bluuebunny/crossref_metadata_2025 huggingface dataset:
Aesthetic Treatment of Tillaux-Chaput fractures
Authors: Feng Shi-Ming
Published: September 2018

Category:

Arthroscopy

Introduction/Purpose:

This study aim to investigate the clinical result of treating Tillaux-Chaput fractures using the all-inside ankle arthroscopy technique.

Methods:

We retrospectively evaluated 23 Tillaux-Chaput fractures patients who underwent all-inside ankle arthroscopy technique and were follow-up from May 2013 to June 2016. There were 15 males and 8 females, with the mean age of 30.4 years (range, 10-57 years). Right ankle was involved in 15 patients and left ankle in 8 patients. Eighteen patients had single Tillaux-Chaput fractures and 5 patients had combined proximal fibular fractures. While 20 cases were diagnosed by X-rays and 3 cases by CT. Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using Herbert screw(s). The joints function was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score.

Results:

Operative incisions of 23 cases were primary healing without complications of nerve, vessel and tendon injuries. The period of follow-up was 19.6 months (range, 12-25 months) and the time of Fracture union was 23.3 weeks (range, 12-36 weeks). At the time of last follow-up, none of the patients had any restriction in the ankle function and range of motion, with the ankle pain and weight-bearing walking pain. AOFAS score was changed from preoperative 53.3 points to 92.1 points, with the excellent-good rate of 100%.

Conclusion:

All-arthroscopy teatment by the anterolateral and anteriormedal approaches is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.
Compressive Stockings After Hindfoot and Ankle Surgery
Authors: Grubhofer Florian , Wirth Stephan
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Swelling and pain are common after foot and ankle procedures. We hypothesized that compressive stockings (CS) treatment after hindfoot surgery would positively influence patient outcomes.

Methods:

We undertook this randomized controlled trial in 87 consecutive patients to analyze the clinical effect of CS after hindfoot and ankle surgery and evaluate CS-wearing compliance using sensors that were implanted into CS. Ankle swelling, pain status, quality of life (SF-36 score), and the American Orthopaedic Foot & Ankle Score (AOFAS) were set as the primary end points. The CS wearing time in hours and percentage were investigated as the secondary end points. All participants with CS (group I) were informed about the implanted sensor after the CS were taken off. A subgroup analysis of group I was performed to detect differences between patients with high vs low compliance.

Results:

At 12 weeks, the results of ankle swelling (mean 234 mm in group I and 232 mm in group II), pain in the visual analog scale (1.7 group I vs 1.9 in group II), the SF-36 score (38 points in group I vs 30 points in group II), and the AOFAS score (a mean of 76 points in both groups) showed no statistical differences between the 2 groups. The mean wearing time was 136 (range, 0-470) hours, which corresponds to a compliance rate of 65%. Sixteen participants had high compliance (>80%, >170 hours), and 21 patients had low or noncompliance. The clinical results of patients with high wearing compliance were not significantly better compared to the results of patients with low compliance.

Conclusion:

CS therapy after ankle and hindfoot surgery was associated with a low wearing compliance and did not influence ankle swelling, function, pain, and the quality of life compared to the control group. Furthermore, the clinical results of patients with high compliance were not better compared to the results of patients with low or noncompliance wearing behavior.
Tibiotalocalcaneal Arthrodesis Using a Straight Intramedullary Nail
Authors: Jeyaseelan Lucky , Cullen Nicholas , Goldberg Andrew , Welck Matthew
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Tibiotalocalcaneal (TTC) arthrodesis using a hindfoot intramedullary nail has been shown to be a safe and reliable technique in patients with severe ankle and hindfoot disease. There is debate about the use of straight nails versus curved nails. Proponents of the curved nail argue that straight nails predispose to greater risk of lateral plantar nerve injury, poor calcaneal bone purchase and inability to maintain satisfactory hindfoot valgus alignment. However, the subtalar joint is a condyloid joint enabling rotation of the talus on the calcaneum to create varus/valgus position of the calcaneal tuberosity. We present a clinical series of patients undergoing TTC fusion using a straight nail assessed by clinical and radiological outcomes to establish whether theoretical risks of straight nails are reflected in clinical practice.

Methods:

This single centre, retrospective study of prospectively collected data on a sequential series of patients to undergo TTC fusion, with pre and post-operative weight bearing CT imaging. Data was collected on indication for procedure, co-morbidities, post-operative complications, union rate as well as clinical scores, EQ5D and MOXFQ. Weight bearing CT imaging was analysed using the validated TALUS™ (torque ankle lever arm system) method on weight bearing CT, providing calcaneal offset, hindfoot angle and hindfoot alignment. These were used as markers of hindfoot alignment.

