bluuebunny/crossref_metadata_2025 huggingface dataset:
The Nursing Assessment of Medication Acceptance: the reliability and validity of a schizophrenia medication adherence scale
Authors: Hori Hikaru , Ueda Nobuhisa , Shiozuka Hideki , Igata Ryohei , Miki Tazuko , Atake Kiyokazu , Takeuchi Yuji , Shirozu Hiroaki , Ohara Naotoshi , Konishi Yuki , Nagai Hiroshi , Sakurai Noriaki , Kubota Takanori , Yoshimura Reiji
Published: October 2016

Background:

Many patients with schizophrenia have low medication adherence. There is, however, no objective assessment scale that can be used by nurses or caregiver specialists. The Nursing Assessment of Medication Acceptance (NAMA) was developed to assess patients’ medication adherence. The aim of this study was to examine the validity and reliability of the NAMA in patients with schizophrenia.

Methods:

A total of 121 Japanese patients with schizophrenia were enrolled. All patients underwent evaluation using the NAMA and the Drug Attitude Inventory (DAI-10). Reliability was investigated using a test-retest method and a parallel-test method. To determine the test-retest reliability of the NAMA, we tested 101 schizophrenia patients twice, with the second assessment 2–4 weeks after the date of the first assessment. For validity verification, standard-related validity and the degree of concordance with the DAI-10 scores were measured.

Results:

The Cronbach’s alpha value of the NAMA in schizophrenia was 0.88. The test-retest correlation coefficients were all between 0.53–0.74. The total scores and all subscores for the NAMA were significantly correlated, and the NAMA total scores were significantly correlated with the DAI-10 total scores.

Conclusions:

The NAMA shows good reliability and validity in measuring medication adherence in schizophrenia.
Pain may be an important factor to consider in inflammatory bowel disease patients troubled by fatigue
Authors: Jelsness‐Jørgensen Lars‐Petter , Frigstad Svein‐Oskar , Moum Bjørn , Grimstad Tore , Opheim Randi , Jahnsen Jørgen , Bernklev Tomm
Published: October 2016

Background

Pain has been associated with fatigue in many chronic diseases, but data are not available for inflammatory bowel disease (IBD). The aim of this study was to investigate whether fatigue is associated with pain in IBD after adjusting for the relevant covariates.

Methods

Participants were recruited from nine hospitals in the south‐eastern and western part of Norway. Socio‐demographic variables were self‐reported by patients. Disease activity was assessed by disease activity indices and faecal calprotectin. Patient‐reported outcomes (PROs) were collected using the Fatigue Questionnaire (FQ), Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS) and Basic Nordic Sleep Questionnaire.

Results

From a total of 452 invited patients, 414 (91.6%) provided written informed consent. After excluding any missing data, 408 total patients were included in the analyses (ulcerative colitis = 180 and Crohn’s disease = 228). In the crude analysis, substantial and chronic fatigue were associated with increased pain intensity regardless of the diagnosis. However, when controlling for relevant covariates in the ANCOVA, the differences in pain intensity among patients with and without substantial or chronic fatigue were insignificant. The Cohen’s d effect size was small to moderate (>0.20) in patients with chronic fatigue.

Conclusions

Despite a tendency of elevated pain intensity scores among patients with fatigue, these differences were insignificant after controlling for the relevant covariates. However, based on Cohen’s effect size, these differences may be of clinical importance in a subset of patients.
Trainee logbook analysis reveals regional operative experience
Authors: Yamamoto Hidekazu , Datta Soumendra N , Maan Zafar , Junaid Islam , Webster Jeff , Greenwell Tamsin , Kavia Rajesh
Published: October 2016

Objective:

Indicative operative numbers have become a new benchmark for higher surgical training. The aim of the deanery-led audit was to assess our regional operative experience using trainee logbooks against indicative number standards and to develop a tool to help guide regional training.

Subjects and methods:

Annual logbook data were collected using a questionnaire from urology trainees in a single region. Logbook data were excluded for an incomplete entry or work at multiple trusts in the same year. Logbooks were assumed to be current and validated. Analysis of variance (ANOVA) was used for statistical analysis.

Results:

Altogether 24 trainees across 19 different training sites responded to the questionnaire. A total of 9777 indicative procedures were included in the analysis. Median annual operative numbers were lower than required for 10/13 procedures, but mean annual operative numbers were higher than required for only 1/13 procedures (andrology). Significant variation in annual operative numbers across training sites was observed for 6/13 procedures. Annual logbook data was used to rank training sites by procedure-specific volumes and likelihood of trainees to achieve the annual operative target.

