bluuebunny/crossref_metadata_2025 huggingface dataset:
There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability
Authors: Shah Ashish , Cone Brent , Netto Cesar de Cesar , Araoye Ibukunoluwa , Hudson Parke , Sahranavard Bahman , Pinter Zachariah , Jones Caleb , Bergstresser Shelby , Lee Sung
Published: September 2017

Category:

Ankle

Introduction/Purpose:

Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair.

Methods:

This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test.

Results:

Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively.

Conclusion:

Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.
Management of Hepple Stage V Osteochondral Lesion of Talus with Platelet-Rich Plasma (PRP) Scaffold
Authors: Shi Zhongmin
Published: September 2017

Category:

Ankle

Introduction/Purpose:

There is no consensus on treatment or prognosis for Hepple stage V Osteochondral lesion of talus (OLTs), especially for lesion more than 1.5 cm2. This research was to investigate surgical techniques and clinical outcomes of platelet-rich plasma (PRP) scaffold for Hepple stage V OLTs.

Methods:

14 patients were treated by cancellous bone graft with PRP gel scaffold between 2013 and 2015 with average age of 38.9 years old and mean set of 23.5 months. Ankle X-ray and MRI were obtained at the final follow-up for evaluation. Functional outcomes were scored by the Visual Analog Scale (VAS) score, American Orthopaedics Foot and Ankle Society (AOFAS) ankle- hindfoot score and Short Form (36) Survey score (SF-36). Range of motion (ROM) of ankle joint and complications were also recorded.

Results:

13 patients got the final follow-up with a mean duration of 18 months. MRI showed complete regeneration of subchondral bone and cartilage in all patients. The post-operative VAS, AOFAS ankle-hindfoot score and SF-36 score improved significantly (P<0.0001) without obvious complications.

Conclusion:

We suggest that for the patients of Hepple stage V OLTs, cancellous bone graft with PRP scaffold may be a safe and effective treatment.
Scaffolds Based Therapy for Osteochondral Lesion of Talus
Authors: Shimozono Yoshiharu , Yasui Youichi , Kennedy John
Published: September 2017

Category:

Ankle, Arthroscopy, Basic Sciences/Biologics

Introduction/Purpose:

Numerous surgical treatment strategies for osteochondral lesions of the talus (OLT) have been proposed, but ideal treatment has yet to be established. Scaffold based-therapy for OLT is quickly becoming more popular as a new approach for reparative treatment. The purpose of this study was to systematically review published literature reporting clinical outcome of scaffold based-therapy for OLT and establish whether sufficient evidence exists to support use of scaffolds for OLT.

Methods:

A systematic search of the MEDLINE and EMBASE databases was performed in June 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), variable reporting outcome data and clinical outcomes. Modified Coleman Methodology Score (MCMS) was used to evaluate the QOE.

Results:

Twenty-five studies with 678 ankles were included; 96% were either LOE 3 or 4, and all studies were of poor or fair QOE. There were 6 different scaffold repair techniques, including one-step and two-step procedures. The categories of general demographics (93%) and patient-reported outcome data (84%) were well reported. The study design and imaging data were less reported with 72% and 78% respectively. Clinical variables (50%) and patient history (30%) were the least reported in studies. Clinical outcomes were evaluated using a number of different scoring systems. The weighted mean AOFAS score improved from 60.5 ± 6.3 preoperatively to 86.9 ± 8.4 at a weighted mean 41.3 month follow-up. Six studies reported that weighted mean 71.6% of patients returned to sport activity at previous level.

Conclusion:

This systematic review demonstrated that there is a lack of supporting data to justify current scaffold based therapy for treatment of OLT, although a lot of available commercial scaffolds for OLT exist. Further well-designed studies are necessary to determine the effectiveness of scaffold based therapy for OLT, especially compared with the available traditional treatments.
Clinical Implication of Os subfibulare
Authors: Shin Hyuk Soo , Lee Dong Yeon , Lee Doo Jae
Published: September 2017

Category:

Ankle, Sports, Trauma

Introduction/Purpose:

Os subfibulare, defined as a separated ossicle of the distal fibular, has been linked to various clinical problems such as subfibulare pain and chronic lateral ankle instability. However, whether os subfibulare is congenital or traumatic remains unclear. The objectives of this study were: 1) to determine the incidence of os subfibulare development after ankle sprain in children and adolescents in a single primary care orthopedic clinic, and 2) to evaluate clinical implication of os subfibulare associated with ankle sprain in children and adolescents

Methods:

Among 896 pediatric patients (age ranging from 3 to 16 years) who visited a single primary care unit after sustaining ankle inversion injury, 627 patients who were followed up for over 2 weeks were included in this study. For each pediatric patient, physical examination and radiographic examination (anteroposterior, lateral, and mortise view of the bilateral ankle) were performed. The incidence of os subfibulare was evaluated based on initial radiographic examination. To analyze the incidence of new os subfibulare formation after ankle inversion injury, radiographs of 193 patients who were followed up for more than 6 months were evaluated according to the grade of injury.

