bluuebunny/crossref_metadata_2025 huggingface dataset:
Complication rates and short-term outcomes similar after hammertoe correction in older patients
Authors: Mueller Claire , Boden Stephanie , Labib Sameh , Bariteau Jason
Published: September 2017

Category:

Lesser Toes

Introduction/Purpose:

Hammertoe deformities are common lesser toe deformities and multiple methods exist for surgical treatment. The population continues to age and to date, no studies have looked specifically at outcomes in the geriatric cohort, who are often at greater risk of complications or functional compromise due to increased co-morbidities. This study examines differences in short-term outcomes of pain, improvement of SF-36 scores, and complication rates in younger compared to older patients who underwent surgical correction of hammertoe deformities.

Methods:

47 patients undergoing surgical correction of hammertoe deformities were prospectively followed. All surgical procedures were performed by a single surgeon and the specific surgical technique was tailored to each patient’s deformity. All patients were treated with early mobilization and progressive weight-bearing as tolerated. Subjective assessment of function was obtained using pre-operative and post-operative Visual Analogue Scale (VAS) and Short Form Health Survey (SF-36) scores with a minimum of six-month follow-up. 38 patients met inclusion criteria for length of follow-up (5 males, 33 females). Patients were divided into two groups based on age at the time of surgery (those younger than sixty years old, and those older than sixty years old). The improvements in mean (+/- SEM) VAS and SF-36 scores for patients younger than sixty years were compared to outcomes of patients older than sixty years of age, and results were assessed for statistical significance using a student’s t-test.

Results:

The mean age was 46.4 +/- 4.1 years in the younger patients and 68.0 +/- 1.2 years in the older cohort. The mean improvement in VAS score from pre-op to six months post-op was 2.8 +/- 0.8 and 2.8 +/- 0.6 (p = 0.95) in the younger and older cohorts, respectively (Table 1). The mean improvement in SF-36 Physical Component Score from pre-op to six months post-op was 8.6 +/- 6.7 and 6.7 +/- 4.4 (p= 0.81) in the younger and older cohorts, respectively. The mean improvement in SF-36 Mental Component Score was 1.5 +/- 3.7 and 1.4 +/- 4.2 (p=0.99) in the younger and older cohorts, respectively. One complication occurred in the younger cohort (0.11%) and no complications were reported in the older cohort.

Conclusion:

Outcomes of surgical correction of hammertoe deformities in older patients were similar to outcomes in younger patients at short-term follow-up. The study had sufficient power to detect differences in means as small as 5-8% depending on the specific outcome parameter. This study establishes a cohort of patients who will be followed to determine the effect of age on long-term outcomes of pain, SF-36 scores, and complication rates of surgical correction of hammertoe deformities. Future studies will also compare radiologic outcomes of hammertoe deformities preoperatively and postoperatively.
Anterior Talofibular Ligament Abnormalities on Routine Magnetic Resonance Imaging of the Ankle
Authors: O’Neil Joseph , McDonald Elizabeth , Chapman Talia , Casper David , Shakked Rachel , Pedowitz David
Published: September 2017

Category:

Ankle, Sports, Trauma

Introduction/Purpose:

The anterior talofibular ligament (ATFL) is one of the most commonly injured structures of the lower extremity after an ankle sprain. Evidence of remote injury to this structure is frequently encountered on magnetic resonance imaging (MRI) of the ankle, with uncertain clinical significance. Previous studies in the orthopaedic literature have discussed the prevalence of abnormal MRI findings in asymptomatic patients, most notably with regards to the spine and shoulder. More recently, a study on the prevalence of peroneal tendon abnormalities on routine MRI of the ankle was published. However, to our knowledge, no such study exists for the ATFL. The purpose of this study is to determine the prevalence of abnormal findings of the ATFL on MRI in asymptomatic individuals.

Methods:

All foot and ankle MRIs performed at our institution over a 4-month period were considered for inclusion in our study. Studies were excluded if performed on patients with documented ankle inversion injuries, ankle sprains, lateral ankle trauma, tenderness over the ATFL, or ankle instability. A total of 320 MRIs were eligible for inclusion. The integrity of the ATFL was noted in addition to the primary pathology.

Results:

The median age of the patients included in this study was 51 years with 203 females (63%) and 117 males (37%). One hundred eighteen (37%) of the 320 MRIs demonstrated some ATFL pathology. The most commonly encountered ATFL pathologies were thickening (38%), chronic tear (35%), attenuation (25%) and acute tear (2%).

Conclusion:

The results of this study demonstrate that a sizeable percentage of asymptomatic individuals (37%) will have ATFL abnormalities on magnetic resonance imaging of the foot and ankle. This study can have important clinical implications for patients who present with concerning MRI findings that do not correlate clinically. Based on our results, orthopaedic surgeons or any other physician providing musculoskeletal care can provide counseling and reassurance to patients who present with ATFL pathology on MRI but an absence of clinical findings. Much like MRI of the shoulder or spine, abnormalities must be correlated with the clinical exam.
Outcomes after Lengthening Calcaneal Osteotomy for Flexible Flatfoot Deformity– Evans versus Hintermann Osteotomy
Authors: Plaass Christian , Ettinger Sarah , Claassen Leif , Yao Daiwei , Stukenborg-Colsman Christina , Daniilidis Kiriakos , Mattinger Tim
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

Evans and Hintermann calcaneal osteotomies are commonly used to correct flexible pes planovalgus deformity. Both methods are well accepted with good clinical results. The aim of this study was to compare the outcomes after Evans or Hintermann osteotomy.