Conclusion:

Trainee logbook data is useful for objective ranking of training sites. In our region, difficulty in surpassing indicative numbers would arise due to significant case number variation between training sites and not due to regional insufficiency in case numbers. Regular analysis of trainee logbooks would allow better management of regional training with respect to indicative numbers.
Methylmercury Exposure in Women of Childbearing Age and Children
Authors: Colvin N. Elizabeth , Mahan Pamela Lynn , Harris Jeffrey
Published: October 2016

As frontline clinicians, occupational and environmental health nurses play an important role in educating workers and the public about the dangers and toxic effects of environmental contaminants. One of these contaminants is methylmercury, which enters the body through the consumption of contaminated fish and seafood. Methylmercury affects the central nervous system where it may cause psychiatric disturbances, ataxia, neuropathy, and visual and hearing loss. Because their central nervous systems are rapidly developing, the most vulnerable subgroups are infants in utero, babies, and young children. Pregnant women and nursing mothers can directly expose their infants because methylmercury passes through the placenta to the infant and is also present in breast milk. The purpose of this article is to provide an overview for occupational and environmental health nurses and other health care practitioners about the causes and consequences of methylmercury exposure in women of childbearing age and children so that they can better educate workers about this environmental contaminant.
Tendon Resection and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair
Authors: Ryu Chang Hyun , Bae Seung Hwan , Seo Sang Gyo , Lee Ho Seong
Published: October 2016

Category:

Other.

Introduction/Purpose:

An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon, itself, as well as the thin surrounding soft tissue. For management of an infected Achilles tendon following tendon repair, we first focused on complete debridement with tenectomy and then promoted scar healing of the Achilles tendon using functional management.

Methods:

We retrospectively reviewed all of the medical records of 15 patients with post-operative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, twenty two to 97 months). Tenectomy with radical debridement was performed, and the ankle was placed in a short leg splint for two weeks. The splint was then replaced with an ankle brace for the next four weeks. Partial weight-bearing walking was allowed immediately, and full weight-bearing walking was allowed two weeks postoperatively. We assessed the physical parameters such as range of motion, the calf circumference, capability of single heel raising, satisfactions and the Arner Lindholm scale were recorded. Laboratory test, post- operative ultrasonography and isokinetic plantar flexion power was also checked.

Results:

At the final follow-up, any sign of infection had disappeared without recurrence in all of the patients. Achilles tendon continuity recovered in all by scar healing. Compared to the contralateral side, there was no difference in the range of motion in eight patients. According to the Arner Lindholm scale, nine of fifteen cases were excellent and the other six cases were good. Their ability regarding single-heel rising on involved leg was achieved in ten patients. Eleven of 15 patients could return to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity within the tendon sheath was observed on the ultrasonographic examination or MRI.

Conclusion:

Tenectomy of infected Achilles tendon and radical debridement with vigorous rehabilitation is simple and successful management way for the postoperative infection following Achilles tendon repair.
Is Cigarette Use Associated with Increased Complication Rates and Worse Functional Outcomes Following Total Ankle Arthroplasty?
Authors: Lampley Alexander J. , Gross Christopher E. , Green Cynthia , DeOrio James K. , Adams Samuel B. , Easley Mark E. , Nunley James A.
Published: October 2016

Category:

Ankle

Introduction/Purpose:

Tobacco use is a known risk factor for increased perioperative complications rates and having worse functional outcomes in many orthopaedic procedures. To date, no study has elucidated the effect of cigarette smoking on complications or functional outcomes scores after total ankle arthroplasty (TAA). The purpose of this study is to compare the rate of perioperative complications and outcome scores in nonsmokers, former smokers, and current smokers.

Methods:

We retrospectively reviewed the records of 642 patients who had TAA between June 2007 and February 2014 with a known smoking status. These patients were separated into three groups based on their smoking status: 34 current smokers, 249 former smokers, and 359 nonsmokers. Outcome scores and perioperative complications which included wound complications, talar component subsidence, periprosthetic infection, and periprosthetic bone cyst were compared between the groups.

Results:

When compared to nonsmokers, active smokers had a statistically significant increased risk of wound complications (Hazard ratio [HR] 3.5; p=0.03). Although the active smokers had an increased rate of talar component subsidence (HR 1.6; p=0.66) and persistent pain (HR 1.4; p=0.35), these findings were not statistically significant. Although all groups demonstrated improvement in outcome scores at 1 year and 2 year follow up compared to their preoperative scores, the active smokers showed statistically significant less improvement in their outcome scores than the nonsmokers and former smokers at 1 and 2 year follow up. Furthermore, there was no significant difference in the outcome scores or complications when comparing the nonsmokers to the former smokers.

Conclusion:

Patients with tobacco use undergoing TAA have a higher rate of perioperative complications and worse outcome scores compared to nonsmokers and former smokers. Furthermore, tobacco cessation appears to reverse the effects of smoking which allows TAA to be an effective and safe procedure for providing pain relief and improving function in former smokers as they have perioperative complication rates and outcomes similar to nonsmokers.
Noninvasive Measurement of Normal Foot and Ankle Joint Reaction Force
Authors: Ho Bryant S. , Maqsoodi Noorullah , Vasconcellos Daniel , Osman Walid , Fowler Xavier , Elfar John C. , Olles Mark , Ketz John , Flemister Adolph S. , Oh Irvin C.
Published: October 2016

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Various biomechanical studies have examined pressure changes across the foot and ankle joints. However, most of these studies disrupted the capsuloligamentous complex surrounding the joint to insert pressure sensors, compromising the integrity of the natural joint structure and the accuracy of biomechanical assessments. This is the first noninvasive study to report measurement of natural joint reaction forces (JRF) across the foot and ankle while preserving all soft tissue structures. Since articular surfaces experience equal and opposing compression forces, we aimed to evaluate the distraction force needed to overcome these compression forces.