Results:

65 patients (37 males, 28 females) were included in the study, with an average age of 57 years. Average follow-up was 20 months. Indications for TTC fusion included Charcot arthropathy, talar avascular necrosis, post traumatic arthritis and non-union of previous arthrodeses. Union rate was 91% (59/65). Overall complication rate was 11% (7/65) and most were minor wound complications. There were no plantar nerve injuries noted. There were no nail cut outs from the calcaneum. On all markers of hindfoot alignment, cases showed a more physiological degree of hindfoot valgus compared to pre-operative measures. There were significant improvement in both EQ5D and MOXFQ scores (p<0.05).

Conclusion:

We present the largest series of TTC fusion using a straight intramedullary nail and the first series to analyse hindfoot alignment using weight bearing 3D CT imaging. Our data regarding correction of hindfoot alignment is supported by biomechanical theories of subtalar varus/valgus, being related to rotatory changes at the subtalar joint, questioning the perceived need for a curved nail. This is particularly at the level of the entry point of the nail. The principles of valgus hindfoot nails are based on biomechanical laboratory studies and cadaveric studies, neither of which reflect our findings in clinical practice.
Pigmented Villonodular Synovitis of the Foot and Ankle
Authors: Jeyaseelan Lucky , Cullen Nicholas , Welck Matthew , Goldberg Andrew
Published: September 2018

Category:

Other

Introduction/Purpose:

Pigmented Villonodular Synovitis (PVNS) is a benign but potentially locally aggressive condition, that results in an increased proliferation of synovium, causing villous or nodular changes of synovial-lined joints and tendon sheaths. The estimated incidence of PVNS is 1.8 new cases annually per million people, of which 2.5% occur in the foot and ankle, reflected by the limited reports of PVNS in the foot and ankle literature. We present our clinical experience of 76 patients presenting with PVNS about the foot and ankle.

Methods:

Patients with PVNS of the foot and ankle were identified from our tertiary referral hospital patient database from 2007 to 2017. The case notes were carefully reviewed to analyse the clinical, radiological, and histopathological features and to investigate their clinical behaviour, management and the factors influencing recurrence.

Results:

76 patients were identified (32 male, 44 female) with a mean age of 39 years and mean follow-up of 5 years. The majority of cases were of localised, nodular PVNS (52%, 40/76) with the diffuse PVNS cases (48%, 36/76) presenting most commonly in the hindfoot. The most common presentation was of a swelling/lump (78%- 62/79), of which pain was an associated feature in 11% (7/62) and restricted range of motion a feature in 10% (6/62). Osteoarthritic change and cortical erosions were more commonly associated with diffuse PVNS. All patients underwent open synovectomy with a recurrence rate of 11% (7/76), all of which were the diffuse type. In those cases where synovectomy was paired with arthrodesis of the joint, there were no cases of recurrence (12%,9/76).

Conclusion:

We present our tertiary referral experience of PVNS in the foot and ankle as the largest series in the foot ankle ankle literature to date. A high index of suspicion is required in diagnosing PVNS. Nodular PVNS appears more common in the foot whereas diffuse PVNS more common in the ankle and hindfoot. Open synovectomy yields low recurrence rates. Although theorised, there is insufficient evidence to establish whether concurrent arthrodesis of the affected joint reduces risk of recurrence.
Risk factors for rerupture after conservative management of acute Achilles tendon rupture
Authors: Lee Kang , Won Jong-Hwa
Published: September 2018

Category:

Sports

Introduction/Purpose:

Recently, results after conservative management for acute Achilles tendon rupture have been improving after the introduction of real time assessment of tendon healing using ultrasonography and introduction of early weight-bearing and functional brace. Yet, many surgeons prefer surgical management of all acute ruptures due to the risk of tendon rerupture. The purposes of this study are to evaluate incidence and pattern of rerupture of Achilles tendon after complete healing, and to investigate factors related to it.

Methods:

A total of 202 patients with acute Achilles tendon rupture, who underwent conservative management with cast(3 to 7 weeks) and functional brace, were the subjects of this study. In patients having both tendons injured, only one side was randomly selected for analysis. Hence, for 202 patients, migration free survivorship was analyzed using Kaplan-Meier method, and association with possible risk factors was analyzed by Cox regression analysis using proportional hazards model. Factors include age, sex, history of Achilles tendinopathy, cast duration, calf atrophy(mean calf circumference difference at least 2 cm), possibility of SHR(single heel raise), Achilles thickness after complete healing, and insufficient opposition of tendon ends(10mm>gap>5 mm) after cast, initial gap with ankle neutral.