Methods:

We retrospectively examined 49 patients who were operated for the treatment of flexible flatfoot deformity between October 2007 and March 2014. Sixteen Evans and 36 Hintermann osteotomies were performed. The data was collected using clinical and radiological examination as well as clinical scores (FAOS, SF-36) during regular follow-up. A paired t-test was used for statistical analysis. A one-way anova with the Holm-Sidak’s multiple comparisons test was used to compare non-parametric data.

Results:

The mean age was 39.6 ± 18.69 years in the Hintermann (H) group and 32.8 ± 17.86 years in the Evans (E) group. The mean follow up was 67.67 ± 20.57 months in the E- and 39.71 ± 12.77 months in the H-group. In both groups FAOS and SF-36 improved significantly (p<0.05). The hindfoot alignment improved significantly in both groups (p<0.05). The mean time to return to work and sports was 14.25 ± 8.92 and 19.0 ± 18.62 weeks in the E-group, 19.36 ± 16.71 and 28.25 ± 20.07 weeks in the H- group. Seven patients of each group needed an implant removal; one patient underwent an arthrodesis of the subtalar joint in the E-group. There were no significant differences between the outcomes of both groups.

Conclusion:

Both surgical techniques lead to good correction of the flatfoot deformity and show a significant improvement of the clinical outcome scores. Neither of these two surgical techniques can be identified as being superior.
Three-dimensional Analysis of the Talocrural Joint Axis
Authors: Plaass Christian , Claassen Leif , Stukenborg-Colsman Christina , Yao Daiwei , Daniilidis Kiriakos , Ettinger Sarah , Nowakowski Andrej
Published: September 2017

Category:

Ankle

Introduction/Purpose:

The total ankle replacement (TAR) is increasingly used in cases of severe ankle arthritis. Although the knowledge about joint kinematics is crucial for designing and positioning of TAR there is no consensus about the talocrural joint axis. The aim of the present study was the determination of the kinematic rotational axis of the talocrural joint as an orientation for prosthesis positioning.

Methods:

We analyzed 96 CT-scans of full cadaver caucasien legs. With the software Mimic, 3-Matic (both Materialize) and GOM inspect we generated three-dimensional reconstruction models of the talus and a best fitting cone orientated to the talar articular surface. The kinematic rotational axis was defined to be the axis of this cone.

Results:

The determination of the kinematic rotational axis showed a high inter- and intrarater reliability. The kinematic rotational axis of the talocrural joint is orientated from lateral-distal to medial-proximal (84.9° ± 8.5 compared to mechanical tibial axis in frontal plane), from dorsal-proximal to anterior-distal (93.1° ± 42.3 compared to mechanical tibial axis in sagittal plane) and from dorsal-lateral to anterior-medial (169.0° ± 6.7 compared to mechanical tibial axis in axial plane). A high standard deviation especially in the sagittal plane was noteworthy.

Conclusion:

With the present study we present a new reproducable single-axis model of the talocrural joint. Our data showed relevant interindividual variations. The consideration of these variations might support the development of patient-specific TAR implantation techniques.
Enhanced Treatment
Authors: Raheman Firas , Ahluwalia Raju , Kavarthapu Venu
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

Ankle fracture fixation has commonly been undertaken with an inpatient process due to swelling and surgery may not always be conducted on the next available operating list. In the UK there has been a move over the last 5 years to manage many trauma cases semi-electively and within the day case departments, to give patients more choice in their treatment. We conducted a study looking at the impact of a home therapy ankle pathway combined with day case- surgery on the length of stay and safety of patients with ankle fractures requiring surgical fixation conducted by group consultant trauma surgeons and their teams.

Methods:

Patients were assessed in two periods from Jan 2015 to Dec 2016; all patients were placed in a plaster of paris back slab in casualty with the ankle reduced, limb care advice given – elevation, cooling and DVT thromboprophylaxis. A group of patients were assessed for home therapy and day case surgery and were then discharged home on crutches after a slot was determined on a rapid access trauma list typically six days later. Patients who were not suitable for home therapy were excluded from review. We compared two cohorts of patients with weber B fractures whom choose surgical fixation, which would have been suitable for both day case and in-patient care over a 12-month period. We performed a prospective audit of the cases undertaken and analysis of the number of cases, complications and the cost benefits

Results:

143-patients identified; 21 patients identified for home-therapy & day-case, and 32 patients for inpatient management. Within home-care & day case group: 1-tri-malleolar-fracture, 11-bi-malleolar fractures and 9-uni-malleolar and within inpatient group there were a similar mixture of fracture patterns. Time-to-surgery for inpatient management was 2.38 (1-16d) days; length of stay was 4.94 days (2-31d). Home-care & day-case time to surgery was 5.8 days (2-7). No patient admitted following surgery. All patients followed to pre-morbid ambulation levels. One DVT confirmed in the inpatient group no-wound-complications or failures of fixation reported. A mean 1.5 hrs operating time was required (59.3 min tourniquet time); day-case-surgery is £228 per patient cheaper than in- patient surgery. Cost efficiency based on 4.94 bed-day-improvement is 158 bed-days a cost-saving of £1,235 per patient.