Methods:

Ten fresh-frozen cadavers of the lower extremity were obtained that were disarticulated at the knee joint. Steinmann pins were percutaneously placed across the distal tibia, and the center of the talus, navicular, cuboid, and calcaneus while preserving all surrounding soft tissues. A custom fixation device was utilized in conjunction with a tensile testing machine to allow distraction in line with the axis of the tibiotalar, subtalar, talonavicular (TN), and calcaneocuboid (CC) joints. Displacement was measured as distance between Steinmann pins on either side of the joint examined. Under progressive axial distraction, displacement and force were measured. Best-fit polynomials were calculated to fit the force-displacement curves. The inflection point, representing the joint reaction force (JRF) where distraction forces across the joint equal the compression forces, was calculated for each curve.

Results:

All force-displacement curves demonstrated an inflection point. Prior to the inflection point, relatively large increases in distraction force resulted in minimal displacement. Once the inflection point was reached, relatively small increases in distraction force resulted in large increases in displacement. Each cadaver was measured three times with high reproducibility. The mean JRF were tibiotalar 33.8 N [standard deviation (SD) 10], subtalar 18.2 N (SD 12), TN 13.3 N (SD 4), and CC 14.7 N (5.8).

Conclusion:

We present the first application of a reliable and noninvasive method of measuring JRF of the foot and ankle joints. In the medium or small joints, dissection of the capsule and surrounding ligaments can significantly alter joint stability and biomechanics. By preserving all the periarticular soft tissues, this experimental model will allow future investigation of biomechanical changes of pathologic states and efficacy of surgical intervention under conditions that most accurately reflect the in vivo state.
Weight Bearing Compliance after Foot and Ankle Surgery
Authors: Gershkovich Grigory , Arango Dillon , Shaffer Gene W. , Ndu Anthony
Published: October 2016

Category:

Other

Introduction/Purpose:

Patients are frequently required to maintain a non-weight bearing (NWB) status after foot and ankle surgery in order to prevent post op complications. Adherence to these instructions is of paramount importance and lack of compliance may lead to wound breakdown, loss of fracture fixation, or hardware failure. Unfortunately due to a number of factors, patients are frequently unable to comply with their weight bearing (WB) requirements. Lack of compliance has recently been demonstrated in studies as it relates to either partial or NWB instructions. This study examined rates of non-compliance in a socioeconomically disadvantaged population with results showing an 88% non-compliance rate. We present preliminary data on WB compliance and further seek to identify demographic data and risk factors possibly contributing to this epidemic.

Methods:

Pressure sensing films (70-350 PSI) were used for this study. When pressure is applied, the film turns an intense pink color. After lower extremity surgery is performed patients are placed in a short leg plaster splint. The sensor is placed superficial to the plaster/webril. One sensor is placed beneath both the forefoot and one beneath the hind foot and the splint is then marked with an “S” to indicate study participation. Once the patient follows up, either the attending physician or a certified cast technician will retrieve the sensors for documentation. An additional sensor is placed on a non-weight bearing portion of the anterior tibia to serve as a control. After retrieval of sensors, results are analyzed by at least 4 team members to decide on WB compliance. Pink coloration of 30% or more is considered positive in our study.

Results:

At the time of this abstract, 25 patients had returned for follow up. 22/25 (88%) patients were found to have at least 1 out of 2 sensors positive. 13/25 (52%) had both forefoot and hind foot sensors positive. 3 patients had both sensors without any pressure changes. 5 patients had lost at least 1 sensor.

Conclusion:

To date, 88% of our patients have been found to be non-compliant with their weight bearing status instructions. The results of this study agree with previous studies demonstrating a high rate of non-compliance even after education and instruction. Our study exhibited a higher rate of non-compliance when compared to other studies, possibly due to patient demographics. More data is needed to ascertain the effect of certain risk factors in order to identify the proper method of patient education/instruction and to possibly create a standardized weight bearing compliance educational program.
Can Preoperative Risk Factors be used to Predict Unplanned Admission or Readmission Rates? A Study of Foot and Ankle Patients
Authors: Rofaiel James R. , Lau Johnny , Katchky Ryan , Rampersaud Raja
Published: October 2016

Category:

Other

Introduction/Purpose:

In the current health care climate, there is an increasing focus on cost savings and resource management. As such, there is an emphasis on decreasing length of stay and performing surgery on an outpatient basis. Consequently, some patients will have unanticipated intra-operative or post-operative adverse events that will necessitate an unplanned post-operative hospital admission or a readmission after discharge. These unplanned admissions or readmissions represent an increased burden on health care systems and can cause cancellation of other scheduled procedures. The purpose of this study is to investigate whether pre-operative patient risk factors or intra-operative events could predict unplanned admission or readmission following discharge in patients undergoing either elective or emergency foot and ankle surgery.

Methods:

Data was prospectively collected on a total of 889 patients. The patients were divided into two groups: patients without readmissions (N=791) and patients who had an unplanned admission or readmission (N=98). We also collected and analyzed the following variables: age, gender, BMI, diabetes, ASA class, surgery start time, length of surgery, regional vs. general anesthetic, elective vs. trauma surgery and type of procedure. Logistic regression models were used to identify risk factors that could independently predict unplanned admissions or readmissions to hospital following foot and ankle surgery.