Results:

At initial visit, 1% of examined ankles (13 from 1,254 ankles of 627 patients) showed well corticated ossicle not related to initial injuries. We cannot recognize the existence of accessory ossification center of the fibula in our study population. Overall incidence of os subfibulare at final follow up after ankle inversion injury was 23.9% (150/627). Os subfibulare at final follow up was correlated with initial injury grade (OR: 8.0, p = 0.001). In patients with initial avulsion fragment, 64.9% (61/94 cases) had residual ossicle at the final radiograph after being followed up for more than 6 months. As for the morphology of ossicle, 54 cases with wafer bone fragment at the time of initial injury showed oval or round shape ossicles at final radiograph.

Conclusion:

The incidence of os subfibulare at the initial radiograph was about 1%. The chance of ossicle formation after ankle inversion injury was substantially high in pediatric population. Based on the findings of our study, we carefully suggest that majority, if not all, of os subfibulare would be posttraumatic in pediatric period. Therefore, ankle inversion injury in children should be managed more actively to reduce the chance of posttraumatic os subfibulare formation.
Comparison of Fixation Stability of the Novel Lisfranc Plate to Transarticular Screws
Authors: Shymon Stephen , Harris Thomas , Cassinelli Spenser , Ebramzadeh Edward , Fleming John , Agrawal Virat , Sangiorgio Sophia
Published: September 2017

Category:

Midfoot/Forefoot, Trauma

Introduction/Purpose:

The objective of this study was to compare the stability of fixation of ligamentous Lisfranc injuries stabilized using two devices: a novel Lisfranc plate and conventional transarticular screws.

Methods:

A biomechanical cadaver model was developed to compare the fixation stability of a novel Lisfranc plate to that of traditional fixation, using transarticular screws. Thirteen pairs of cadaveric specimens were tested intact, after a simulated injury, and after implant fixation. Optical motion tracking was used to measure the three dimensional (3D) motion between each of the following four bones: first metatarsal, second metatarsal, first cuneiform, and second cuneiform. Testing included both cyclic abduction loading and cyclic axial loading.

Results:

Both the Lisfranc plate and screw fixation method provided stability such that the average 3D motions across the Lisfranc joint (between the second metatarsal and the first cuneiform), were between 0.2 and 0.4 mm under cyclic abduction loading and between 0.4 and 0.5 mm under cyclic axial loading. Comparing the stability of fixation between the Lisfranc plate and the screws, the differences in motion were all 0.3 mm or lower, with no significant differences (p > 0.16).

Conclusion:

Average 3D motions of the Lisfranc joint were 0.5 mm or below, whether fixed with the Lisfranc plate or the screws. Therefore, the Lisfranc plate provided comparable stability to the transarticular screws, which have been established as the gold standard for arthrodesis in Lisfranc injuries. Due to its anatomical placement, the Lisfranc plate may provide adequate support without risk of iatrogenic injury to the articular cartilage.
Intramedullary fibular fixation is a versatile tool in the operative management of fractures of the distal tibia and fibula
Authors: Singh Anjani , Smith Michael , Hakim Zuned
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

Intramedullary fixation of the fibula has been proposed as a minimally invasive alternative to traditional plate fixation in fractures of around the ankle. Previous studies have demonstrated a low complication rate, particularly when both distal locking and trans-syndesmotic screws are used. More recently, they have been used to act as a lateral buttress to prevent valgus malunion in fractures of the distal tibia and fibula. After four years of using fibular intramedullary devices in our unit we set out to audit our practice.

Methods:

We retrospectively searched our electronic operation database for operations in which fibular nails were used, from their first use in our unit in 2012 through to the end of 2016. Electronic operative and clinic notes were reviewed. We gathered basic demographic information and classified fractures according to the AO/OTA system, and studied pre- and post-operative radiographs for evidence of malunion.

Results:

Eighteen cases were identified. Median age at surgery was 66 (Range 23 to 83 years). Seven patients smoked, one was diabetic. Fibular nails were used in six in AO type 44 and twelve in AO type 42 and 43 fractures. Five were open. Fibular nails were used alongside tibial IM nails, tibial bridging plates, percutaneous tibial fixation and a tibial circular frame and were chosen because of concerns about poor soft tissues or wounds over the lateral side. Twelve cases had syndesmotic fixation. Median follow-up was five months (range 0-48 months). One nail was removed to compress a tibial fracture. All fractures united with no progressive malunion. One prominent distal locking screw was removed and one superficial wound infection required oral antibiotics.