Conclusion:

We believe home-care and day-case ankle fracture surgery is both valid and cost effective in optimizing the management of the appropriate ankle fractures without any significant rise in co-morbidity. For the patient there is little difference in waiting times and a pre planned surgical episode can give them flexibility to plan their treatment. The total potential saving per patient to the health care provider could be approx. £1,486 per patient. Furthermore, in our healthcare system it reduces demand for inpatient beds, provides significant cost savings for the provider and improves patient satisfaction due to choice and reduction wasted bed days
Prevalence and Associated Factors of Severe Disease in an Athletic Population
Authors: Sartorelli Elena , Martinelli Nicoló , Hosseinzadeh Mohammad , Bonifacini Carlo Corrado , Romeo Giovanni , Prati Alberto Bianchi Castagnone
Published: September 2017

Category:

Hindfoot, Sports, Children

Introduction/Purpose:

Sever disease is a common cause of pain in growing kids, but there is no consensus among researchers regarding its etiology. Recently several papers studied the role of sport on the physical and the psychological development of the child, including the possibility that these activities can cause overuse injuries in childhood. The purpose of the present study is to identify any association between heel pain due to calcaneal apophysitis and level of sport activity, type of sport, type of terrain, body mass index (BMI) and foot posture.

Methods:

We studied 430 athletic children in a population-based sample of soccer (29.53%), basketball (48.37%) and volleyball (22.79%) players, aged between 6 and 14 years. Physical examination, Foot Posture Index (FPI), Oxford ankle and foot questionnaire Italian version for children and parents and a custom made questionnaire on sport were collected from each athlete. Diagnosis of Sever disease was made with a positive heel squeeze test.

Results:

Our data showed that body mass index, sex, type of terrain, type of sport, FPI should not be considered risk factors for calcaneal apophysitis, while exists a statistical significant higher risk for younger age (p < 0.01), lower number of training session/week (p = 0.02) and shorter session (p < 0.01).

Conclusion:

The prevalence of Severe disease in athletic children in the study sample was higher in younger and low active patients. BMI was not associated with an increased risk neither sport specialization. Investigating association between the type of terrain and Sever disease it does not appear to have a significant role. Analysis of the FPI produced no significant risk factors. The strengths of this study consists in a large population size, all participants underwent clinical assessment, and the use of a detailed, previously validated test, scales and questionnaire.
Outcomes of First Metatarsophalangeal Joint Fusion in Patients with Greater Than Fifteen Percent Intermetatarsal Angle. Is Lag Screw Essential?
Authors: Shah Ashish , Hudson Parke , Araoye Ibukunoluwa , Pinter Zachariah , Motwani Girish , Sahranavard Bahman , Cone Brent , de Cesar Netto Cesar
Published: September 2017

Category:

Midfoot/Forefoot

Introduction/Purpose:

Metatarsophalangeal arthrodesis has usually been performed using a dorsal plate to immobilize the MTP joint with or without lag screw fixation. Data in the literature is sparse on outcomes of dorsal plate plus lag screw fixation, especially in patients with IMA greater than 15 percent. Our objective was to compare IMA correction outcomes and union rates between dorsal plate only fusions and dorsal plate plus lag screw fixation in patients with IMA greater than 15 percent.

Methods:

We retrospectively reviewed the charts of 36 patients (39 feet) who underwent first MTP joint arthrodesis for moderate to severe HV deformity between 2011 and 2015. Average age was 61 (range, 39 to 84) years. There were 24 females and 12 males. A single surgeon performed all operations. Joints were immobilized postoperatively using either dorsal locking plate alone or dorsal locking plate with a lag screw. Union (at least 3 bridging cortices) was determined radiographically at 6 weeks, 3 months, 6 months and yearly. All suspect nonunions were examined with CT. Other radiographic parameters examined included preoperative and postoperative hallux valgus, intermetatarsal, and dorsiflexion angles (HVA, IMA, and DFA respectively). Student’s t test was used to compare group means while Pearson’s Chi square test was used to compare group rates.

Results:

Overall union rate was 82.1% (32/39). There was no significant difference in union rates between the two groups (dorsal plate only = 81.5% (22/27), dorsal plate plus lag screw group = 83.3% (10/12)) (P > 0.05). Average follow-up was 9 (range 7 to 35) months. Overall, the average IMA correction was 4.7 (preoperative = 17.8, postoperative = 13.1) degrees. Average IMA corrections were 4.7 and 4.54 degrees in the dorsal plate only group and dorsal plate plus lag screw groups respectively. Overall, average HVA correction was 21 (preoperative = 39.5, postoperative = 18.5) degrees.

Conclusion:

Our findings indicate that there is no difference in the fusion rates between both patient groups with IMA greater than fifteen percent. Because other published studies have a wide range of IMAs preoperatively, our study represents more attainable goals in patients with severe (IMA greater than 15%) deformities. In addition, our findings suggest that in such patients, MTP arthrodesis may not be sufficient as a standalone procedure for correction of IMA. Additional proximal osteotomy may be required for correction of the IMA.
Early Outcomes of Arthroscopic Modified Brostrom Operation for Chronic Ankle Instability
Authors: Shim Dong-Woo , Hwang Yeokgu , Park Yoo Jung , Lee Jin Woo
Published: September 2017

Category:

Ankle, Arthroscopy

Introduction/Purpose:

The gold standard for the surgical treatment of chronic lateral ankle instability is the modified Brostrom procedure. Surgery aims to re-establish ankle stability and function, without compromising ankle motion. Recently introduced all inside arthroscopic modified Brostrom procedure coincide with the goal on that aspect. The purpose of this study was to investigate the early outcomes of all inside arthroscopic modified Brostrom operation for chronic ankle instability.

