bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molybdenum Rhenium (MoRe®) as a Biologically Superior Alloy for Foot and Ankle Implants
Authors: Pedowitz David , Parekh Selene , Adams Samuel , Nunley James , Easley Mark , Hyer Christopher , Brigido Stephen 
Published: September 2018

Category: Other Introduction/Purpose: The most common complications in orthopaedic surgery of the foot and ankle documented in the literature are postoperative infections with a frequency between 1 and 8%. The development of an implant-associated infection can be a potentially devastating complication following foot and ankle surgery. This leads to a high number of revision surgeries after initial fracture stabilization and potential loss of function of the joint and quality of life in the long-term follow-up. Titanium, the most commonly used alloy for foot and ankle implants, has limited strength and is notch-sensitive so repetitive stress leads to fatigue failure of implants and limits design options. Better materials with both optimized mechanical and biological properties could result in the development of superior foot and ankle implants. Methods: Several studies were performed to evaluate the biological properties of MoRe®: A study was conducted to characterize the hydrophilic properties by contact angle comparisons of the MoRe alloy compared to Titanium. A cell growth study was conducted to look at the influence of MoRe alloy on osteoblast growth and differentiation as compared to Titanium. A bone implantation study was conducted based on ISO 10993: Biological Evaluation of Medical Devices, Part 6: Tests for Local Effects after Implantation to evaluate the local tissue and bone response of MoRe® alloy test coupon compared to Titanium controls, when implanted in the mid-shaft femoral bone of rabbits for 4, 13 and 26 weeks. Biofilm formation study was conducted to quantify attachment and biofilm development of S. aureus bacteria upon MoRe® alloy in comparison to CoCr alloy in a well-controlled, reproducible, ex vivo laboratory experiment. Results: MoRe®, composed purely (99.99%) of molybdenum and rhenium, is a cofactor to the enzymes xanthine and sulfite oxidase, which are essential to bone metabolism. Rhenium is an inert metal with no biological affect. MoRe® has superior hydrophilicity (CA 37°±3°) compared to Titanium (CA 58°±3°), a key factor in cell adhesion, migration and replication. Pre-osteoblast cell seeding was found to be equivalent between MoRe° and Titanium alloy (10,000 cells/cm2). The bone implantation study demonstrated continued bone maturation over time for both MoRe® and Titanium implant sites with similar osteoconduction and bone remodeling histology of the cortical and medullary bone at 4, 13 and 26 weeks. The biofilm study found that S. aureus better colonized cobalt chrome alloy in comparison to MoRe® (p = 0.009). Conclusion: The MoRe® alloy, with its advantageous biological properties and hydrophilicity, offers great promise for the design of a new generation of bio-friendly foot and ankle implants with superior cell growth, osseointegration and biofilm resistance resulting in better outcomes for patients.
Arthroscopically Assisted Treatment of Complex Ankle Fractures
Authors: Polzer Hans , Baumbach Sebastian , Braunstein Mareen 
Published: September 2018

