order reconstruction of the derivatives is shown to be a good ersatz of cubic splines which do not behave very well as time step tends to zero. A conservative semi-Lagrangian scheme along the lines of [2] is then described; here conservation of mass is automatically satisfied and constant states are shown to be preserved up to first order in time.
Dying of ash (Fraxinus excelsior L.) in the ‘Jesionowe Góry’ Nature Reserve
Authors: Orzechowski Michał , Kacprzak Jakub , Kędziora Wojciech
Published: October 2016

The aim of this study was to analyse changes in the health status of ash stands belonging to the age classes VI and VIII growing in optimal site conditions and to compare the ash dieback with other age classes in the Jesionowe Góry Nature Reserve. Our research was conducted during the growing season in 2006 and 2007 on 22 permanent and 54 temporary sample plots. The health condition of the stands and the structure of natural regeneration were determined with a one-year interval. The amount of damage was defined using leaf loss, pest infestation and shoot dieback. Based on our estimation of natural regeneration, the capability for stand evolution in the future was determined.
Global repertoires and urban fluidity: youth languages in Africa
Authors: Nassenstein Nico , Hollington Andrea
Published: October 2016

The linguistic practices and creativity of youths reflect an amazing way of dealing with the dynamics of urban and global African city life. Communities of practice (CoP) emerge, in which global trends, local concepts and cutting-edge styles, identities of resistance and contested spaces all play a role and impact on the linguistic practices of youths. The implementation of linguistic manipulative patterns that are often acquired from other youth languages, as well as strategies such as translanguaging, borrowing, language crossing and bricolage, brought about through local, global and pan-African contact and trends, including music cultures such as Hip Hop and Reggae, have molded youth identities and urban practices. The focus of this article is on youth languages found in Addis Ababa (Ethiopia) and Kinshasa/Goma (DR Congo), where the multilayered range of social and linguistic impacts of globalization has led to new linguistic practices and identities. Both speakers’ fluid patterns of contact and manipulation across digital (Facebook, WhatsApp, YouTube, Twitter) and real spaces, and their manipulative strategies in the formation of new “repertoires”, are analyzed in the article. Youth languages, especially in the African context, have usually been described as modern, urban and fluid. We argue that these characteristics also hold for other linguistic practices and non-urban contexts, and that youth languages differ in terms of the speed and manner in which these processes and modifications occur or are deliberately employed.