bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Jones Dressing Cast for Safe Aftercare of Foot and Ankle Surgery: A Modification of the Jones Dressing Bandage
Authors: Gottlieb Tonio , Klaue Kaj 
Published: November 2020

Category: Ankle; Basic Sciences/Biologics; Hindfoot; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: The management of postoperative soft tissue healing is fundamental for the success of elective foot and ankle surgery. As postoperative edema is more relevant in such surgery due to its localization, soft tissue healing can take longer and pain can restrict function. There is no universal approach to surgery aftercare among foot and ankle surgeons. Although infections following foot and ankle surgery are rare, soft tissue healing can be jeopardized after extensive and multiple approaches. Postoperative edema, however, is common and contributes to unfavorable conditions for wound healing. Our study addresses the results of avoiding postoperative edema with the use of the Jones dressing cast. Methods: We defined a precise fixation technique of the foot and ankle in the immediate post-operative phase using what we call ‘the Jones dressing cast’. This technique is a modification of the Jones dressing bandage. In a previous study we compared two groups of patients (N = 20/23) who underwent similar reconstructive surgery with the application of the described cast for one week and without. At the twomonth follow-up we observed that the group treated with the cast required less pain relief, spent less time in hospital and achieved faster autonomy using crutches (Gottlieb and Klaue, 2013). In this study we considered a group of 45 patients who underwent similar reconstructive procedures to those in the first study and who were treated with the cast for two weeks post-operatively. There was no visual check of the soft tissues before removal of the cast. Results: Although patients in Group 2 had more complex surgery, mobility was achieved earlier and hospitalization time was shorter. The incidence of infection was lower in the group wearing the cast for 2 weeks. The patients treated with the cast for 2 weeks regained autonomous mobility significantly earlier than those in Group 1 (cast 1 week or less). Conclusion: The Jones dressing cast is a useful tool that can help minimize postoperative complication rates. Wearing the cast for two weeks is preferable. Our study suggests its effectiveness in reducing soft tissue complications and facilitating independent mobility.
Posterolateral Plate Fixation with Pantalarlock® is More Stable than Nail Fixation in Tibiotalocalcaneal Arthrodesis in a Biomechanical Cadaver Study
Authors: Gutteck Natalia 
Published: November 2020

Category: Ankle; Ankle Arthritis Introduction/Purpose: Despite the promising results of ankle joint arthroplasty, the tibiotalocalcaneal (TTC) arthrodesis remains an established procedure in treatment of combined pathology of the ankle and subtalar joint. Despite the promising results in biomechanical investigations, nonunion rates of up to 24% are described in recent studies. The objective of this work was a comparative study of the biomechanical properties of the posterolateral plate fixation with retrograde intramedullary nail fixation. Methods: Twenty four fresh-frozen human lower leg specimens (12 pairs) were used for the comparative biomechanical testing. Every specimen was preconditioned with 100N over 200 cycles. After every 250 cycles the force was increased by 50N from 200 to 600N. This was followed by cyclic loading in dorsi-/plantiflexion with 800N for 3000 cycles. All specimens were subjected to bone densitometry (DXA) and computed tomography. Results: Significantly higher number of spacimens with nails (4) failed during the cycling testing in dorsi-/plantarflexion and futher two during the cyclic testing with 800N. Two specimens with plates failed during the cyclic testing with 800N. Statistical analysis showed that the specimens with the plate were significantly more stable in each test direction. The Pearson correlation demonstrated for the specimens with plate a linear relationship between the stiffness and the determined bone density. Conclusion: We expect a considerable reduction of the pseudarthrosis rate and shorten the postoperative treatment phase in clinical set up and appropriate advantages in the treatment of high risk patients with severe deformity of the ankle, bone defects, neuropathic deformity, poor bone quality and osteoporosis. The choice of most predictable and stable implant is essential for the successful fusion. In conclusion, the posterolateral plate ostesynthesis for TTC arthrodesis is significantly stiffer compared to the nail osteosynthesis in osteoporotic bone model.
Diagnosing Syndesmosis Instability: Dynamic Ultrasound versus Arthroscopy: A Cadaveric Study
Authors: Hagemeijer Noortje , Sato Go , Bhimani Rohan , Lubberts Bart , Elghazy Mohamed Abdelaziz , Kerkhoffs Gino , Guss Daniel , DiGiovanni Christopher W. 
Published: November 2020