Results:

Factors that could be used to independently predict readmission were length of surgery (p 0.0154, Odds Ratio 1.004) and trauma surgery (0.0167; 1.978). For every 1-hour increase in length of surgery, the odds of unplanned admission/readmission increase by 1.27 times. The odds of patients undergoing surgery for acute traumatic injuries getting readmitted are 1.978 times higher than for elective surgery patients.

Conclusion:

In conclusion, our study showed that pre-operative patient risk factors including BMI, diabetes, and ASA status were unable to predict whether patients would have an unplanned admission or readmission. The two factors that were able to predict whether patients would have an unplanned admission or readmission were length of the procedure and trauma surgery – both of which are not readily modifiable. Our results showed that in spite of institutional measures to ensure timely discharge, only 11% of patients required an unplanned admission or readmission.
Content Relevance of the Foot and Ankle Ability Measure in Patients with Achilles Tendon Diseases
Authors: Reb Christopher W. , Pedowitz David I. , Raikin Steven , Daniel Joseph N.
Published: October 2016

Category:

Sports

Introduction/Purpose:

The Foot and Ankle Ability Measure (FAAM) is a widely used evaluative, region-specific patient reported outcome measure. Its construct validity, test-retest reliability, and responsiveness are reasonably well supported in patients with a variety of lower extremity musculoskeletal conditions. However, since its development, the FAAM’s content relevance has never been subject to patient assessment. Therefore, this study was designed to assess the content relevance of the FAAM among patients with Achilles tendon diseases.

Methods:

IRB-approved, prospective, observational study of patients with Achilles tendon diseases. Subjects gave informed consent to complete a standard FAAM and a FAAM content relevance questionnaire. For each item of the relevance questionnaire, the standard FAAM’s visual analogue scale was replaced by a categorical scale asking subjects to rank the individual item as 1-Not Relevant, 2-Somewhat Relevant, or 3-Very Relevant to their lower extremity condition. The same was asked regarding both the entire ADL and Sports subscales, respectively. Descriptive statistics (mean, standard deviation) were calculated using pooled individual question scores and then 95% confidence intervals were constructed. Any individual item or subscale with a mean score above 2.0 was considered to have substantial content relevance. Floor and ceiling effects were deemed to have been present if 20% or more of patients gave all items of a subscale either the lowest or highest possible scores, respectively.

Results:

There were 59 respondents with mean age of 52.6 years (range, 28 to 79 years). Mean time from presentation to content relevance assessment was 19.6 weeks (range, 1 to 100 weeks). There were 39 (66%) surgical patients and 20 (34%) nonsurgical patients. Diagnoses included 28 (47%) rupture, 18 (31%) tendinosis, and 13 (22%) paratenonitis. 10 (17%) were pre- treatment and 49 (83%) post-treatment. For each individual item and subscale, the mean relevance was above 2.0 indicating substantial relevance. The 95% confidence interval crossed below this threshold for only one item, ‘Personal Care’ (mean 2.02, 95% CI 1.79 to 2.24). No floor effects were detected. Ceiling effects were apparent for only the Sports subscale (n=25,42.4%).

Conclusion:

These findings demonstrate that the FAAM has substantial item and subscale-level content relevance in patients with Achilles tendon diseases. Future work should aim to provide additional psychometric data specific to patients with Achilles tendon diseases in order to allow more precise use of the FAAM in this specific patient population.
A New Surgical Method for the End-Stage Ankle Arthritis–Total Ankle Arthroplasty with Artificial Talus
Authors: Tanaka Yasuhito , Takakura Yoshinori , Taniguchi Akira , Kurokawa Hiroaki
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) is a popular surgical treatment for the patients with end-stage ankle arthritis. Along with development of the implant, indication for TAA has been extended to the severe deformity due to osteoarthritis or rheumatoid arthritis. However, a certain rate of complication after TAA is still remaining. The main reasons for failed TAA are the complications of talar component such as aseptic loosening or subsidence. We developed artificial talar prosthesis and indicated for the patient with idiopathic necrosis of the talus. This time we applied this new implant combined with tibial component of the TAA for the patient with end-stage ankle arthritis having severe collapse of the talus. The purpose of this study is to evaluate the outcomes of TAA with artificial talus.

Methods:

【Materials】Thirteen patients (13 ankles) treated by TAA with artificial talus since 2007 to 2014 were investigated. The mean duration of follow-up was 35 months (range; 12 to 66 months). Twelve patients (12 ankles) were suffering from osteoarthritis of the ankle, and 1 was from rheumatoid arthritis. The mean age at the surgery was 71 year-old(range; 61 to 81 year-old). 【Methods】Clinical outcomes were evaluated by Visual Analog Scale (VAS) scores. Functional outcomes were assessed by scoring system produced by the Japanese Society for Surgery of the Foot (JSSF ankle-hindfoot scale) before surgery and at the final follow- up.

Results:

Postoperative VAS was improved from 8.9 to 2.3. Postoperative JSSF scale were improved from 41 to 87. There were no case that required the revision surgery due to implant failure or deep infection.