Methods:

From January 2015 to August 2016, 30 patients were included. The visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, Foot and Ankle Outcome Score (FAOS), and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Clinical outcome evaluations were performed preoperatively, at 3 months and 6 months postoperatively, and at a final follow-up using the VAS score, the AOFAS ankle-hindfoot score, FAOS, and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle.

Results:

Thirty patients (19 males and 11 females) were followed up for a mean of 11.0 (range 4 – 23) months. The VAS, AOFAS, 1 FAOS subscale (Quality-of-life) and the Karlsson scores were improved significantly at the each follow-up period of 3 month, 6 month and 1 year postoperatively. Other 4 subscales of FAOS showed no significant outcomes (Table 1). The mean anterior talar translation and talar tilt showed significant improvements from 5.8 mm (SD = 0.4) and 7.9° (SD = 1.0) to 5.3 mm (SD = 0.3) and 5.7° (SD = 0.6) at the final follow-up each (p = 0.034, p=0.034).

Conclusion:

The arthroscopic modified Brostrom technique could be a viable alternative to the gold-standard open modified Brostrom procedure for anatomic repair of chronic lateral ankle instability. It can yield outstanding functional and clinical outcomes without adverse effects in terms of pain.
Immediate Weight Bearing after Bi-planar Plantar Fixation of Lapidus
Authors: Smith W. Bret , Santrock Robert , Dayton Paul , Hatch Daniel
Published: September 2017

Category:

Bunion

Introduction/Purpose:

There are many options when choosing to repair HAV (hallux abducto-valgus) deformity of the foot. The Lapidus procedure and its modifications are often selected to correct these deformities due to multiplanar correction at the CORA (center of rotational angulation). As with any surgical procedure, there are advantages and disadvantages when selecting the correct technique. One drawback often identified with the Lapidus procedure is the need for extended immobilization and the inability to weight bear for an extended period of time. The objectives of this study were to demonstrate a new, novel construct that can allow for immediate weight bearing after Lapidus arthrodesis with predictable outcomes.

Methods:

This IRB approved study was comprised of 4 centers that performed a specific modification of the Lapidus procedure with an identical fixation construct. The construct consisted of 2 mini-plates that were applied across the first tarsometatarsal (TMT) joint. The plates were applied while the joint was held in compression. The plates were oriented dorsal and plantar-medial allowing for a greater than 90° spread between plates for appropriate distribution of the forces and a true multi-planar construct. This concept takes into account biplanar stability as described by Kolner[1] and micromotion to stimulate secondary bone healing as described by Perren[2]. All patients were placed into a protective, cushioned dressing with a rigid bottom shoe or boot depending on surgeon preference. The patients were allowed weight-bear as tolerated with walker or crutches for safety as soon as the regional anesthesia dissipated to allow for complete sensation in the operative limb.

Results:

Twelve months of consecutive cases with immediate weight bearing and minimum follow-up of 6 months were included in the study. All cases that met inclusion criteria were included in the analysis; inclusion criteria were primary corrections of a HAV deformity with correction done via the described technique performed within the approved date range. Procedures not utilizing the described technique, revision procedures and procedures that extended the arthrodesis outside of the first TMT joint were excluded.

Conclusion:

Preoperative and postoperative measurements of 50 patients were obtained in this study. Radiographic evaluation of the fusion site was used to determine if the arthrodesis demonstrated healing at a minimum of 6 months. Other studies have shown early weight bearing (<3 weeks) is possible after the Lapidus procedure [3], this study demonstrated that immediate weight bearing after a modified Lapidus procedure is possible with a decreased reported nonunion rate (4.0%). This modified procedure did not result in a recurrence of the deformity. We expect continuation of the study to demonstrate that there are no long-term issues.
The Function Axis of Rotation of the Ankle Joint during Simulated Gait
Authors: Sturnick Daniel , Demetracopoulos Constantine , Saito Guilherme Honda
Published: September 2017

Category:

Ankle, Ankle Arthritis, Hindfoot

Introduction/Purpose:

Implant component positioning is considered as an important factor in function and longevity in total ankle arthroplasty (TAA). However, accurate and repeatable positioning remains a limitation with current techniques and instrumentation. In addition, further investigation is needed to objectively define the optimum component positioning. Cadaveric gait simulation is a valuable tool for investigating foot and ankle joint mechanics during functional tasks such as the stance phase of gait. The objective of this study was to investigate the functional axis of rotation of the native ankle joint during simulated gait.