Category: Ankle Introduction/Purpose: To evaluate whether sagittal translation could be detected with ultrasound and arthroscopy and to compare the increasing tibiofibular sagittal translation seen with ultrasound (US) and Arthroscopy. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. The ankle syndesmosis was evaluated using a handheld US device (Butterfly iQ, Butterfly Network Inc, Guilford) and arthroscopy with intact-, and after sequent sectioning of anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior- inferior tibiofibular ligament (PITFL). Sagittal plane translation was simulated with 100N of anterior to posterior (A-to-P) and posterior to anterior (P-to-A) hook force which was applied 5cm above of the ankle joint (Figure 1). Pearson’s correlation, one- way repeated measures ANOVA, and Wilcoxon signed-rank test were used for comparison. Three cadavers were measured by two independent observers to assess reliability and analyzed using intraclass correlation coefficients (ICC). Results: A-to-P translation values obtained with US and Arthroscopy had a correlation of -0.14, and P-to-A translation correlation of 0.44. Using US, intact translation was 0.94+-0.62 with A-to-P hook and 0.87+-0.5 with P-to-A hook. Subsequent A- to-P and P-to-A translation increased with 0.07+-0.96mm and 0.04+-0.76 after AITFL cut, with 0.53+-0.9 and 0.15+-0.5 after IOL cut, and with 0.81+-1.3mm and 0.45+-0.8 after PITFL cut (p-values between 0.122 and 0.270) . Using arthroscopy, intact translation was 0.40 +-0.3 with A-to-P hook and 0.99+-0.5 with P-to-A hook. Subsequent A-to-P and P-to-A translation increased from intact with; 0.001+-0.3 and 0.30+-0.4 after AITFL cut, 0.19+-0.4 and 0.74+-0.7 after IOL cut, and 0.40+-0.5 and 1.1+-0.9 after PITFL cut (p-values between 0.005 and 0.037). No statistical differences between US and Arthroscopy were found. Conclusion: US was unable to differentiate between the different stages of injury, even though a similar increase in translation was seen as compared to arthroscopy. Probably this is due to the high variability seen in the US translation values. As US does have several advantages over arthroscopy; availability, non-invasiveness, low costs, and allowance of using the contralateral side as a direct comparison, this technique should be further explored as a potential diagnostic assessment technique of diagnosing occult syndesmotic instability in the sagittal plane.
Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspect Syndesmotic Instability: A Cadaveric Study
Authors: Hagemeijer Noortje , Bhimani Rohan , Saengsin Jirawat , Lubberts Bart , Waryasz Gregory R. , Kerkhoffs Gino , DiGiovanni Christopher W. 
Published: November 2020

Category: Ankle; Sports; Trauma Introduction/Purpose: To evaluate syndesmotic instability by measuring the tibiofibular clear space (TFCS) opening using a portable ultrasound device. In addition, we assessed the optimal amount of external rotation torque required to detect syndesmotic instability. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used. Using a portable ultrasound device (Butterfly iQ, Butterfly Network Inc) the ankle syndesmosis was evaluated in the intact stage, and after sequentially sectioning of the anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL)(Figure 1). In each ligamentous sectioning stage TFCS in millimeter (mm) was measured with ultrasound while consecutively 0N, 45N, 60N, 75N, and 90N external rotation directed torque was applied to the ankle. To evaluate which amount of torque would be sufficient to detect syndesmotic instability the delta increase of TFCS opening at different states of torque compared to the unstressed state was calculated. One-way repeated measures ANOVA was used to detect whether an increase in delta-TFCS opening could be detected between the intact state and consecutive syndesmotic ligament transection stages. Correction for multiple comparisons was performed using the Bonferroni-Holm correction. Results: Under all torque-loading conditions TFCS (mean+-SDmm) opening increased as additional syndesmosis ligaments were transected (p-values<0.001). With all ligaments intact an increase of TFCS opening was detected during torque increment, ranging from 4.50+-1.2mm at 0N to 5.7+-1.00mm at 90N. After AITFL transection this amount increased from 5.2+-1.4mm at 0N to 6.5+-1.8mm at 90N. After AITFL+IOL transaction from 6.2+-1.3mm at 0N to 10.6+-6.2mm increase at 90N, and after AITFL+IOL+PITFL transection the TFCS opening increased from 6.8+-1.2mm at 0N to 11.1+-2.8mm at 90N. Significant difference from intact was seen after transection of the IOL, already from the unstressed (0N) state on (difference 3.0+-1.4mm, p-value 0.036). Additionally, the AITF+IOL could also be differentiated from AITFL transection stage at 45N with a difference in TFCS opening of 2.06+-1.2mm (p-value 0.006). Conclusion: Portable dynamic ultrasonography is a useful tool to evaluate suspect syndesmotic instability. TFCS opening increased as additional ligaments of the syndesmosis were transected and application of 45N torque seems to be sufficient to detect syndesmotic instability.
The Use of Long Acting Opioids to Prevent Rebound Pain Following Peripheral Nerve Blocks for Outpatient Foot and Ankle Surgery
Authors: Herzog Leah , Wilson Sylvia H. , Gross Christopher E. 
Published: November 2020