Conclusion:

The ankle has small joint surface compared with other weight-bearing joints, that causes the complications of talar component. For the patients with severe deformity or osteonecrosis of the talus, indications of TAA should be applied carefully. Patients of end-stage ankle arthritis with poor bone stock in the talus may have been unsatisfied with use of previous implant models of TAA. The artificial talus could be a possible option to solve this problem. In the current study, TAA with artificial talus remained favorable clinical and functional results for the patient with severe deformity or poor bone stock in the talus.
Comparative Analysis of Quality of Life, and Sport Activities, After Lower-Limb Joint Replacement
Authors: Besse Jean-Luc , Lomberget-Daubie Marie-Caroline , Bourdin Muriel , Chouteau Julien , Fessy Michel-Henry
Published: October 2016

Category:

Other

Introduction/Purpose:

For 30 years THA and TKA have been gold standards for severe osteoarthritis. Results are not better in TAA than in ankle arthrodesis according to meta-analysis. Ten year TAA survivorship improved from 80 to 90% but is still worse than in THA and TKA. It is generally thought that THA has better results than TKA and TAA but there have been few quality of life comparative studies. The present study compared functional results, quality of life (QoL) and sports capacity following ankle (TAA), hip (THA) and knee arthroplasty (TKA).

Methods:

Three continuous series (69 TAA, 716 THA, 121 TKA) operated on by 3 senior surgeons, from 2006 to 2011, were matched for age and follow-up. Patients older than 80 years, multiple arthroplasty in different joints, rheumatoid arthritis and revision of components were excluded. Questionnaires on general quality of life (SF-36, WOMAC, Bonnin's sports questionnaire) and specific function (AOFAS, FAAM, IKS function, Harris) were sent to 3 series (42 TAA, 132 THA and 60 TKA). Statistical analysis used JMP Pro 9.0.0 software. 95% of TAA (42 patients, FU 35±16.2 months, age 63±10.1 years), 82.9% of THA (132 patients, FU 31.5±6.7 months, age 64±8.4 years) and 86.6% of TKA patients (60 patients, FU 31.4±9.4 months, age 71.8±6.7 years) responded.

Results:

76.3% of TAA, 90.2% of THA and 84.6% of TKA patients were very satisfied or satisfied. Global SF-36 scores were 58.5±18.5 (TAA), 64.5±16 (THA) and 55.3±17.4 (TKA). Le Global WOMAC scores (/96pts. the higher the more severe) were 25.3±18.3 (TAA), 14.2±16.7 (THA), and 21.4±24.5 (TKA). Functional results were good or excellent in 60.6% of TAAs (AOFAS score), 78.3% of THAs (Harris score) and 48.7% of TKAs (IKS score). Activity of Daily Living FAAM subscales (/84pts) were 54.9±22.5; Sports FAAM subscales (/32pts) 8.2±9.1. Sporting activity was frequent: 86.8% (TAA), 86.9% (THA) and 74.4% (TKA), and pain-free in 44%, 66.8% and 62.9% respectively. TAA patients practiced a mean 3.3 sports, THA patients 2.5 and TKA patients 1.9.

Conclusion:

QoL on SF36 was better in THA, and equivalent between TAA and TKA. Specific scores were less relevant than general scores. Sports activities were most restricted in TKA. This encourages the use of TAA. There is still work to do to improve specific scores.
Instability of the Medial Column Post Triple Arthrodesis for Stage III Posterior Tibial Tendon Dysfunction
Authors: Lee Wei Ting , Avila Adriana , Han Qin Ling , Myerson Mark S.
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

Triple arthrodesis remains the ideal procedure for management of painful rigid flatfoot deformity. While concurrent extended medial column arthrodesis of either the cuneonavicular joint or the 1st tarsometatarsal joint is occasionally required, they are not routinely performed. We hypothesized that following triple arthrodesis, there will be minimal change in the alignment of the medial column joints. The aim of this study was to examine the effect of the triple arthrodesis on the stability and alignment of the medial column joints.

Methods:

This was a retrospective review of 212 consecutive patients who underwent triple arthrodesis between 2002-2013 for correction of painful Stage III flatfoot deformity. Radiographs of the feet were obtained preoperatively, at 6 weeks, 6 months, 1 year, 3 years and 5 years following surgery. The post operative stability and alignment of the medial column was determined by comparing the radiographs over time. Five radiological parameters were studied: medial cuneiform-calcaneus angle (CCA), medial cuneiform-1st metatarsal angle (MCA), 1st/2nd inter metatarsal angle (IMA), medial cuneiform-navicular distance (NCD) and calcaneal pitch angle. These measurements determined the presence of instability in the sagittal plane (CCA and MCA) and coronal plane (NCD and IMA) of the medial cuneonavicular (NC) joint, and the 1st tarsometatarsal(TMT) joint.

Results:

Our study demonstrated the presence of medial column instability after triple arthrodesis. This instability was most apparent in the sagittal plane of the NC joint (P < 0.001), and was associated with a decreased in the calcaneal pitch (P < 0.001). There was a slight decrease in the IMA(P < 0.001) as well. The coronal plane of the NC joint, and the sagittal plane of the 1st TMT joint remained stable throughout the measurements. The instability is best appreciated in Fig(B) where there is a reduction in the CCA and calcaneal pitch compared to the X-ray in Fig(A) taken 15 months earlier.