Methods:

The stance phase of healthy gait was simulated with six mid-tibia cadaveric specimens using a previously validated device and methodology. A robotic platform reproduced tibial-ground kinematics by moving a force plate relative to the stationary specimen while physiologic loads were applied to the extrinsic tendons to actuate the foot. (Figure 1A). Ankle kinematics were measured from reflective markers attached to the tibia and talus via surgical pins. The helical axes of rotation of the talus with respect to the tibia was calculated during three portions of stance: initial plantarflexion during earlier-stance after heal strike, dorsiflexion during mid-stance, and final plantarflexion during late-stance. The position and orientation of these kinematic-defined axes of rotation were compared to the transmalleolar axis and reduced to its anteroposterior position and transverse plane angle (Figure 1B).

Results:

Analyses revealed that ankle joint functional axis of rotation varied from the anatomic reference throughout stance. The kinematic center of rotation was located 16.4 ± 5.8 mm, 16.5 ± 6.6 mm, and 15.6 ± 6.5 mm anterior to the transmalleolar axis during early-, mid- and late-portions of stance, respectively.

Conclusion:

This study revealed that the position of the flexion-extension axis varies greatly between specimens during simulated gait. While previous reports have suggested that the transmalleolar axis is an acceptable approximation for the ankle joint center, these findings suggest that further research in warranted to better describe the complex tibiotalar kinematics. This work may provide future insight to guide implant design and advance techniques, to better place articular constraints of a total ankle in the native center of rotation of the joint.
Minimal Invasive Reconstruction of Neglected Achilles Tendon Rupture
Authors: Sung Ki Sun , Yim Hyun Seok
Published: September 2017

Category:

Sports

Introduction/Purpose:

Recently minimal invasive reconstruction using semitendinosus tendon autograft was shown to be safe and successful for neglected Achilles tendon ruptures. We hypothesized that allograft could also result in similar result like in the reconstruction of anterior cruciate ligament of the knee joint.

Methods:

Between December 2013 and September 2015, 19 consecutive neglected Achilles tendon rupture cases underwent minimally invasive reconstruction using semitendinosus allograft tendon regardless of rupture time and gap. Out of them, 5 patients had flexor hallucis longus tendon transfer additionally. Thirteen were male, and the average age at the time of surgery was 63(30~82). MRI was checked to confirm the diagnosis in all cases. The Achilles tendon total rupture score(ATRS) was measured for clinical outcome at both pre and post surgery. Thompson squeezing test, knee flexion test, and single-heel-rise test were recorded. Isokinetic strength of plantar flexion by peak torque with plantar flexion at speeds of 30 and 120°/sec was measured to check triceps muscle power after surgery.

Results:

The mean follow-up period was 13.6(6~26) months. The ATRS was improved from 34(7~72) to 70(48~97) after the surgery(p<0.0001). At the latest visit, all patients showed negative Thompson squeezing test, and in knee flexion test 16 patients showed normal ankle plantar flexion. Thirteen patients could raise their affected heel at the time. In the affected leg at speeds of 30 and 120°/sec, the isokinetic strength was 14.9(6.0~31.9) and 10.0 Nm (2.8~ 19.0) Nm preoperatively, and 37.3(12.1~90) and 19.6(7.8~47) Nm at the latest follow-up. (P=0.012, 0.017) There was no wound problem, rerupture or other complications related to the surgery.

Conclusion:

Minimally invasive reconstruction using semitendinosus allograft tendon seems to safe and effective for the treatment of neglected Achilles tendon without sacrificing other healthy tissues. We think that this technique can provide a significant improvement of symptoms and function with fewer complications.
Wound Complications in Calcaneus Fractures Treated with the Sinus Tarsi Approach
Authors: Swords Michael , Brady Candice , Popovich John
Published: September 2017

Category:

Trauma

Introduction/Purpose:

The purpose of this study is to evaluate risk factors and complications associated with surgical treatment of calcaneus fractures using a sinus tarsi approach in a consecutive series of 164 displaced intra articular calcaneus fractures treated with a sinus tarsi approach.

Methods:

150 patients with a total of 164 displaced intra articular calcaneus fractures were treated by a single surgeon using a sinus tarsi approach. Age, nicotine use, diabetes, steroid use, time from injury to surgery were all recorded. Time of suture removal, post operative antibiotics, local wound care and need for secondary surgery for wound problems were recorded.

Results:

average age was 49.5 years old. follow up averaged 309 days. 60 (39.2%) used nicotine, 14 (8.54%) were diabetics with 3 insulin dependent, 6 used oral steroids or DMARDs, eight fractures (4.88%) were open fractures. Average time from injury to surgery was 10.63 days. Sutures were removed at an average of 16.25 days. 7 patients developed incisional complications. 6 were treated successfully with antibiotics and local wound care. 1 patient require secondary surgery for wound complications. There was no difference in patients treated less then 14 days or more then 14 days from injury. there was no difference in complications in smokers vs. non smokers or diabetics vs. non diabetics.

Conclusion:

The sinus tarsi approach is a safe surgical approach with an acceptable complication rate for fixation of displaced intra articular calcaneus fractures.
Assessing Lateral Ankle Instability Following Modified Brostrom Procedure
Authors: Vasileff Chris , Nowatzke Ryan , Ostosh Andrew , Anderson John , Bohay Donald , Maskill John , Padley Michelle
Published: September 2017

Category:

Ankle

Introduction/Purpose:

The modified Brostrom procedure obtained excellent to good results in 80% of patients treated for lateral ankle instability, making it one of the most common procedures for the treatment of this injury. In patients with a gastrocnemius contracture, however, the modified Brostrom repair leaves the narrower posterior talar dome held within the mortise. This decreased bony contact reduces stability and may be perceived by patients as continued instability post-operatively. The purpose of this study is to demonstrate that performing a gastrocnemius recession in conjunction with a modified Brostrom will increase the degree of stability of the ankle. This is the first study of its kind to our knowledge and hopes to further our knowledge of the functional improvements in the treatment of lateral ankle instability.