Category: Ankle; Bunion Introduction/Purpose: Peripheral nerve blocks have become an integral part of orthopedic surgery to assist with postoperative pain. However, 40% of patients who undergo a peripheral nerve block will experience rebound pain, which in turn, long-acting narcotics may be able to block. Unfortunately, this rebound pain can cancel out the potential benefits of decreased opioid medication use. Therefore, this study seeks to compare the difference in patient reported pain scores in those patients whom received long-acting opioid pain medication and those who did not. Methods: This is a retrospective review of patient-reported pain scores for 96 patients who underwent a peripheral nerve block for outpatient foot and ankle surgery. 48 patients either received three days of long-acting opioids or did not. Each patient was asked to fill out and return a pain diary as well as fill out a pain catastrophizing survey (PCS) at their postoperative appointment. The pain diary discussed their Visual Analogue Scale pain scores, amount of pain medication, and time they took the medicine. This data was then collected and compared via paired student t-tests for evaluation of significance. Results: Pain diaries were completed by 69 patients (72%). There were no significant differences between those comorbidities, types of procedures, age, or BMI between the groups. Mean postoperative pain scores did not differ between patients that did and did not receive postoperative extended release opioid medications (p = 0.226). Mean opioid consumption did not differ between groups (p = 0.945). There were no correlations between daily reported pain scores or the postoperative day with the highest pain score for those who received long acting opioid pain medication versus those who did not (r=0.336, p=0.550). Conclusion: Rebound pain is a difficult potential side effect of peripheral nerve blocks that currently does not have a preventative measure. This study was an attempted effort to help eliminate rebound pain, but there did not appear to be a significant benefit to adding long-acting opioid pain medication in addition to the peripheral nerve block and short-acting pain medication
A Comparative Study between Lateral Approach Alone and Combination of Medial and Lateral Approaches for Intra-Articular Calcaneal Fractures with Displaced Sustentaculum Fragment
Authors: Hio Naohiro , Taki Masanori 
Published: November 2020