Conclusion:

The triple arthrodesis procedure corrects the foot deformity, but it is associated with subsequent instability of the medial column mild at the NC joint and abduction of the forefoot at the TMT joints. However, the clinical significance of this instability is not apparent from the study. Since very few patients required subsequent treatment for TMT and NC pathologies after a successful triple arthrodesis, we found insufficient justification for extending the triple arthrodesis distally.
Metatarsalgia After Hallux Valgus Correction is Associated with Relative First Metatarsal Length
Authors: Fukushi Jun-ichi , Nakagawa Satoru , Nakagawa Takeshi , Mizu-uchi Hideki , Iwamoto Yukihide
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Metatarsalgia of the lesser metatarsal heads are frequently associated with hallux valgus. The aim of this study was to evaluate how the relative length and the position of the first metatarsal head influences the prognosis of metatarsalgia and plantar callosities beneath the lessor metatarsal heads.

Methods:

A retrospective analysis of the clinical data and radiographs of 102 cases was performed at a mean follow-up period of 16 months after biplane interlocking osteotomies. Clinical evaluation was made using the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Radiological evaluation was made with standard weight-bearing AP radiographs, and the hallux valgus angle (HVA), inter-metatarsal 1-2 angle (IMA), distal metatarsal articular angulation (DMAA), and the sesamoid position were evaluated. Relative first metatarsal length (RML) was determined according to Nilsonne/Morton’s technique.

Results:

The mean preoperative HVA decreased from 37 to 3 degrees, and the mean IMA from 17 to 4 degrees. The mean JSSF- hallux score improved from 56 to 96 points. The mean preoperative area of plantar callosities decreased from 3.1 to 1.5 mm2. Sixty percent of metatarsalgia improved, and 85% of painless callosities disappeared postoperatively. Among radiological parameters, postoperative RML was most significantly associated with JSSF score (P < .0001) and the presence of postoperative metatarsalgia (P < .0001). ROC analysis revealed that the RML cut-off point was -3 mm for avoiding metatarsalgia, with an area under the curve of 0.884, a specificity of 88%, and a sensitivity of 85%.

Conclusion:

Preservation of RML during first metatarsal osteotomy is important to prevent postoperative metatarsalgia.
Methodology for the Audiovisual Analysis of Surgical Team Performance in Orthopedic Ankle Surgery
Authors: Beaman Doug , Perkins R. Serene
Published: October 2016

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Defining and quantitatively measuring surgeon and operating room team performance remains a scientific and clinical challenge. Evidence-based, objective methods to assess surgical skill have been identified; however, a quantifiable and valid methodology to measure intraoperative performance is lacking. We aimed to determine the optimal approach to audiovisually assess a surgeon and a surgical team. We aimed to develop a high-fidelity method to analyze and improve surgeon and team performance.

Methods:

Funding of this study was provided through a grant awarded by the American Orthopaedic Foot and Ankle Society (#2015-24-P). Sixteen predetermined, bilateral ankle surgeries (frame placement, frame removal, and total ankle replacement) were performed between July and December 2015 in both live and simulated operating room settings. Still photography and web- based three-dimensional modeling software were used to determine optimum camera position for the first eight procedures. Three compact, high-resolution camcorders (GoPro® Hero, San Mateo, CA) were then employed in different locations with a variety of mounting strategies to record eight additional, matched ankle procedures in a simulated environment. A multiview box and wireless routers were used for live viewing of surgeries on a high-definition television screen. Video-based editing software was used to replay and analyze audiovisual output.

Results:

There are several visual angles that optimally capture the dynamics of a surgical team and are specific to surgery type. These angles are measurable (in degrees) and vary according to the position of the surgeon, team members, operating room table, and C-arm, as well as laterality of the procedure itself. Triangulated placement of multiple cameras, including a head mounted device, are required to assess subtle elements of operating room team performance, including individual strengths and weaknesses, nontechnical skills, and team dynamics. High-fidelity recording equipment and video-based editing software facilitate the assessment of characteristics unique to reconstructive ankle surgery.

Conclusion:

The effectiveness of a surgical team can be assessed with high-fidelity recording and editing equipment in defined configurations. Our approach, which to our knowledge has not been previously described, facilitates the evaluation of communication styles, technical skills, and teamwork and provides a foundation for intraoperative leadership. We propose that our audiovisual methodology can be used to coach surgeons and their teams, in order to make collaborative improvements in a non-punitive manner. Enhancing the performance of each member of the surgical team may reduce risk and ultimately improve patient outcomes, and is likely to be reproducible across disciplines.
Morphological Characteristics of the Posterior Malleolus Fragment According to the Ankle Fracture Patterns by Lauge-Hansen
Authors: Cho Jaeho , Park Chul hyun , Chun Dong Il , Choi Hongjoon
Published: October 2016

Category:

Trauma

Introduction/Purpose:

The posterior malleolus fragment (PMF) of an ankle fracture occurs in various shapes with regard to injury mechanism. The purpose of this study was to evaluate the morphological characteristics of the posterior malleolus fragment according to the ankle fracture pattern by Lauge-Hansen classification using computer tomographic images.