Results:

Rerupture occurred in 7 of 202 patients. Factors significantly associated with rerupture in Kaplan-Meier survivorship analysis and univariate Cox regression analysis were sex, history of Achilles tendinopathy, calf atrophy, possibility of SHR. When these factors were analyzed by multivariate analysis, possibility of SHR was the only significant factor with a hazard ratio of 3.14.

Conclusion:

Our data suggest that possibility of SHR requires special attention during the follow-up. The risk of rerupture after conservative management of acute Achilles tendon rupture can be reduced by sufficient recovery of calf muscle strength with early weightbearing and accelerated rehabilitation with aid of ultrasonography.
Tenogenic differentiation of mesenchymal stem cells
Authors: Lee Seung Yeol , Kim Hyang , Lee Kyoung Min
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Tendon repair has been a challenging issue for surgeons in treating. Although tissue engineering with mesenchymal stem cells (MSC) have been used for tendon repair in both in vivo and in vitro, the stem cells are obtained through invasive procedures, and there is usually a lack of adequate numbers for clinical use. The purpose of this study was to compare the potential of tri-lineage differentiation and to investigate the potential of tenogenic differentiation of human tonsil derived MSCs (T-MSCs), bone marrow derived MSCs (BM-MSCs), and adipose tissue derived MSCs (AD-MSCs).

Methods:

Each tissue was obtained from 8 patients. After isolation of MSCs, flow cytometry analysis was used to characterize the phenotypes of the MSCs. Differentiation capacity to adipo-, osteo-, and chondrocytes were induced by culturing each MSCs for 3 weeks in commercially available media. Each MSCs was treated with 5ng/ml and 10ng/ml of TGF-ß3 with vehicle control.

Results:

Immunophenotypic surface marker analysis of BM-MSC, AD-MSC, and TMSCs revealed that these MSCs expressed a typical MSCs. mRNA expression levels of the markers for tri-lineage differentiation were significantly lower in TMSC than other MSCs. The tenogenic transcription factor, scleraxis, showed a statistically significant increase in all MSCs differentiation groups except for the 7th day TMSC differentiation group (Figure). Gene expression of tenascin-C, an ECM glycoprotein, was specifically expressed in the T-MSC differentiation group at 14 days (Figure). Comparing the ratio of collagen 1 to collagen 3 genes, the BM-MSC showed a decrease in the ratio on days 3 and 7 unlike AD-MSCs and TMSCs. Only TMSC showed a significant increase in the ratio compared with other MSCs on the 14th day.

Conclusion:

The tonsil-MSC has low fat, bone and cartilage differentiation potential and has excellent tendon-specific differentiation potential, thus being highly useful as a tendon-tailored cell therapy agent.
How Are Coronal Alignments of the Knee and Hindfoot Correlated?
Authors: Lintz Francois , Dagneaux Louis , Dufrenot Maryama , Burssens Arne , Richter Martinus , Barg Alexej , de Cesar Netto Cesar
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Hindfoot and knee coronal alignments have shown to be related in previous literature suggesting that there might be some degree of compensation between the two. However, previous studies have focused on the effects of knee surgery on hindfoot alignment, not on the preoperative relationship. Recent 3D weight bearing imaging technology may help to investigate this. The objective of this study was to analyse the preoperative relationships between knee and hindfoot coronal alignments using bilateral weight bearing CT (WBCT) and biplanar low dose radiography (BLDR). We hypothesized that hindfoot valgus and varus respectively compensates knee varus and valgus.

Methods:

Relevant ethical approval was obtained for this retrospective comparative level 3 study including 124 limbs in 62 patients (32 female, 30 male), mean age 56 (23-84). Mean BMI was 27 (20-38). Cases included had been referred continuously according to diagnostic protocols in our institution, for a combined WBCT and BLDR investigation. Age, gender and BMI were recorded. Cases with a history of trauma or surgery, which may have caused a change in lower limb alignment, were excluded. Hindfoot alignment was measured using a semi automatic software (TALAS, Curvebeam, Warrington PA, USA) and given as Foot Ankle Offset (FAO). Knee alignment was measured using the EOS platform (EOS Imaging, Paris, France) and given as HKA. Distribution and demographics of hindfoot alignment in the varus and valgus knee groups were studied. Correlations were investigated using linear regression and Bland and Altman plots.

Results:

Incidence of Varus hindfeet was 15.8% in the Valgus knee group and 25.5% in the Varus knee group but the difference was not significant (p=0.82). Bland and Altman plots did not yield any additional result. No linear correlation was found between hindfoot and knee coronal alignments in the study population.