Conclusion:

We have expanded the use of this device beyond the technique originally described. It’s use has been demonstrated across a range of fractures about the distal tibia and fibula in a variety of different operations with excellent results. Minimally invasive fibular nailing is particularly useful in patients with poor soft tissues or where there is high risk of post-operative infection.
Radiographic analysis of Hallux valgus. A study on foot arch by severity
Authors: Takahiro Yamada , Usami Norio , Hiroko Ikezawa , Takatori Naoko , Hiraishi Eiichi , Inokuchi Suguru
Published: September 2017

Category:

Bunion

Introduction/Purpose:

X-ray measurement for hallux valgus has been conducted with various results in the evaluation. However, it was not quite clarified yet and it still remains questionable why a mild case shifts to a severe case during the course. We report about the difference between the severity and the foot shape.

Methods:

The study subjects were 206 feet of 138 patients. Mild case: 80 feet, mean age 53 y.o (A) Moderate case: 61 feet, 62 y.o (B) Severe case: 65 feet, 67 y.o (C) For the examination items, HVA, M1-2 angle, and M1-5 angle were measured with the x-ray frontal radiograph for loading position, and First, Second, Fifth intermetatarsal angle (M1Y/M2Y/M5Y) on sagittal plane were also measured. We also evaluated the foot arch ratio with Yokokura Method, then compared/examined those results after dividing the cases into the mild, moderate, and severe group with age bracket.

Results:

The age of Group C were older than Group A, B. M1-2 angle: In younger generation, three is significant difference between Group A and B. M1-5 angle: Significant in 60 s between A and B. In 70 s, significant: all group. Navicular height: all group is low arch with aging. Significant between A and C It is becoming low arch at Lisfranc level with aging in all group. There is significantly low height at M5 with aging in all group. On sagittal plane, bone axis of M1 and M2 is lowered at 40 s in Group A and B and 70 s in Group C.

Conclusion:

In hallux valgus, the foot shape was changed in coronal and sagittal plane. It means the collapse of bone structure at foot and ankle. It may possibly be shifting to a severe case with aging. However, we could not find any result definitely suggesting such condition.
Treatment Of Intra-Articular Calcaneal Fractures Using Sinus Tarsi Approach And Only Screws
Authors: Urbina Christian , Olmedo Cristian , Gallardo Fernando Vargas , Lagos Leonardo , Chaparro Felipe , Soto Christian Bastias , Parra Mauricio , Rivera Maximiliano
Published: September 2017

Category:

Hindfoot, Trauma

Introduction/Purpose:

Displaced intra-articular calcaneal fracture have been usually treated with open reduction and internal fixation using extensile lateral approach, however this management has been associated with high rates of soft tissues complications. Minimally invasive approaches might be an alternative to reduce these complications and improve the outcomes. Our aims were to describe the radiological and clinical outcomes of patients with intra-articular calcaneal fractures treated with a minimally invasive surgical technique. To determine if the Böhler’s angle is restored and maintained through the time. To determine the posterior facet joint reduction using CT scan. To report the frequency the soft tissue complications, days of hospitalization after the surgery, and the need of secondary procedures or additional admissions using this technique.

Methods:

Retrospective review of patients with intra-articular calcaneal fractures treated with sinus tarsi approach and fixation only with screws between January 2014 and July 2016. Twenty fractures in 15 patients were included. The clinical files and imagenology studies were analized.

Results:

The mean age was 47 years. Eighteen males and 2 females. One open fracture. Ten smoker patients. Two with diabetes mellitus. Ten cases were joint depression fractures and 10 were tongue fractures of the Essex Lopresti classification. Ten cases were Sanders II and 10 Sanders III. The mean Böhler’s angle was 2º preoperative, 22º in the postoperative and 19º at the last follow up. Postoperative posterior facet joint reduction was good o excellent in 19 cases. The mean days of hospitalization was 2.9. Two cases needed hardware removal. One patient had minor soft tissue complications. No patient had major complications.

Conclusion:

Our experience showed a low soft tissue complications rate, an adequate correction of the posterior facet joint reduction and adecuate correction and maintenance of the Böhler’s angle, few days of hospitalization after the surgery, and no need of secondary surgical procedures due to acute complications. We conclude this is a suitable alternative in order to reduce the soft tissue complications with accurate correction and preservation of the radiological parameters.
The painful total ankle replacement
Authors: Vulcano Ettore , Myerson Mark
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

The last decade has seen a considerable increase in the use of in total ankle arthroplasty (TAA) to treat patients with end-stage arthritis of the knee. However, the longevity of the implants is still far from that of total knee and hip arthroplasties

Methods:

To introduce a systematic approach to the painful TAA based on the literature and on the senior author’s experience

Results:

See algorithm attached

Conclusion:

This new diagnostic and treatment algorithm may be useful to guide less experienced surgeons navigate through the possible causes and treatments of a painful TAA
Surgical Outcomes of Severe Turf Toe Injuries in High-Level Football Players
Authors: Waldrop Norman , Smith Kenneth
Published: September 2017

Category:

Sports

Introduction/Purpose:

Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without surgical intervention, there are instances where surgery is required to allow the athlete to return to play. Surgical turf toe repair restores the continuity of the plantar plate structures, re-establishes stability, and simultaneously addresses any sesamoid pathology or cartilage lesions. Although there is extensive literature on turf toe injuries and its nonoperative management, there are currently no reports on surgical outcomes in athletes larger than three to four patients.