Methods:

This was a retrospective chart review with patients from the Orthopedic Associates of Michigan. 414 total patients in total with 82 who received gastrocnemius recession in conjunction with modified Bröstrom were evaluated for the purposes of this study. All patients were at least 14 years of age. Patients must have undergone a modified Brostrom procedure at a Spectrum Health or Metro Health facility from 1/1/2002 – 12/31/12 by performed Drs. Anderson, Bohay, or Maskill.

Results:

The mean age of all of the patients was 34.98 years (range 14-79). Pre-operatively, average AOFAS pain score for patients receiving modified Brostrom in isolation was 20.33, patients receiving concomitant gastrocnemius recession was 17.07. Post-operatively, average AOFAS pain score for patients receiving modified Brostrom in isolation was 32.29, patients receiving concomitant gastrocnemius recession was 32.44. Pre-operatively, proportion of patients meeting AOFAS stability criteria for those receiving modified Brostrom in isolation was 9.8%, those receiving concomitant gastrocnemius recession was 13.4%. Post- operatively, proportion of patients meeting AOFAS stability criteria for those receiving modified Brostrom in isolation was 76.8%, those receiving concomitant gastrocnemius recession was 86.6%.

Conclusion:

Patients receiving a concomitant gastrocnemius recession in addition to their modified Brostrom had increased pain pre-operatively but equivalent pain levels post-operatively compared to those who received a modified Brostrom in isolation. Additionally, there was a clinically significant increase in the percentage of patients with post-operative stability in those who received the gastrocnemius recession.
Correction of Rigid Equinovarus Deformity in Adults by Tibiotalocalcaneal Arthrodesis with Retrograde Intramedullary Nail
Authors: Yang Yunfeng , Zhou Haichao , Zhang Yun
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

To evaluate the results of tibiotalocalcaneal arthrodesis with retrograde intrameduallary nail for rigid equinovarus deformity in adults.

Methods:

We performed a retrospective review of rigid equinovarus deformity in adults treated with tibiotalocalcaneal arthrodesis using retrograde intramedullary nail between January 2011 and July 2014.The main outcome evaluations included American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, visual analogue scale (VAS) score and fusion time. All complications were recorded.

Results:

A total of 14 cases were enrolled. The average AOFAS ankle and hindfoot score improved from 34.4(range from 11 to 48; SD±10.4) preoperatively to 41.6(range from 26 to 55; SD±8.3) at 3 months postoperatively(P=0.041). The score increased significantly at 6 months postoperatively, which was even a little higher at 12 months. The change of the VAS score was similar to that of the AOFAS ankle and hindfoot score. The average VAS score decreased from 6.5 preoperatively to 1.4 at 12 months postoperatively. In total, five patients (35.7%) had complications; three cases developed delayed union, one case developed superficial infection and one experienced the tibial split operatively. Bone fusion was achieved in all patients at a mean of 13 weeks.

Conclusion:

Tibitalocalcaneal arthrodesis with retrograde intramedullary nail is an effective procedure to correct rigid equinovarus deformity in adults, with a high rate of bone fusion and satisfying outcomes.
A Prospective Study Evaluating Intra-Articular Hyaluronic Acid (1 ml) for Ankle Osteoarthritis
Authors: Younger Alastair , Wing Kevin , Veljkovic Andrea , Penner Murray
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

Early ankle arthritis can result in disabling symptoms and loss of function. However the degree of arthritis may not be severe enough or the symptoms severe enough to merit a fusion or replacement. For other patients they may wish to delay surgery to avoid financial issues with recovery time. Many of these patients have also been treated with NSAIDs, physiotherapy and bracing with variable effect. Stabilized long chain Hyaluronic acid (NASHA) has been used successfully in the knee, and has given a longer duration of effect compared to steroid injection. The purpose of this study was to determine the effect of hyaluronic acid in the ankle for sustainable symptom relief.

Methods:

A power analysis determined that a minimum of 29 patients would be required to appropriately power the study. A total of 37 adult patients with KL grade II and III ankle arthritis were enrolled in the study at a single institution. Patients recruited via a newspaper advertisement and from the surgical clinics and and screened for standard inclusion and exclusion criteria. The VAS pain preoperatively had to be greater than 30 / 100 mm. Outcomes were recorded at baseline, weeks 6, 12 and 26. The injection was performed after the baseline assessment using 1 ml of Hyaluronic acid NASHA (Q-Med AB, Uppsala, Sweden; DUROLANE 10 mg / mL) with or without local anesthetic to the skin. Outcomes included a VAS from the AOS scale for pain and disability, review of adverse events, physical exam, and use of rescue medication.

Results:

35 of 37 patients completed the study. At baseline the VAS pain was 7.2 (SD +/-1.8). At 6 weeks the pain score was 5.4 (+/-2.5) improving by 1.8 points with a 26% improvement. At 12 weeks the pain score was 5.3 (+/-2.7) for a 29% improvement. At week 26 the pain score was 5 (+/- 2.7) for a 32% improvement. 4 adverse events were recorded – one patient reported increased pain after injection. One reported pain and swelling, one reported inflammation, and one pain after injection.