Conclusion:

Our results do not confirm prior findings regarding compensatory valgus in varus knees, and do not confirm the hypothesis according to which linear compensatory mechanisms may relate knee and hindfoot alignments. In practice, these results suggest that in cases where knee and hindfoot misalignments are associated, the causes for each should be analyzed independently before any assumption is made as to hypothetical interactions. Furthermore, subsequent studies are warranted to investigate whether other kinds of non-linear correlations way be found in selected populations.
Comorbidities associated with poor outcomes following operative hammertoe correction in a geriatric population
Authors: Maidman Samuel , Bariteau Jason , Boden Stephanie , Boden Allison , Tenenbaum Shay
Published: September 2018

Category:

Lesser Toes

Introduction/Purpose:

Hammertoe deformities are one of the most common lesser foot deformities and are extremely prevalent in the geriatric population. When nonoperative treatment fails, surgical correction can improve functional status and pain. While complications following these surgeries are rare, older patients with comorbid conditions are often considered worse operative candidates due to an increased risk of adverse outcomes. The aim of this study is to determine if specific comorbidities or perioperative variables are associated with increased complications or unsuccessful outcomes following operative hammertoe correction in geriatric patients.

Methods:

Prospectively collected data was reviewed on 31 consecutive patients aged 60 or older who underwent operative correction of hammertoe deformity. Patient demographics, comorbidities, perioperative variables, and postoperative complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component Score (SF-36 PCS) with a minimum of six-month follow-up. Data was examined using Fisher’s method and multivariable analysis.

Results:

29.0% (9/31) of patients had a history of smoking, 61.2% (19/31) were on anticoagulant therapy, 19.4% (6/31) had osteoporosis, 16.1% (5/31) had rheumatoid arthritis, and 9.7% (3/31) had diabetes mellitus. The mean tourniquet and operative times were 65.7 (SE=6.2) and 95.4 (SE=7.4) minutes, respectively. Postoperative complications occurred in 12.9% (4/31) of patients with the most prevalent being wound infections that were treated with antibiotics in 9.7% (3/31). Impaired wound healing, joint nonunion, and the need for revision surgery each occurred in 3.2% (1/31) of patients. Mean 6-month improvement in VAS was 2.1 (SE=0.5) and mean improvement in SF-36 PCS was 10.2 (SE = 3.4). No significant association was found between comorbidities or perioperative variables and postoperative complications or improved outcomes.

Conclusion:

No specific comorbidities or perioperative variables were identified that increase the risk for unsuccessful surgical correction of hammertoe deformities. While comorbidities in the geriatric population have traditionally been thought to increase complication rates and lead to poor outcomes, further research in this area is warranted. Comorbidities should not necessarily be a deterrent for geriatric patients pursuing operative hammertoe correction.
Definition of a Safe Zone for Screw Fixation of Posterior Talar Process Fracture by Three-dimensional Technology
Authors: Mao Haijiao
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Percutaneous screw fixation can provide stable fixation with a minimally invasive surgical technique for posterior talar process fracture . This surgical technique is limited procedure due to the complex anatomy of the posterior talar process and the varying narrow safe bony zone. The purpose of this study was to investigate the optimal posterior screw placement and the geometry of safe zones for screw insertion in the posterior talar process by analyzing with three-dimensional technology.

Methods:

One hundred adult who had feet CT scans were evaluated. CT data were imported into Mimics 18.01 software for three -dimensional reconstruction; Two 3.0mm-diameter screws were simulated from the posterior to anterior position for posterior talar process. The morphology parameters of posterior talar process was also quantitatively measured. The incidences of safe at different angles were investigated in order to determine optimal angle for screw direction. The safe zone and the length and entry point of screw were defined.

Results:

The safe zone was mainly between the 30% location and the 60% location; the width of each safe zone was13.6±1.4; the maximum height of each safe zone was 7.8±1.2. The height of the safe zone was lowest at the 30% location (4.5) and highest at the 50% location (7.3). The mixed safe zone of all talar was between the 50% location and the 60% location And inserting a 48.7 mm screw, 5.6 cm laterally and 7.4 cm superiorly from the lateral tubercle of the posterior process of the talus towards the talar head is safest. The second screw best position is the medial posterior process the talus.

Conclusion:

The zones for safe screw positioning are very narrow, making percutaneous screw fixation of the posterior talar process a challenging procedure. The predefined angles with computer-assisted three-dimensional techniques for the most frequently positioned percutaneous screws may aid in preoperative planning, shorten the operation time and reduce the incidence of surgical complications.
Comparison of Visual Analog Pain Score Reported to Physician vs. Nurse, Part II
Authors: Martin Kevin , McBride Trevor , Wake Jeffrey , Van Buren Jeffrey , Dewar Cuyler
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as researchers and health care networks seek to define treatment outcomes. However, interpretation and clinical applications of PROMs are still under investigation. The visual analogue scale (VAS) is considered a reliable and validated measure of acute pain. In a previous study, it was found that in surgical candidates the VAS pain score was significantly higher when reporting to the surgeon as opposed to the nurse. The aim of this current study is to examine whether this phenomenon occurs in patients that do not ultimately go on to have a surgical procedure. We hypothesize that there will be no difference in patient reporting to the surgeon versus the nursing staff.