Methods:

After obtaining Institutional Review Board approval, we attained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. Our patient population consisted of thirteen patients. Their charts were reviewed for age, BMI, level of competition, injury mechanism (if known), football position, setting of injury (practice or game) and playing surface. In addition, we recorded the specifics of the surgical procedure, a listing of all injured structures, the surgical implants used and the great toe range of motion at final followup visit. In addition, a followup survey was administered to all patients.

Results:

The average patient was 19.5 years old with an average followup time of 21.4 months. Our group consisted of six linemen and seven skill position players. There was one semiprofessional player, ten collegiate players and two high school players. Eight of the 13 patients had complete rupture of both fibular and tibial phalangeal sesamoid ligaments while five patients had a partial injury. Seven of the patients had a suture only primary repair while in six patients suture anchors were utilized. The average playing time missed was 16.4 weeks. No patient had to stop playing football or change positions due to the injury or surgery. At final followup, the average patient had a VAS pain score of 0.21.

Conclusion:

Severe turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. The injuries sustained and procedures performed were variable in our patient population but every player was able to return to play at a high level with the use of a custom orthotic placed inside their cleat. This study represents the largest cohort of operatively treated severe turf toe injuries in the literature and demonstrates that good clinical outcomes can be expected with surgical repair.
Does Hardware Removal Improve Function Following Ankle Open Reduction and Internal Fixation?
Authors: Williams Benjamin , Chau Michael , McCreary Dylan , Cunningham Brian , Peña Fernando , Swiontkowski Marc
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

Orthopaedic hardware removal (HWR) is one of the most common orthopaedic procedures performed, with rates reported between 5% and 16%. Despite the high rates of HWR, there is still no consensus or guideline for removal after osseous healing without infection. Outcome studies for HWR are scarce, particularly in the lower extremity. The purpose of this study is to evaluate the effect of removal of symptomatic ankle hardware using the Short Musculoskeletal Function Assessment (SMFA) dysfunction index as the primary outcome. We hypothesize that HWR after ankle fracture will result in improved functional outcomes.

Methods:

Utilizing a prospectively collected ankle fracture registry, all patients that underwent HWR between 2013 and 2016 were retrospectively reviewed. Inclusion criteria were skeletal maturity, closed intra-articular ankle fracture, symptomatic ankle hardware and completion of the SMFA questionnaire prior to and 5-months after hardware removal. Exclusion criteria were development of a nonunion, infection or complex regional pain syndrome from initial surgery. The primary outcome was change in SMFA score from baseline. Paired t-test was used to compare baseline and follow-up SMFA scores. A multiple linear regression model evaluated the effects of age, sex, body mass index (BMI), smoking status, number of comorbidities, and Lauge-Hansen fracture classification on outcomes.

Results:

The study included 43 patients (31 females, 12 males), mean age 49.9 (range, 19 to 83). Mean time from initial surgery to HWR was 37±46 months (range, 2.2 to 209). Follow-up SMFA questionnaires were completed 5.7±0.5 months (range, 5.1 to 7.4) after HWR. The fractures were classified as 23 (53%) supination-external rotation, 6 (14%) pronation-external rotation, 2 (4.7%) pronation-abduction and 1 (2.3%) supination-adduction. Eleven fractures (26%) were classified as pilons. The SMFA dysfunction index improved significantly from baseline to follow-up (3.71±7.4, p=0.002). Significant improvement was seen in the secondary outcomes of SMFA bother index (4.40±8.9, p=0.003) and SMFA daily activities domain (4.12±9.1, p=0.006). Regression analysis revealed a significant improvement in the bother index correlating with female gender (p=0.01) and decreasing number of comorbidities (p=0.03).

Conclusion:

Our study demonstrates that patients with ankle fractures have a significant improvement in function following the removal of symptomatic ankle hardware. Patients also showed a significant improvement in the bother index and daily activities domain of the SMFA. Further investigation into the specific indications for HWR and the impact of injury and fracture pattern on outcomes is warranted.
Publications Rates for Podium and Poster Presentations from the American Orthopaedic Foot and Ankle Society
Authors: Williams Benjamin , Kunas Grace , Deland Jonathan , Ellis Scott
Published: September 2017

Category:

Other

Introduction/Purpose:

National orthopaedic meetings are used to disseminate current research. These abstracts are commonly intended to go on to full-text publication in peer-reviewed journals. Several studies have reviewed the abstract to full-text journal publications for orthopaedic society meetings and reported a 34% to 73% publication rate. This has not been studied for the foot and ankle literature. The purpose of this study is to determine the full-text journal publication rates of podium and poster presentations from the American Orthopaedic Foot and Ankle Society (AOFAS) Annual meetings between 2008 and 2012.