Methods:

We retrospectively analyzed computer tomography data of 107 patients (107 ankles) who underwent surgery for tri- malleolus fracture from January 2012 to December 2014. A total of 76 ankles belong to Supination-Exorotation stage IV (SER group), 31 belong to Pronation- Exorotation stage IV (PER group). The type of PMF of two groups was respectively assessed by Haraguchi and Jan Bartonicek classification. The cross angle (α), fragment length ratio (FLR), fragment area ratio (FAR), sagittal angle and fragment height (FH) were measured as morphologic assessments.

Results:

The PMF type in SER group had mainly the posterolateral shape, while that in PER group had mainly the psotermedial two parts or large, posterolateral triangular shape (P= 0.02). The average cross angle (α) was no significant difference between two groups (SER group = 19.4°, PER group = 17.6°). The fragment length ratio and fragment height in PER group were significantly larger than that in SER group (P= 0.024, P=0.006). The fragment in PER group was significantly more vertical than that in SER group (P= 0.017).

Conclusion:

Morphological characteristics of the posterior malleolus fragment are different between SER group and PER group in trimalleolar ankle fracture. The SER type fractures are associated with smaller “rotational” fragment, while the PER type fractures are associated with larger “rotational and vertical” fragment with regard to the fragment volume and articular involvement.
Operative Treatment for Osteoarthritis of the First Metatarsophalangeal Joint
Authors: Voskuijl Timothy , Onstenk Ron
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Controversy remains whether hemiarthroplasty or arthrodesis results in better postoperative outcomes for patients who request surgery for advanced osteoarthritis of the first metatarsophalangeal joint. We tested the primary null hypothesis that the treatment groups would not differ in postoperative American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal scale scores after a follow-up period of ≥1 year. Secondary analyses addressed satisfaction rates, percentage of patients who would recommend the procedure, and unplanned repeat operation rates.

Methods:

A total of 58 primary arthrodeses and 36 hemiarthroplasties performed from January 2005 to December 2010 were evaluated at ≥1 year postoperatively.

Results:

At a mean average of 4 (range 1 to 7) years after surgery, the mean American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal scale score was 77.5 ± 18.5 in the arthrodesis group and 77.8 ± 12.0 in the arthroplasty group (p = .93). The number of repeat operations did not differ between these 2 groups, and patients treated with hemiarthroplasty reported greater mean satisfaction (p = .04).

Conclusion:

These results showed that the symptom intensity and magnitude of disability were similar at ≥1 year after arthrodesis or hemiarthroplasty for osteoarthritis of the first metatarsophalangeal joint, although the patients were subjectively more pleased with the results after hemiarthroplasty.
Posterior Arthroscopic Tibiotalocalcaneal Fusion
Authors: Eleftheropoulos Alexandros , Giannaros Iraklis V. , Christou Antonios , Petrakis Iordanis G.
Published: October 2016

Category:

Arthroscopy

Introduction/Purpose:

Hindfoot arthritis is treated usually with Tibiotalocalcaneal fusion when conservative treatment has failed. Indications of TCC fusion are wide, including post - traumatic arthritis, rheumatoid arthritis, acquired flat foot deformity (Myerson stage IV), failed total ankle arthroplasty. In the vast majority of these cases, there are skin problems because of systemic diseases or wound problems following prior surgery. Several methods have already been described and it seems that the use of intramedullary nail offers a load-sharing rigid internal fixation. The purpose of this presentation is to describe an alternative less invasive surgical technique of TTC fusion using an intramedullary retrograde nail via a posterior arthroscopy of the hindfoot. We present the surgical technique, the early results and quote several cases treated by this method.

Methods:

Under spinal or general anaesthesia, the patient is positioned prone. Using the standard posteromedial and posterolateral portals, a standard knee arthroscope is inserted via the posterolateral portal. Via the posteromedial portal, a soft tissue shaver is introduced to prepare the posterior gutter. Most of the preparation of the articular surface of the ankle joint is achieved with the arthroscope through the posterolateral portal and the instruments through the posteromedial portal. After the preparation of the ankle joint surfaces, under fluoroscopic control, a guide wire is inserted through calcaneus and talus into the tibia. Reaming is performed. Then a retrograde intramedullary nail is inserted through the calcaneal and the talus to the tibia. An anodized titanium alloy intramedullary nail is used and locked statically with one screw in the calcaneus, one in the talus and two screws in the tibial shaft. The preparation of the subtalar articular surfaces then takes place.

Results:

Deformity correction and hindfoot fusion were achieved in all five cases. There were no major complications, such as infection, trauma complications, nonunion, malunion or hardware failure. Fusion was achieved in about three months time (plus minus two weeks). All the patients returned back to their daily activities in four to five months time. The post-op AOFAS score was significantly improved. The mean hospitalization was 1.2 days. After the discharged, all the patients were followed at the outpatient clinic in a regular basis.