Methods:

This study is a retrospective cohort of 201 consecutive non-surgical foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from “no pain” to worst pain.” Differences in reported pain levels were analyzed.

Results:

The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the Surgeon was 4.2 (p<.001). Contrary to our hypothesis, there was a statistically significant difference in pain scores reported to the surgeon compared to the nurse. We then analyzed the mean difference of pain scores reported to surgeon and nurse for surgical versus non-surgical patients. The mean difference in VAS scores reported to physician and nurse for surgical patients was 2.87 whereas the mean difference for non-surgical patients was 1.00 (p < .001).

Conclusion:

The current study found statistically significant differences between VAS pain scores reported to the surgeon versus the nurse in non-surgical patients. These results support the trend found in our previous study which demonstrated discrepancies in patient pain reporting, with surgical patients reporting significantly higher pain scores to the surgeon versus the nurse. However, the mean difference between reported pain scores, to the providers, is significantly higher for surgical patients as compared to non-surgical patients. The cause of this phenomenon remains unclear, however, this study provides more information regarding patient reported VAS pain scores in an outpatient clinical setting.
Safe Zone for Insertion of a Fibular Lag Screw in Ankle Fracture Fixation
Authors: Mason Lyndon , Kaye Angus , Marlow William , Williams Geraint , Molloy Andrew
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Fibular lag screw placement during ankle fracture fixation is not without risk. The screw placement endangers either the tendons of the peronei or the posterior rim of the incisura if misplaced. Our aim was to identify a predictable safe zone for screw placement.

Methods:

45 radiographs of Weber B fractures were reviewed to determine the typical height of lag screw entry and exit points. 63 MRI scans of anatomically normal ankles were reviewed to evaluate tendon position and syndesmosis location. The safe zone could then be determined using composite images.

Results:

On review of the 45 ankle fracture radiographs; the typical lag screw exit point was found to be 14.2 mm above the ankle joint (95% Confidence Interval: 11.3-17.1 mm). Using the composite MRI images, there was a consistent flat anterior aspect of the fibula at this level. A safe zone trajectory was seen to occur between 31 and 45 degrees taken from the anterior aspect of the flat fibular surface at this level. The minimum distance to at-risk structures using this trajectory was 4 mm. If this consistent entry point is used, the MRI scans demonstrated that if the drill was aimed towards the medial edge of the Achilles tendon, the correct trajectory would be performed.

Conclusion:

The flat surface of the fibula is a constant landmark on MRI and is visible during surgery. The peroneal tendons and posterior rim of the incisura have a constant predictable position related to this. The safe zone for insertion of a lag screw is between 31 and 45 degrees medial to the anterior aspect of this flat surface. This represents aiming the drill towards the medial aspect of the Achilles tendon.
Anatomy of the Lateral Plantar Ligaments of the Transverse Metatarsal Arch
Authors: Mason Lyndon , Jayatilaka Lara , Fisher Lauren , Fisher Andrew , Swanton Eric , Molloy Andrew
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

The anatomy of the Lisfranc complex is well understood. In contrast, the lateral tarsometatarsal ligamentous structures are under-investigated. Our study aimed to identify the plantar ligamentous structures of the lateral tarsometatarsal joints and their significance in transverse metatarsal arch injuries.

Methods:

We examined 10 cadaveric lower limbs that had been preserved for dissection at the Human Anatomy and Resource Centre at Liverpool University in a solution of formaldehyde. The lower limbs were carefully dissected to identify the ligamentous structures of the plantar aspect of the transverse metatarsal arch.

Results:

In all specimens, the long plantar ligament blended with a transverse metatarsal ligament spanning from the 2nd to the 5th metatarsal. This transverse metatarsal ligament formed the basis of the roof and distal aspect of the peroneus longus canal. The separate long plantar ligament formed the floor of the peroneus longus canal. In addition, separate intermetarsal ligaments were identifiable connecting each metatarsal. The long plantar ligament provides a connection through the transverse metatarsal ligament, connecting the transverse and longitudinal arches of the foot

Conclusion:

The plantar ligamentous structures of the lateral tarsometatarsal joints are a combination of individual intermetatarsal ligaments and a transverse metatarsal ligament. This explains the homogenous nature of a divergent tarsometatarsal joint injury and why middle and lateral columns move as one. It also has clinical significance in the observation that in some cases lateral column instability can be overcome when the middle column is stabilised.
Clinical usefulness of acellular dermal matrix combined negative pressure wound therapy in diabetic foot amputee
Authors: Moon Youngseok , Ahn Ji-Yong
Published: September 2018