Methods:

All abstracts submitted to and subsequently accepted for podium and poster presentations from the 2008 to 2012 AOFAS annual meetings were compiled from the AOFAS and the published meeting programs. In May 2016, PubMed searches were performed using individual key words in the abstract title with all authors’ names. The results were reviewed for matches to the meeting abstracts with regards to content similarities. Time to full-text publication was recorded. Full-text publication rates for podium and poster presentations were calculated per year. The top journals of publication for podium and poster abstracts were calculated. Continuous data was summarized using mean ± standard deviation and categorical data was summarized using counts and percents. Difference in publication rates between podium and poster presentations was determined by an odds ratio.

Results:

From 2008 to 2012, 1262 abstracts were submitted to the annual meeting. The overall abstract publication rate was 62.4%: 73.7% for podium abstracts and 55.8% for poster abstracts. Podium presentations were significantly more likely to be published compared to posters (p< 0.0001; odds ratio 2.17, 95% CI, 1.64-2.86). Mean time to publication was 1.53 and 1.37 years for podium and poster presentations, respectively (p=0.124). The three most common journals for published podium abstracts were Foot and Ankle International (FAI) (50.4%), Journal of Bone and Joint Surgery (JBJS) (13.0%) and The American Journal of Sports Medicine (AJSM) (4.3%). For poster abstracts, the three most common journals were: FAI (36.9%), Journal of Foot and Ankle Surgery (9.4%) and Foot and Ankle Specialist (8.5%).

Conclusion:

Podium abstracts were over two times more likely to be published compared to poster abstracts. The overall full- text publication rate for the AOFAS was one of the higher reported rates compared to other national orthopaedic society meetings. The significance of the high full-text publication rate is unclear; it may reflect the quality of presented material or commitment to publication by the authors. The top journal for podium and poster abstracts was FAI, indicating the presentations’ specialty-focus.
Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type IV Intra-articular Calcaneal Fractures
Authors: Woo Seunghun , Chung Hyung Jin , Bae Su-Young , Goh Tae Sik
Published: September 2017

Category:

Trauma

Introduction/Purpose:

To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA).

Methods:

Between March 2003 and November 2013, 22 patients with 22 Sanders type IV intra-articular calcaneal fractures were included in this study. Of these, 11 feet were treated with ORIF (ORIF group), 11 feet were treated with ORIF and PSTA (PSTA group). The mean follow-up periods was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot Scale (AOFAS score), the Visual Analog Scale Pain score (VAS score) at 6-, 12 month, and last follow-up. The patient satisfaction, returning to previous occupation and postoperative complications were also investigated.

Results:

Complete bone union were achieved in all patients. No statistical difference was found between the results for ORIF compared with PSTA: the mean preoperative Bohler angle were, respectively, -3.2±9.2 and -6.6±12.7 degrees (p=0.475); the mean last follow-up AOFAS scores were 73.8±14.9 and 80.5±4.6 (p=0.795); the mean VAS last follow-up VAS scores were 29.7±20.6 and 23.4±10.0 (p=0.986). Secondary subtalar arthrodesis were conducted in 5 patients (45.5%) of ORIF group due to subtalar osteoarthritis symptom within 2 years, postoperatively.

Conclusion:

We were unable to demonstrate a significant difference of clinical outcomes between ORIF and PSTA however, the patient satisfaction was higher in the PSTA group. PSTA may be considerable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.
The Significance of Intraoperative First Metatarsal Traction Test in Hallux Valgus Surgical Decision Making
Authors: Xinyu Li , Yan Alan
Published: September 2017

Category:

Bunion

Introduction/Purpose:

To investigate the significance of using an intraoperative first metatarsal traction test in hallux valgus correction surgery in decision making of the procedure choice and operation designs.

Methods:

From Jun 2015 to Jun 2016, correction surgery performed in patients with hallux valgus 40 cases with 68 feet. We used the intra-operative first metatarsal traction test to judge the grade of laxity of the 1st TMT and the factual IMA and thus help to make the decision of the level of osteotomy and or fusion. We adopted distal Chevon osteotomy (11 cases 16.2%) when the congruence of the surface of the 1st MPJ remains more than ½ under tension with the traction test. Proximal Scarf osteotomy (54 cases 79.4%) was used when the congruence was less than ½. While if there was a complete incongruent dislocation, Lapidus procedure (3 cases 4.4%) was carried out. We measured IMA and HVA in the patients preoperative, intraoperative, 3 days after operation and at 6 months’ follow-up. Same measurements were done on the 40 patients from the same time without traction test

Results:

Retrospective review of the 2 groups showing significant improvement (p<0.001) but more reliable larger correction of IMA angles in the intraoperative traction test group. The patients of the intraoperative traction test group had average higher satisfaction rate with more reliable improvement of symptoms and less postoperative complications. Significant improvement (P<0.001) and postoperative AOFAS score average of 93.2 was recorded in traction test method group vs. a 84.3 in control group. The traction test group largely retained the correction in half year follow up which is significant when comparing to the control

Conclusion:

The intraoperative traction test of first metatarsal objectively guided the decision making of procedure choice and operation design optimization. The traction test gave a reliable assessment of the laxity of first TMT thus avoiding inadequate correction of Hallux Valgus with improper surgical designs. The test can be potentially used as an objective intraoperative guidance in avoidance of inadequate correction with inappropriate surgical choices and thus maintain the correction in the long term with patient satisfaction
Lost Wages Secondary to Ankle Arthritis in Patients Undergoing Ankle Fusion or Replacement
Authors: Younger Alastair , Wing Kevin , Veljkovic Andrea , Penner Murray , Gagné Oliver
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

Wait lists for consultation and surgery for ankle arthritis are often over three years in our Province. While waiting for surgery patients may become unemployed and lose income. Earlier consultation and earlier treatment may allow these patients to return to work. The purpose of this paper is to calculate the lost wages annually and over the remaining working lifetime of a cohort of patients, and use this to extrapolate the lost wages for patients undergoing ankle arthritis surgery in the Province of British Columbia.

Methods:

Using data from an ankle outcome database, patients under the age of 60 were studied. Employment was recorded at the time of surgery, at 2 years, and an average 6.7 years follow up. Using the MODEMS instrument, patients self classified as (1) working, (2) on leave of absence, (3) unemployed, (4) homemaker, (5) student, (6) Retired (not due to ill health), (7) disabled or retired due to ill health. Items 2,3,7 were considered unemployed and items 1,4,5,6 employed. Using annual rates of ankle arthritis surgery from our Province of 4.6 million people, the cumulative lost income was determined using the statistics Canada website (http://www12.statcan.gc.ca/nhs-enm/2011). Lost wages were calculated from the time of surgery until 75. All figures are quoted in Canadian dollars.

Results:

127 of 276 database patients (46%) were under the age of 60 at the time of surgery. The average age was 51 years. 61 (48%) were unemployed. 2 years after surgery the unemployment rate was 42% and remained a similar rate at mean 6.7 years after surgery. There were 140 ankle arthritis operations in 2013 in our Province. Using the database rates the lost wages the working lifetime of these patients is $ 22.8 million. Using prior statistics (FAI 2015) the total surgical cost of ankle arthritis surgery in the Province is $ 1.1 million (1/20th the lost income). The cumulative lost wages per million population per year for ankle arthritis is 4.9 million dollars, and the money spent on surgery is 0.24 million dollars.

Conclusion:

The lost wages within the ankle arthritis population is of concern with regards to productivity, as well as the mental health and financial stability of these patients and their families. Earlier access to care may maintain the employment status in this patient group. Once patients are out of the work force it is very hard for them to return. The money spent on surgery is 1/20th of the lost wages.
Treatment Outcomes of Buttress Plating for Posterior Pilon Fractures
Authors: Yu Guang-Rong , Zhang Mingzhu
Published: September 2017

Category:

Ankle

Introduction/Purpose:

The purpose of current study was to retrospectively analyze the clinical outcomes of buttress plate treatment of posterior pilon fractures

Methods:

Between January 2005 and December 2009, 16 patients with posterior pilon fractures underwent buttress plate fixation. There were 11 males and 5 females and the mean age was 37.6 years (range, 23 to 62 years). Preoperative radiographs, CT scans and three dimensional reconstructions were used to evaluate the fracture patterns. On the basis of the extension of the fracture lines presented on the CT scans, a posterolateral approach or a combination of both posterolateral and posteromedial approaches were used to reduce and fixate the posterior malleolar fragments. Clinical and radiographic examinations were used for postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Visual Analogue Scale (VAS) were used to evaluate the functional outcomes.

Results:

According to the CT scan images, the posterior pilon fractures were classified into 3 types. 14 patients were available for follow-up. The mean time of follow-up was 37.6 months (range, 16 to 52 months). The mean AOFAS score was 86.4 points (range, 70 to 98 points), and the mean VAS score was 1.4 points (range, 0 to 3 points). One patient was found with ankle joint swelling and long term walking discomfort at 2-year follow-up. Other patients received favorable functional outcomes. No hardware failure occurred.

Conclusion:

The clinical outcomes of buttress plate treatment of posterior pilon fractures were satisfactory. Buttress plating availed the patients to return to earlier weight-bearing and functional exercises.
Surgical treatment for Müller-Weiss Disease
Authors: Zhang Mingzhu , Yu Guang-Rong
Published: September 2017

Category:

Midfoot/Forefoot

Introduction/Purpose:

Müller-Weiss disease is an uncommon osteonecrosis of the tarsal navicular of unknown etiology. The surgical treatment is introduced when conservative treatments are failed.