Conclusion:

This alternative surgical technique combines the advantages of the TTC fusion with an intramedullary nail and the advantages of the arthroscopic minimal intervention to the soft tissue envelope. This enables immediate mobilization of the patient and a small period of hospitalization. The key point is the steep learning curve. From the literature review can be found similar techniques with equally positive results.
Technique, Complications, and Mid-Term Results of Hindfoot Arthrodesis with a Posterior Blade Plate
Authors: Barg Alexej , Gorman Troy , Beals Timothy C. , Nickisch Florian , Lyman Mikayla , Saltzman Charles L.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Previous hindfoot surgeries present a unique challenge in performing hindfoot arthrodesis. The use of a blade plate construct is widely accepted, however there is limited data supporting the use of a posterior approach to blade plate arthrodesis. The purpose of this study was to (1) describe demographics of patients who underwent posterior hindfoot arthrodesis using a blade plate, (2) describe our surgical technique, (3) discuss outcomes, and (4) compare patients with and without complications.

Methods:

Between December 2001 and July 2014, 42 patients underwent hindfoot arthrodesis using a posterior blade plate and 40 patients were included in this study. Demographic data including age, gender, body mass index, smoking status, and comorbidities were analyzed. Surgical data including indication for the surgery, previous surgical treatment, and additional surgical procedures were reviewed. Weight-bearing radiographs were used to assess the fusion rate. Clinic and surgery notes were reviewed for possible intraoperative, perioperative, and postoperative complications. Univariate analysis was performed to compare patients who experienced complications with those who did not. There were 27 male and 13 female patients with a mean age of 56.4 ± 13.4 years. Twenty-eight patients had a tibiotalocalcaneal arthrodesis in a primary (n=6), primary staged (n=10), revision (n=9), or revision staged (n=3) setting. Eleven patients had ankle arthrodesis (primary n=7, revision n=4). The latest follow-up averaged 46.5 ± 27.5 months (range, 13.7-137.2 months).

Results:

Patients had a median of two previous hindfoot or ankle surgeries (range, 0-9 surgeries). Thirty-three of 40 (82%) procedures fused at an average of 24.4 ± 21.2 weeks. Four patients had a delayed osseous union. Seven patients had a nonunion, including ankle (n=3), subtalar (n=3), and both (n=1) joints. Patient groups with, and without primary solid osseous unions were comparable in terms of demographic data and surgical details. Eighteen major and eight minor complications were observed. Patients with or without complications were comparable in terms of demographic data and surgical characteristics. In total six patients (15%) underwent below knee amputation due to unsatisfactory results.

Conclusion:

Indications for hindfoot arthrodesis using posterior blade plate fixation include a diverse patient population. These surgeries may be performed as primary, revision, primary staged, or revision staged procedures. Most of the patients in our cohort had previous ankle/hindfoot surgeries. The fusion rate is lower than in primary hindfoot arthrodesis as reported in the current literature. The complications rate is high.
The Reduced Quantity and Functionality of Mesenchymal Stem Cells in the Synovium of Charcot Neuroarthropathy
Authors: Schon Lew C. , Mitchell Reed , Zahoor Talal A. , Zhang Zijun
Published: October 2016

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Managing Charcot Neuroarthropathy (CNA) remains a challenge facing the foot and ankle surgeons. Lack of understanding the pathogenesis of the disease prevents the development of novel therapies. Our previous studies revealed the involvement of fibroblast-like synoviocytes in the pathology of CNA. Residing in the synovium are also mesenchymal stem cells (MSCs), which maintain tissue homeostasis. In this study, MSCs isolated from the synovium of CNA and non-CNA patients were comparatively analyzed for their potential role in the pathology of CNA.

Methods:

Synovial samples were collected from CNA patients (n=7) and patients with osteoarthritis or intraarticular fracture (non-CNA; n=7), during foot and ankle procedures (approved by IRB). The synovial samples were minced and digested with 0.1% collagenase to isolate MSCs. The cells were plated and cultured in low density for counting colony-forming units-fibroblast (CFU- F), which is indicative of the number of MSCs. The colonies formed by CNA-MSCs and non-CNA MSCs were further characterized by size and imaging density. CNA-MSCs and non-CNA MSCs were cultured in adipogenic, osteogenic and chondrogenic differentiation media. The differentiation potentials of CNA-MSCs and non-CNA MSCs were assessed with histochemical staining and quantitative gene expression.

Results:

CFU-F: The number of colonies formed by CNA-MSCs was 6 ± 3.5 per (1/2) plate, while it was 43 ± 21.6 by the non- CNA MSCs (p < 0.05; Fig 1). The average size (pixels) of colonies was smaller in the CNA-MSCs than the non-CNA MSCs (4780 vs. 7960). When the colonies were stratified into high, medium and low density subgroups, colonies formed by the CNA-MSCs had a reduced density compared with the non-CNA MSCs (30±6 vs. 35±10) in the high density subgroup. Differentiation: Expression of adipogenic marker gene PPAR-γ by CNA-MSCs was less than half of that by non-CNA MSCs. The expression of osteogenic marker gene RUNX2 by CNA-MSCs was a third of that by the non-CNA MSCs. Similarly, the expression of chondrogenic marker genes, including SOX9 and type II collagen, by the CNA-MSCs declined as compared with the non- CNA MSCs.

Conclusion:

The synovium in CNA joints had fewer MSCs and that may impact joint’s response to inflammation and tissue repair. Furthermore, CNA-MSCs were declined in differentiation potentials. Analyses of the size and density of the colonies formed by CNA-MSCs showed that a subpopulation of MSCs was particularly affected. Further study will focus on the pathological role of the high-density subpopulation of MSCs in the development of CNA.