Category:

Diabetes

Introduction/Purpose:

Negative pressure wound therapies (NPWT) have been useful to prevent further amputation by filling defect with granulation in diabetic foot amputee. However the hospitalized period have been prolonged to complete filling defect with NPWT. There were many efforts to accelerate rate of granulation filling using dermal matrix in NPWT. We hypothesized outcomes of acellular dermal matrix combined negative pressure wound therapy (NPWT) can be useful in comparison of exclusive usage of NPWT. The aim of this study was to investigate clinical outcomes of acellular dermal matrix of combined negative pressure wound therapy in DM foot amputee.

Methods:

This study included 40 patients of 40 ischemic diabetic feet. We divide these diabetic feet into two groups: 20 cases of acellular dermal matrix combined NPWT and 20 cases of exclusive usage of NPWT. We performed the amputation and combined NPWT at a mean age of 50.7 years (26 to 75) with the mean 12 months follow-up between June, 2014, and January, 2017. FTSG was performed after sufficient granulation healing of DM foot amputee in case of need. We evaluated multiple risk factors preoperatively and postoperatively. The wound healing after FTSG was evaluated during the followup. Number of NPWT was checked during the hospitalized period. Necessity of further amputation was decided as failed cases. Success rate of NPWT was evaluated in two groups. Multiple risk factors were evaluated.

Results:

Failed case was 3 cases (exclusive usage of NPWT) and 2 cases (acellular dermal matrix usage combined NPWT). Other feet showed complete healing of wound. Mean NPWT number of times to complete filling of granulation were significantly lesser in acellular dermal matrix combined NPWT group. Decreasing rate of wound defect was significantly shorter in acellular dermal matrix combined NPWT group. There were no significant correlations between wound healing and risk factors (CRP, HbA1C) (p=0.223, p=0.175).

Conclusion:

Acellular dermal matrix usage combined negative pressure wound therapy in DM foot amputee can be helpful to improve filling granulation filling rate with NPWT than exclusive usage of NPWT.
Physician treatment preferences in non-displaced distal fibula fractures
Authors: Neufeld Steven , Merenstein Dan
Published: September 2018

Category:

Trauma

Introduction/Purpose:

Background: Several studies have demonstrated equivocal long-term functional outcomes for both operative and nonoperative treatment of Weber-B fractures, however there are currently no evidence-based practice guidelines. The purpose of this study was to determine which treatment modality was preferred by orthopedic surgeons in the United States and Internationally, despite the lack of accepted guidelines.

Methods:

Methods: A survey of 428 practicing orthopedic surgeons was conducted to evaluate physician treatment preferences for non-displaced Weber-B fractures. Analyses were performed to determine physician preference for operative versus nonoperative fracture treatment, as well as to determine group differences between U.S, international and foot and ankle orthopedic surgeons compared to all other orthopedic surgeons. A cost effective analysis was conducted to compare differences among nonoperative and operative preferences.

Results:

Nonoperative treatment of non-displaced Weber-B fractures was preferred by 90.4% of orthopedic surgeons compared to operative treatment (9.6%; P<0.0001). Internationally-based orthopedic surgeons chose operative management at a higher rate (30/129) than U.S.-based surgeons (11/299; P<0.0001). General orthopedic surgeons were not more likely than subspecialty orthopedic surgeons to choose operative management, but foot and ankle subspecialists chose operative treatment at a higher rate compared to all other orthopedic surgeons (11/61 versus 29/362; P=0.0185). The direct medical costs and the indirect societal costs are likely to be 249 percent greater if managed operatively.

Conclusion:

Our findings suggest that while the vast majority of practicing surgeons choose to non-operatively manage non-displaced Weber-B fractures, there still exist a significant percentage of physicians who prefer to operate on these fractures. Given the existing literature suggesting equivalent outcomes for operatively and non-operatively treated Weber-B fractures, the current data suggests the need for further research into the reasons behind such differences in treatment preferences, as well as the evolution of evidence-based practice guidelines to guide the management of this very common fracture.
The Infinity Total Ankle System
Authors: Penner Murray , Davis W. Hodges , Bemenderfer Thomas , Waly Feras , Anderson Robert
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Background: Increasing interest in 2-component total ankle arthroplasty (TAA) designs and the increased use of TAA overall has led to the development of a new generation of 2-component TAA implants. The first of these to become available was the Infinity Total Ankle System (Wright Medical Technology, Memphis, TN), introduced in 2014. Despite it currently being the most commonly used TAA implant in the UK and among the most commonly used in the USA, published clinical results are lacking.