Category: Hindfoot; Trauma Introduction/Purpose: In intra-articular calcaneal fractures, the sustentaculum fragment, which is the reference for reduction, often undergoes varus plantar flexion displacement and requires accurate reduction. Although the lateral approach is generally used as a surgical approach, it is considered that the use of the combination of medial and lateral approaches can achieve more accurate reduction. Here we report a comparative study of between the group with the lateral approach alone (L-group) and the group with the combination of the medial and lateral approaches (ML-group) for calcaneal fractures with displacement of sustentaculum fragment. Methods: L-group included 11 feet, six feet of which were categorized as Sanders classification type 2, four as type 3, one as type 4. ML-group included 14 feet, ten as type 2, two as type 3, two as type 4. In both groups, small incision such as sinus tarsi approach were used for lateral approach and screws and/or plates were used for fixation. We assessed Creighton-Nebraska scale, pre- and postoperative width and height of the calcaneal body, step of subtalar joint surface and inclination angle of the sustentaculum fragment. Results: The mean postoperative clinical evaluation for the L-group / ML-group was 90.5+-7.9 points / 87.2+-9.6 points respectively. The pre- and postoperative image assessments showed improvements in the mean width from 123.4+-15.3% to 110.3+-14.1% / 129.9+-23.1% to 109.9+-14.1%, in the mean height from 88.1+-5.2% to 98.1+-3.7% / 86.0+-9.6% to 95.4+-5.9%, in the step of subtalar joint surface from 9.0+-6.3mm to 0.9+-1.1mm / 10.0+-8.0mm to 0.7+-1.0mm, and in the inclination angle of sustentaculum fragment from 10.3+-5.1 ° to 5.5+-5.0 ° / 12.1+-7.5 ° to 0.5+-1.0 °, respectively. There was a significant difference between the two groups in the inclination angle of the sustentaculum fragment, but no significant difference was observed in the other assessments. Complications were more common with ML-group. Conclusion: Displacement of the sustentaculum fragment in calcaneal fractures can be more reduced accurately by using the combination of medial and lateral approaches, although there is no significant difference in clinical results.
Modified Ankle-Hindfoot Alignment Radiological Evaluation Method and Application in the Flatfeet
Authors: Hong-Mou Zhao 
Published: November 2020

Category: Hindfoot Introduction/Purpose: Based on a prospective study, a new method of photographing and measuring of hindfoot alignment based on X-ray was proposed, and its reliability is verified, as well as its application in flatfeet. Methods: This study included 28 patients (40 feet) with flatfeet and 20 volunteers (40 feet) from January to December in 2018. The shooting frame, designed by our team, has been used to take the hindfoot alignment view at 10°, 15°, 20°, 25°, 30° respectively. Our modified tibio-hindfoot angles (THA) at standard Saltzman position (shooting at 20°) were evaluated, and the consistency were compared with the van Dijk method and the modified van Dijk method, and compared with weight-bearing CT. The visibility of tibiotalar space were evaluated in all shooting angles. The consistency of the modified THA method at different projection angles were evaluated. The angle of hindfoot valgus of flatfoot patients was measured with use of the modified THA method, and compared in different shooting angles. Results: The mean THA in standard Saltzman view in normal people were significantly differences between the three evaluation methods (P < 0.001). The results of modified THA method were significantly larger than those of Van Dijk method (P < 0.001) and modified Van Dijk method (P < 0.001). There was no significant difference between the results of modified THA method and the weight-bearing CT (P=0.605), and the intra- and inter-group consistency was the best in modified THA group. The tibiotalar space in the normal group were visible in all cases at 10°, 15°, 20°; and visible in some cases at 25°; and invisible in all cases at 30°. In the flatfoot group, the tibiotalar space were visible in all cases at 10°; and in some cases at 15° and 20°; and invisible in all cases at 25° and 30°. In the normal group, the modified THA was 4.84±1.81° at 10°, 4.96±1.77° at 15°, 4.94±2.04° at 20°. No significant difference was found between the three groups (P=0.616). In the flat foot group, the modified THA of 18 feet, which was visible at 10°, 15° and 20°, was 13.58±3.57° at 10°, 13.62±3.83° at 15° and 13.38±4.06° at 20°. There was no significant difference between the three groups (P=0.425). Conclusion: The modified THA evaluation method is simple to use and has high intra- and inter-group consistency. It can be used to evaluate hindfoot alignment. For patients with flatfeet, the 10° position view and modified THA measurement can be used to evaluate the hindfoot valgus conditions.
Pathological Characters and Molecular Pathogenesis of Diabetic Neuropathic Osteoarthropathy Cartilages Damage
Authors: Hong-Mou Zhao 
Published: November 2020