Methods:

From January 2005 to Septermber 2014, we treated 49 patients suffering from Müller-Weiss disease, using the surgical arthrodesis of the talonavicular joint and naviculocuneiform joint with tricortical autologous iliac crest block fixed by screws and plate. They were 15 males and 34 females with a median age of 52.4 years. According to the Maceira staging system, 6 feet was grade 2, 20 feet were grade 3, 19 feet were grade 4, and 4 feet were grade 5.We reviewed the medical records of the patients and took the radiological preoperative and postoperative evaluation. The preoperative and postoperative clinical functions were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot Scale. To treat Müller-Weiss disease, we introduced a surgical arthrodesis of the talonavicular joint and naviculocuneiform joint with tricortical autologous iliac crest bone block fixed by screws and plate.

Results:

The median follow up was 26 months. All the feet fused solidly. The median time for complete fusion was 13 weeks. The median AOFAS ankle-hindfoot score improved from 45 points preoperatively to 86 points at last follow-up. But the symptoms free duration took 9 months in average.

Conclusion:

In conclusion, the results of this series demonstrate the arthrodesis of the TNJ and NCJ with tricortical autologous iliac crest graft is a reasonable way for treatment of Müller -Weiss disease. Based on our experience with the patients, we believe that emphasis of the restoration of the length and alignment of the medial column could achieve a good outcome. The surgeon should consider the increased risk of pain along with its associated morbidity and discuss this with the patient preoperatively when considering arthrodesis.
Kinetics and biomarkers of severe cytokine release syndrome after CD19 chimeric antigen receptor–modified T-cell therapy
Authors: Hay Kevin A. , Hanafi Laïla-Aïcha , Li Daniel , Gust Juliane , Liles W. Conrad , Wurfel Mark M. , López José A. , Chen Junmei , Chung Dominic , Harju-Baker Susanna , Cherian Sindhu , Chen Xueyan , Riddell Stanley R. , Maloney David G. , Turtle Cameron J.
Published: September 2017

Key Points

Characterization of the kinetics and risk factors for severe CRS after CD19 CAR T cells will facilitate preemptive therapy and management. Severe CRS is characterized by endothelial activation.
Characteristics of tracheostomy phonation valves
Authors: Prigent H. , Orlikowski D. , Blumen M. B. , Leroux K. , Legrand L. , Lejaille M. , Falaize L. , Ruquet M. , Raphael J-C. , Lofaso F.
Published: September 2017

Phonation valves are commonly used devices that allow the restoration of speech in tracheostomised patients. However, their use should not compromise the physiological benefit of tracheostomy.

Six commercialised phonation valves were studied in a dynamic set-up simulating a respiratory frequency of 20 breaths·min−1, a tidal volume of 0.5 L and a peak flow rate of 0.5 L·s−1. Resistance and additional work of breathing (WOB) were calculated. In 10 tracheostomised patients, evaluations using no phonation valve (baseline), and the most and one of the least resistive valves were carried out. Respiratory patterns and gas exchanges were recorded. Inspiratory difficulty was evaluated using the modified Borg scale.

Valves displayed a wide array of resistance ranging 1.3–5.9 cmH2O·L−1·s−1. Additional WOB varied with a ratio of 4.4 between the best and the worst valve. While the different clinical conditions did not modify respiratory patterns and gas exchanges, a significant effect on the Borg scale rating was observed using ANOVA andpost hocanalysis of baselineversusworst valve and one of the best valvesversusworst valve.

In conclusion, the variety of aerodynamic characteristics of phonation valves should be considered when choosing the device, according to the underlying condition of the patients benefiting from their use.
Allopurinol improves endothelial function in sleep apnoea: a randomised controlled study
Authors: El Solh A. A. , Saliba R. , Bosinski T. , Grant B. J. B. , Berbary E. , Miller N.
Published: September 2017

Increased oxidative stress in obstructive sleep apnoea is thought to contribute to endothelial dysfunction. The objective of this study was to test the hypothesis that inhibition of xanthine oxidase by allopurinol can improve endothelial function in patients with obstructive sleep apnoea.

A randomised double-blind placebo-controlled crossover study was performed on 12 patients with moderate-to-severe obstructive sleep apnoea, comparing 300 mg allopurinol daily for 2 weeks with placebo. Endothelial function was assessed using hyperaemia-induced flow-mediated vasodilation (FMD) at baseline and following treatment. Plasma malondialdehyde levels were compared in order to assess significant changes in oxidative stress.

Baseline FMD correlated significantly with the severity of sleep apnoea and the time spent with an arterial oxygen saturation of <90%. Allopurinol caused a significant increase in FMD compared to placebo (10.4±3.2versus7.4±2.8%, respectively). Plasma malondialdehyde levels were significantly reduced with allopurinol treatment (1.5±0.3versus1.2±0.3 μmol·L−1), consistent with reduced oxidative stress.