Conclusion:

This prospective cohort study shows promise for the use of Hyaluronic acid for the treatment of ankle arthritis with relief of symptoms up to 26 weeks after injection. The injection was safe for all 37 patients, although one patient reported pain and dropped out of the study. We would support the use of Hyaluronic acid for the treatment for moderate ankle arthritis. An RCT would be merited based on this study to compare results with placebo or cortisone injection.
Correction of flatfoot deformity by subtalar arthrodesis through single medial approach
Authors: Yu Guang-Rong , Zhang Mingzhu
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

To study the clinical results using isolate medial approach to correct flatfoot deformity in subtalar joint arthrodesis.

Methods:

14 patients with flatfoot deformity were treated using isolated subtalar joint arthrodesis from March 2011 to March 2014. There were 3 males and 11 females with an average age of 60.81 years (ranged from 51 to 75 years). They are all cases of posterior tibial tendon dysfunctions, 9 of Myerson type Ⅲ, 3 of Ⅱ(b) and 2 of Ⅱ(c).

Results:

The mean duration of surgery was 100.54 minutes (range, 91-124 minutes). 12 patients were followed up for 20.25 months in average (range from 12 to 48 months). All of the cases have healed well, and the mean time of bone union was 9.53 weeks (ranged from 8 to 17 weeks). No infection was found in any cases. A complication was observed 1 patient which is painful ﬁxation. None of the patients experienced a nonunion or an adverse event related to the medial neurovascular structures. The mean Kitaoka score increased from 43.67 to 80.81

Conclusion:

Based on our experience with the procedure, the isolate subtalar joint arthrodesis is a useful alternative to triple arthrodesis for the correction of mild and some moderate flatfoot deformity.
Development of a cadaveric Hallux Rigidus model. Biomechanical testing
Authors: de Solminihac Diego Zanolli , Wagner Emilio , Wagner Pablo , Ortiz Cristian , Díaz Andres Keller , Radkievich Ruben , Palma Felipe , Guzman-Venegas Rodrigo
Published: September 2017

Category:

Bunion

Introduction/Purpose:

Hallux Rigidus (HR) is characterized initially by a decrease in Hallux metatarsophalangeal joint (MTPJ) dorsiflexion, decreasing the total range of motion. To be able to study different surgical treatment options, a cadaveric model has to be developed that recreates the limited range of motion. Our objective was to develop an Hallux Rigidus cadaveric model by shortening the plantar fascia (PF). Hallux MTPJ range of motion and joint stiffness were evaluated.

Methods:

8 cadaveric foot- ankle – distal tibia specimens were prepared, identifying all extensor and flexor tendons proximally. The skin and subcutaneous tissue was kept intact. Each specimen was mounted on a special frame and luminous markers were attached to the skin (Oxford Foot Model). A dead weight equal to 50% of the stance phase force was applied to each tendon, except for the Achilles tendon and the posterior tibialis. 10 Hallux MTPJ dorsiflexion-plantarflexion cycles were performed by pulling the Extensor Hallucis longus tendon using an tensile testing machine (Kinetecnics). A Hallux Rigidus model was then developed by shortening the PF by 6 mm using a triple fiberwire suture technique. The same 10 cycles were repeated with a shortened PF. Each specimen served as its own control. Hallux metatarsophalangeal stiffness and kinematics were tested using a tensile testing machine and high definition cameras.

Results:

The group with a shortened PF significantly reduced the hallux dorsiflexion (18.6 degrees) compared to the native foot (23.7 degress) (p<0.05). No significant difference in joint stiffness was seen between groups: 3.3 N per degree for the native foot and 4.3 N per degree for the Hallux Rigidus model (P>0.05).

Conclusion:

To create a HR model is vital to allow further understanding of the pathology. The cadaveric model should not alter the joint stability (intact periarticular soft tissues) but has to limit Hallux range of motion. The model we present successfully recreates HR by limiting MTPJ dorsiflexion. The absence of stiffness change shows that joint congruity and isometry were not modified. There are a few reports that state a PF shortening as the first stage in HR. This would lead to a hinge-like MTPJ dorsiflexion, creating a dorsal metatarsal head impingement that could evolve to a dorsal exostosis.
Can Specific Implant Designs Implicate Variations in Outcomes of Total Ankle Arthroplasty? A Systematic Review
Authors: Zhao Dahang , Huang Dichao , Wang Chen , Ma Xin Xin
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

Some complications of total ankle arthroplasty could not be reduced by improvement of surgeon experience. The purposes of the study were to determine whether there were variations in term of (1) intraoperative complications, (2) postoperative complication, (3) reoperation, revision and failure, and (4) postoperative radiographic findings among different studies.

Methods:

A comprehensive search was conducted. There were 953 for initial review. Initially, 136 irrelevant records, 174 review articles, 46 case reports and 1 retracted paper were excluded. Of the remaining 596 papers, 23 ultimately met our inclusion for final review.