Purpose:

This study presents the first report of the clinical and radiographic outcomes of the Infinity Total Ankle System with minimum 2 year follow-up

Methods:

The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter.

Results:

The overall implant survival rate was 97% (65 of 67 implants) at mean follow up of 3 years (range 27-47 months). Two cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a non-revision reoperation. Mean FFI and AOS scores at latest follow up improved from preoperative by 21.6 (p<0.0001) and 34.0 (p<0.0001), respectively. No radiographic loosening of any talar or tibial components was identified in the 65 non-revised cases.

Conclusion:

Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those reported for both fixed- and mobile-bearing third generation TAA designs, even when used in cases with deformity and increased case complexity.
Proximal fragment intermetatarsal angle (PFIA) increases after SCARF osteotomy
Authors: Prudente Henrique , Baumfeld Daniel , Nery Caio
Published: September 2018

Category:

Bunion

Introduction/Purpose:

Instability of the joint between the medial cuneiform and the first metatarsal is considered as one of the progression factors of Hallux valgus and its recurrence in some cases. We believe that we must increase the intermetatarsal angle of the proximal fragment during the correction by the SCARF osteotomy, seeking the greater degree of instability of this joint. Doing that, we can prevent further varus displacement, as we have reached the greater degree of instability. The purpose of this study was to evaluate if the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal.

Methods:

This is a retrospective study with 32 patients with mild, moderate and severe hallux valgus, who were submitted to surgical treatment by the SCARF technique. All patients were operated by the same surgeon. Anteroposterior radiographs of the loaded foot were analyzed in the pre and postoperative (3 months) moments. We developed two measures to evaluate the position of the base of the first metatarsal: The Proximal Fragment Intermetatarsal Angle (PFIA), and the distance between the lateral cortex of the first metatarsal and the medial cortex of the second metatarsal (3 cm from the base of the first metatarsal). All measurements were made with a virtual ruler on magnified digital images and rounded to the nearest 0.1 mm. A 95% confidence interval was considered for statistical significant results (p<0,05).

Results:

The mean age of the sample was 44 years, with a predominance of females (62%). The mean pre-operative intermetatarsal angle was 14.9°, while in the postoperative period it was 5.2°, showing that there was correction of the metatarsal positioning. However, the PFIA increased to 17.8° at the post-operative period (p<0,05), showing a greater instability of the first metatarsal cuneiform joint, as the base of the first metatarsal was positioned in a more varus condition. In addition, we observed that there was an increase in the distance between the base of the first metatarsus and the second metatarsus after the surgical procedure, from 13.7 to 16 millimeters (p<0,05).

Conclusion:

We concluded that the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal, leading to more instability at the first metatarsal cuneiform joint, and, in our opinion, less chance of recurrence in the long-term. A prospective and long-term is needed to prove this statement.
Comparison total joint replacement (Roto-Glide) with arthrodesis of the 1st metatarsophalangeal joint – clinical follow-up study including pedography
Authors: Richter Martinus , Zech Stefan
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the 1st metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of JTR (Roto-Glide, Implants International, Thornaby-On-Tees, UK) and A of MTP1.

Methods:

All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2017 were included in the study. The data was extracted from a prospectively acquired database starting November 1, 2011 including all operatively treated patient at the authors´ institution. Exclusion criteria were bilateral treatment (n=24), additional procedures at other toes (n=34), A for revision of TJR (n=12), TJR exchange (n=5), and not completed minimum-24-month-follow-up (n=20). Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at 1st metatarsal/1st toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered. All parameters were compared between TJR and A and between preoperatively and follow-up.

Results:

From November 24, 2011 until October 31, 2015, 19 TJR and 38 A were performed. Parameters (average values if not stated otherwise) for TJR/A were preoperatively: mean age 59/60 years; 5(26%)/10(26%) male; height 167/166 cm; weight 73/74 kg; degree degenerative changes 3.3/3.1; ROM 10.3/0/18.8°//10.8/0/19.2°; percentage force 1st metatarsal/1st toe 7.8/14.5//8.4/15.2; VAS FA 45.5/44.9. Follow-up time on average 37.4/32.6 and range 25.3-71.3/24.1-67.1 months. VAS FA at follow-up was 71.7/69.4; percentage force 1st metatarsal/1st toe 15.6/5.5//16.5/10.5; ROM 35.4/0/20.5°//10.2/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage 1st toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05).

Conclusion:

TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and validated clinical scores (VAS FA). Both improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. TJR was similar to A except better ROM and better pedographic pattern. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.
Comparison Total Joint Replacement (STAR) with Arthrodesis of the Ankle
Authors: Richter Martinus , Zech Stefan
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the ankle. The aim of this study was to compare outcome (clinical and pedographic) of JTR (STAR, Stryker, Airview Boulevard, MN, USA) and A of the ankle.