Category: Basic Sciences/Biologics Introduction/Purpose: The aim of current study was to investigate the pathological characters and relative molecular pathogenesis of the cartilages damage in diabetic neuropathic osteoarthropathy (DNOAP) patients. Methods: The articular cartilages of ankle joint, subtalar joint and talonavicular joint of 8 patients with DNOAP from March 2017 to June 2018 were selected as DNOAP group. And the articular cartilage of matched joints from 8 amputation patients were selected as control group. Masson staining and safranine O/fixed green staining were used to observe the histopathological characteristics of cartilage, and the ultrastructural changes of chondrocytes were observed by electron microscopy. Chondrocyte culture was carried out in DNOAP group and control group. Western blot was used to detect the expression of RANKL, OPG, IL-1ß, IL-6, TNF-a, Aggrecan protein in chondrocyte. DCFH-DA probe was used to detect the level of reactive oxygen species in chondrocyte. Flow cytometry was used to detect the apoptotic rate of chondrocyte. Results: In DNOAP group, chondrocytes decreased, subchondral bone proliferated, structure disordered and osteoclasts formed in a large number in subchondral bone area. Under transmission electron microscopy, mitochondrial and endoplasmic reticulum swelling were observed in DNOAP chondrocytes. The chromatin was partially broken and concentrated at the edge of nuclear membrane. The ROS fluorescence intensity of chondrocyte in DNOAP group was higher than that in normal control group (28.1±2.3 VS 11.9±0.7, P<0.05). The relative expression of RANKL, TNF-a, IL-1ß and IL-6 protein in DNOAP group was higher than that in normal control group, while the relative expression of OPG and Aggrecan protein was lower than that in normal control group (both P < 0.05). Flow cytometry showed that the apoptotic rate of chondrocyte in DNOAP group was 3.3%±0.2%, which was higher than that in normal control group (1.2%±0.1%, P<0.05). Conclusion: Serious destruction of chondrocytes and organelles structure was the pathological characteristics of DNOAP. Inflammation plays a role in promoting the pathogenesis of DNOAP.
Patient Characteristics and Comorbidities in Patients Attending Specialist Foot and Ankle Outpatient Clinics in the UK: A Report of 2000 Patients
Authors: Houchen-Wolloff Linzy , Tomlinson Clare , White Alice E. , Venturini Sara , Best Alistair J. , Allen Patricia , Mangwani Jitendra 
Published: November 2020

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: For integrated care and appropraite referral pathways, it is important to understand the patient demographics, pathologies and comorbidities of patients with foot and ankle pain. We are aware of the burden of foot and ankle problems in UK primary care, with a large number of referrals to outpatient orthopaedic clinics (Ferguson et al. Br J Gen Pract, e422, June 2019). With increasing demands on secondary and tertiary care settings, it is important to think of innovative solutions. To our knowledge there is no large patient case series looking at these aspects of care in foot and ankle patients attending outpatient clinics in the UK. Methods: Therefore the aims of this study were to: 1. To gain a better understanding of the demographics and pathologies of patients attending a specialist foot and ankle clinic. 2.To develop our existing knowledge of the types and prevalence of comorbidities within this population. Data was collected prospectively. All new patients attending a specialist foot and ankle clinic in one centre in the UK were asked to complete a proforma at their first assessment (figure 1). Information was collected on gender, age, occupation, hobbies, location of ankle pain, previous injuries, compensation issues, presence of comorbidities and medications. A descriptive analysis of the data was conducted using SPSS (version 19, IBM). Results: Data from 2001 patients was collected. The mean (SD) age was 52.9 (16.9) years with 76% being female. Nine percent of patients had diabetes (though others may have been seen in diabetic/ vascular clinics and not captured here) and 16% were current smokers. Thirty-three percent of patients had a previous history of injury to the foot and/or ankle. The right foot was affected in 49% and the left in 51%. Location of pain was in the forefoot (52%), midfoot (21%) and hindfoot (27%). Compensation issues were reported in 3%. The proportion of patients in work was 64.4% meaning 35.6% were unemployed (including those who had retired). Conclusion: This large study demonstrates that more women attend specialist foot/ ankle clinics in the UK. Both feet are equally affected; the forefoot was the most common site of pathology. The prevalence of diabetes and smoking are in line with the general UK population (reported as 9% and 15%). A small proportion of patients had compensation issues, with the majority of patients working. This data can be used to help streamline referral pathways and to establish innovative ways of working (e.g. virtual clinics). In turn, this may reduce the burden on outpatient clinics, the health economy and improve patient satisfaction.