Results:

Intraoperative fractures rates were higher studies of BP-type. Most of the pain or stiffness, malalignments, impingements, cysts were occurred in studies of STAR, HINTEGRA, Agility and Salto. Polyethylene insert fractures were occurred in most studies of STAR. Ten reported postoperative osseous fractures which all resulted from patients used STAR and BP-type. Reoperation rates were higher in studies of STAR, BP-type, Agility and Salto. Arthrodesis rates were lower from HINTEGRA. Arthrodesis rates from STAR, BP-type and Salto were higher than their revision rates. Periprosthetic lucency rates were lower from studies of HINTEGRA. The lucency rates of tibia were higher than talus. Cyst could be more easily observed from studies of STAR, Agility and Salto. All the osteoarthritis were reported in studies of STAR, BP-type and Agility.

Conclusion:

Currently the complication rates of TAA significantly decrease with modern implants, surgeons experience and patients selection. Some design-specific features of different prostheses were found in our study which could implicate variations in the complications and radiographic findings. We believed that these result could further improve the implant design.
Mandibular advancement and obstructive sleep apnoea: a method for determining effective mandibular protrusion
Authors: Dort L. C. , Hadjuk E. , Remmers J. E.
Published: September 2017

The objectives of the study were to test the hypotheses that it is possible, during routine polysomnography (PSG), to prospectively identify favourable candidates for mandibular repositioning appliance (MRA) therapy in the treatment of obstructive sleep apnoea (OSA) and to accurately estimate an optimal protrusive distance at which to fabricate the MRA.

A series of subjects underwent a remotely controlled mandibular positioner (RCMP) test during PSG monitoring. The ability of the RCMP test to eliminate OSA and the target protrusion at which that occurred was compared with the success of a custom oral MRA in the 33 subjects who completed the protocol.

The RCMP test was a success in 15 subjects and a failure in 18 subjects. Appliance therapy was initiated in 38 subjects and completed in 33. MRA therapy was successful at target protrusion in 80% of subjects who had a successful RCMP test and failed in 78% of those who failed the RCMP test.

In conclusion the remotely controlled mandibular positioner test outcome demonstrated a statistically significant association with mandibular repositioning appliance outcome. The target protrusion determined during the remotely controlled mandibular positioner test was the effective therapeutic protrusion in subjects with a successful remotely controlled mandibular positioner test.
Inhibition of mast cell PGD2release protects against mannitol-induced airway narrowing
Authors: Brannan J. D. , Gulliksson M. , Anderson S. D. , Chew N. , Seale J. P. , Kumlin M.
Published: September 2017

Mannitol inhalation increases urinary excretion of 9α,11β-prostaglandin F2(a metabolite of prostaglandin D2and marker of mast cell activation) and leukotriene E4. The present study tested the hypothesis that β2-adrenoreceptor agonists and disodium cromoglycate (SCG) protect against mannitol-induced bronchoconstriction by inhibition of mast cell mediator release.

Fourteen asthmatic subjects inhaled mannitol (mean dose 252±213 mg) in order to induce a fall in forced expiratory volume in one second (FEV1) of ≥25%. The same dose was given 15 min after inhalation of formoterol fumarate (24 µg), SCG (40 mg) or placebo. Pre- and post-challenge urine samples were analysed by enzyme immunoassay for 9α,11β-prostaglandin F2and leukotriene E4.

The maximum fall in FEV1of 32±10% on placebo was reduced by 95% following formoterol and 63% following SCG. Following placebo, there was an increase in median urinary 9α,11β-prostaglandin F2concentration from 61 to 92 ng·mmol creatinine−1, but no significant increase in 9α,11β-prostaglandin F2concentration in the presence of either formoterol (69versus67 ng·mmol creatinine−1) or SCG (66versus60 ng·mmol creatinine−1). The increase in urinary leukotriene E4following placebo (from 19 to 31 ng·mmol creatinine−1) was unaffected by the drugs.

These results support the hypothesis that the drug effect on airway response to mannitol is due to inhibition of mast cell prostaglandin D2release.
Effect of prior statin therapy on capillary permeability in the lungs after cardiac or vascular surgery
Authors: van de Visse E. P. , van der Heijden M. , Verheij J. , van Nieuw Amerongen G. P. , van Hinsbergh V. W. M. , Girbes A. R. J. , Groeneveld A. B. J.
Published: September 2017

Cholesterol-lowering statins can ameliorate severe forms of vascular hyperpermeability in experimental studies, and may thereby ameliorate acute lung injury and sepsis. It is unknown whether this also applies to humans. This study aimed to define whether or not prior statin therapy reduces mild post-operative increases in pulmonary capillary protein permeability associated with acute lung injury after cardiac or major vascular surgery.

A prospective observational study was performed in an intensive care unit of a university hospital on 64 patients, 37 after elective cardiac and 27 after major vascular surgery, of whom 68 and 44%, respectively, had received prior statin therapy. A mobile probe system was used to measure the pulmonary leak index (PLI),i.e.the transvascular transport rate of gallium-67-radiolabelled transferrin.

For all of the patients together, the mean PLI did not differ between the statin and control groups (22.9versus24.4×10−3 min−1). The prevalence of an elevated PLI was 57% in the statin and 59% in the control group. Subgroup analysis did not reveal significant differences caused by statins in the PLI of these patients.

Prior statin therapy neither has an adverse effect on mildly increased pulmonary capillary permeability in patients after cardiac or major vascular surgery nor does it ameliorate this increased capillary permeability.