Methods:

All patients that completed follow-up of at least 24 months after TJR and A of the ankle before November 5, 2017 were included in the study. The data was extracted from a prospectively acquired database starting November 1, 2011 including all operatively treated patient at the authors´ institution. Exclusion criteria were bilateral treatment (n=14), extensive additional procedures such as arthrodesis at other joints (n=54), A for revision of TJR (n=8), TJR exchange (n=10), and not completed minimum-24-month-follow-up (n=26). Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at hindfoot and forefoot from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and ankle range of motion for dorsi-/plantarflexion (ROM) were registered. All parameters were compared between TJR and A and between preoperatively and follow-up.

Results:

From October 11, 2011 until October 31, 2015, 36 TJR and 28 A were performed. Parameters (average values if not stated otherwise) for TJR/A were preoperatively age 61/52 years; 20(56%)/14(50%) male; height 171/175 cm; weight 83/87 kg; degree degenerative changes 3.5/3.6; ROM 5.6/0/22.8°//4.8/0/22.1°; percentage force hindfoot/forefoot 45.5/38.3//48.4/34.5; VAS FA 43.8/40.3. Follow-up time on average 35.8/33.1 and range 25.4-66.4/24.1-71.3 months. VAS FA at follow-up was 68.6/61.3; percentage force hindfoot/forefoot 64.3/22.3//53.5/28.5; ROM 15.4/0/33.6°//0/0/0. Parameters did not differ between TJR and A (each p>.05) except lower age for A, higher VAS FA, hindfoot force percentage and ROM for TJR at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05).

Conclusion:

TJR and A were performed in similar patient cohorts regarding demographic parameter (except lower age for A), degree of degenerative changes, ROM, pathological pedographic pattern, and validated clinical scores (VAS FA). Both improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different than physiological pattern) and VAS FA than A. TJR resulted in better clinical outcome including ROM and pedographic pattern. Survival rate of TJR was 100% up to 5.5 years. In this study, TJR outperformed A for treatment of severe ankle osteoarthritis.
Quantitative Assessment of Type-1 Collagen in Charcot Neuroarthropathy with Use of Harmonic Generation and Multiphoton Microscopy
Authors: Saloky Kaitlin , Aynardi Michael , Walley Kempland , Juliano Paul , Matchik Heather , Abraham Thomas
Published: September 2018

Category:

Diabetes

Introduction/Purpose:

Diabetic Charcot neuroarthropathy is characterized by rapid loss of bone with accompanied disruption to the surrounding joints and is often in the absence of trauma or infection. Previous research has demonstrated neuropeptide release and osteoclast activation in addition to increased collagen turnover. Currently, there is limited understanding on the impact of the disease on type-1 collagen within the joint synovium. The purpose of this study was to analyze qualitative and quantitative differences in type-1 collagen between diabetic, neuropathic patient controls and those with Charcot neuroarthropathy.

Methods:

A prospective case-control study using routinely discarded surgical waste synovial tissue from diabetic, neuropathic patients with and without Charcot. The tissue was prepared in the laboratory for analysis. Microscopy was performed using multiphoton excitation fluorescence (MPEF) and second harmonic generation (SHG) microscopy techniques, utilizing a mode locked femto-second i: Sapphire Tsunami (Spectra-Physics, Mountain View, CA) synchronously pumped by a Millenia Xs J (Spectra-Physics) diode-pumped solid state laser. Qualitative and quantitative microscopic analysis was performed on Charcot specimens and controls. A statistical analysis was performed to detect a quantitative difference in type-1 collagen.

Results:

An analysis was performed on 8 samples; 4 neuropathic controls and 4 Charcot neuroarthropathy samples. There was a statistically significant difference between the amount, the quality and organization of type-1 collagen (p<0.0001). The Charcot group had significantly less type-1 collagen when compared to the control (p<0.0001). Qualitative analysis was performed using a mean intensity value. The control group’s mean intensity was 2561.4 nm while the Charcot group’s was 884.1 nm. The Charcot group had a significantly smaller mean intensity indicating poorer quality of collagen (p<0.0001). Orientation index was used to assess the organization of type-1 collagen in the synovium. A smaller orientation index signifies an increase in disorganization. The Charcot group had a significantly smaller orientation index of 16.5 compared to the control group’s 27.8 (p<0.0001).

Conclusion:

Charcot neuroarthropathy leads to significant abnormalities in type-1 collagen within the joint synovium when compared to the diabetic controls. Further research will determine if these differences are attributable to neuropeptide release and osteoclastic activation.