Allopurinol improves endothelial dysfunction in patients with moderate-to-severe obstructive sleep apnoea. These observations suggest that xanthine oxidase contributes significantly to vasodilatory impairment.
Determining device position through minimal user input
Authors: McNaughton James , Crick Tom , Hatch Andrew
Published: September 2017

In many co-located, collaborative systems there is a need for the constituent devices used to be aware of the physical positions of their networked counterparts. This paper addresses this challenge by presenting a novel method of utilising users’ judgement of direction to obtain the location and orientation of a touch interface. The technique requires a user to draw several arrows on an interface which point towards physical landmarks in an environment. This allows for the setup of interface locations in a way which is (i) quick; (ii) inexpensive; (iii) not encumbering; and (iv) capable of being performed despite obstructions in the environment. A user study is presented which investigates what influence a user’s accuracy has on the technique’s resulting calculated location of an interface. The study reveals that the magnitude of a user’s inaccuracies is proportional to the size of the error in the result and that there is no improvement in user accuracy with practice. Finally, we make observations on the future extension and application of this technique.
Envisioning the era of 3D printing: a conceptual model for the fashion industry
Authors: Sun Lushan , Zhao Li
Published: September 2017

The emergence of 3D printing technology in the fashion industries has led to a rapidly growing attention and discussion on its coming impacts, novel approaches and those relevant challenges involved in its supply chain integration. The purpose of this conceptual study is to examine the potential impacts and challenges of integrating Direct Digital Manufacturing methods, specifically 3D printing (3DP), in the fashion industry. To recognize and organize such integration, we first examine the nature of Direct digital manufacturing (DDM) in contrast to traditional manufacturing approaches. After that, a conceptual model applied to DDM integrated fashion industry was then proposed to address this change. With respect to 3DP, four areas of its direct and indirect impacts were prudently examined, which were primarily put on (1) design and product development, (2) sourcing and manufacturing, (3) retail, distribution and consumer, as well as (4) the sustainability optimization. The potential challenges of integrating 3DP, which ultimately leads to the DDM paradigm, in each of these areas were also evaluated. Beyond the identified impacts and challenges, this proposed conceptual model ultimately aims to help lay the groundwork, explore future research topics and curricula for the fashion field integrating DDM, focusing on the 3DP technology.
Preconditioned acoustic least-squares two-way wave-equation migration with exact adjoint operator
Authors: Xu Linan , Sacchi Mauricio D.
Published: September 2017

We have investigated the problem of designing the forward operator and its exact adjoint for two-way wave-equation least-squares migration. We study the problem in the time domain and pay particular attention to the individual operators that are required by the algorithm. We derive our algorithm using the language of linear algebra and establish a simple path to design forward and adjoint operators that pass the dot-product test. We also found that the exact adjoint operator is not equal to the classic reverse time migration algorithm. For instance, one must pay particular attention to boundary conditions to compute the exact adjoint that accurately passes the dot-product test. Forward and adjoint operators are adopted to solve the so-called least-squares reverse time migration problem via the method of conjugate gradients. We also examine a preconditioning strategy to invert extended images.
Revitalization of abandoned oil and gas wells for a geothermal heat exploitation by means of closed circulation: Case study of the deep dry well Pčelić-1
Authors: Macenić Marija , Kurevija Tomislav
Published: September 2017

The aim of our research is to use abandoned deep-hydrocarbon reservoirs and dry wells in the Croatian part of the Pannonian Basin as a geothermal energy source. Croatia has been exploring and exploiting hydrocarbon reserves in the Pannonian Basin from the mid-20th century. Therefore, many oil and gas wells are reaching the end of their production phase and many are already abandoned. These wells could be considered for geothermal energy production through the coaxial heat exchanger principle, which is usually used in shallow geothermal energy extraction. Using the abandoned deep well Pčelić located in the Drava subbasin as a case study, we have derived the available energy and fluid temperature changes during 20 years of operation for two cases: one with a constant base heat load throughout the year and the second as a variable heat load depending on outside air temperatures. We determined that the maximum potential heat extraction in a variable system is 1750 MWh per year, with 1.5 MW of peak heating power in winter, depending on the sink temperature, climate, and consumer input data. The maximum theoretical constant heat extraction for possible industrial direct heating could be 400 kW during the entire period of 20 years, with fluid temperature reaching steady state at a favorable 50°C. To define steady-state ratio between extracted heat and consumed energy at the circulating pump, we evaluated seasonal performance factor (SPF) analysis similar to heat pump systems. Lower values of SPF linked to a higher flow rate implies higher energy extraction. Our results show that when using a lower flow, steady-state SPF ratio is as high as 280, and for a higher flow, steady-state SPF ratio drops to only 25.