Category: Arthroscopy Introduction/Purpose: Especially after complex ankle fractures, patients suffer from residual pain, swelling and stiffness. Evidence suggests that this poor outcome might be related to occult intraarticular injuries. Recent studies documented chondral lesions in up to 89%. Therefore, many authors emphasize the value of ankle arthroscopy in acute fracture treatment (AORIF). Only few studies reported on the findings of AORIF, even less documented the subjective and objective outcome thereafter. Aim of this study was to evaluate the intraarticular lesions and the results following AORIF for complex ankle fractures after 1-year of follow-up. Methods: Patients presenting with closed, complex ankle fractures were included. AORIF was performed following a standardized protocol. Primary outcome was the AOFAS Score. Secondary outcome parameters were the Olerud and Molander Score, Tegner activity scale, arthroscopic findings, functional assessment and complications. Statistical analysis was performed using SSPS 22.0 (IBM). Results: Between 05/13-12/14, 32 patients were enrolled (56% female, 45±16 years). Three patients were lost to follow-up. 16% suffered from uni-, 22% from bi- and 62% from trimalleolar fractures. Chondral lesions were observed in 91% (ICRS 2.9±0.9). In 34% micro fracturing was performed. Full thickness lesions were observed exclusively in in bi- and trimalleolar fractures. Three patients suffered from minor complications. After 1 year, the mean AOFAS was 93±6 and the mean OMAS was 88±8. Linear regression revealed no significant variables affecting the outcome. Conclusion: Intra-articular injuries are common in complex ankle fractures requiring chondral therapy in 34%. AORIF leads to good-excellent results in all but one patient, including those with bi- and trimalleolar fractures without increasing the risk for complications.
The Incidence of Nonunion of the Hallux Interphalangeal Joint Arthrodesis
Authors: Prissel Mark , So Eric , Chu Anson , Wilson Matthew 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Hallux interphalangeal joint (HIPJ) arthrodesis is an effective procedure to treat pain and provide stability, which is often performed for intrinsic pain to the HIPJ. Additionally, this procedure is typically employed in concert with the Jones tenosuspension. Despite that this is an accepted technique, the available literature is scant and questions remain regarding nonunion rates and contributory factors to poor healing. A systematic review of the literature was undertaken to determine the rate of nonunion for HIPJ arthrodesis. Methods: To acquire the highest quality and most relevant studies available, publications were eligible for inclusion only if they involved patients undergoing HIPJ arthrodesis. Studies additionally required mean follow-up of at least six weeks and inclusion of appropriate detail regarding complications, nonunion rates, and patient demographics. Ultimately, 7 studies involving 313 HIPJ arthrodeses met inclusion criteria. Results: A total of 291 patients with a weighted mean age of 48.9 were included. The nonunion rate was 28.3% at a weighted mean follow-up of 8.4 months. The overall complication rate was 33.0%. Conclusion: Considering the increased rate of complications and nonunions for this commonly employed procedure, additional prospective comparative analyses are needed to identify important patient demographics and to determine superior fixation constructs.
Does Hallux valgus severity change after medial capsulotomy? Intraoperative Analysis
Authors: Radkievich Ruben , Caicedo Nathaly , Díaz Andres Keller , Calvo Rafael , Wagner Pablo , Wagner Emilio 
Published: September 2018

Category: Bunion Introduction/Purpose: Most treatment algorithms for hallux valgus surgery consider the intermetatarsal angle (IMA) and the metatarsophalangeal (MTP) angle to help decide which technique to choose. Some guidelines are more stringent, and some use different absolute values to decide between one technique and another. Every open approach includes a medial metatarsophalangeal capsulotomy to gain access to the joint and perform some type of osteotomy. No study is available which measures hallux valgus deformity after an intraoperative metatarsophalangeal capsulotomy, which may change our surgical technique depending on the algorithm in use. Our hypothesis was that when performing a medial capsulotomy, the hallux valgus deformity would increase. Methods: We analyzed 20 feet in 14 hallux valgus patients operated between April to June 2017, average age 57 years, 13 women and 1 men. Patients with previous hallux valgus surgery, arthritic changes, knee or hip comorbidities were excluded. Fluoroscopic images were taken in a standardized manner, simulating weight bearing images, with knee and hip in flexion, stabilizing the foot over the mini C arm in maximal ankle dorsiflexion. All the images were taken by the same observer. Digital images were analyzed, and the IMA and MTP angles were measured by two independent observers. The average preoperative IMA was 13.6 degrees, and the average MTP angle was 23.4 degrees. Statistical analysis was performed using SPSS software, p<0.05. Results: After opening the medial capsule, we observed a significant increase in the IMA (mean 2.78 degrees, 2.4 - 3.1 degrees 95% confidence interval) and in the MTP angle (mean 4.4 degrees, 3.6 - 5.2 degrees 95% confidence interval). No correlation was found between the severity of the deformity and the relative increase in angular measurements. There was no significant variability between the two observers. Conclusion: When using algorithms for treatment decision making in hallux valgus surgery, it is important to clearly define the severity of the deformity to choose appropriately the technique to be used. When choosing a technique near its correction limit, if we consider that the deformity will increase after opening the medial capsule, it may be possible to underestimate the deformity and therefore use an underpowered technique, leading to a suboptimal result. We recommend therefore to add 3 and 5 degrees to the IMA and MTP angle measurement respectively, and then choose the appropriate technique.
Time to surgery for ankle fractures
Authors: Rai Paul , Mangwani Jitendra 
Published: September 2018

Category: Trauma Introduction/Purpose: Ankle fractures constitute 9% of all fractures and surgical fixation is often required when they are unstable. The bony anatomy has little soft tissue coverage overlying the malleoli. The surgical site is therefore at risk of infection and wound breakdown. BOAST guidelines advise operative fixation on the first or second day after injury. Often in practice this window is missed and fixation is undertaken many days after the injury. We aimed to prospectively review the incidence of early wound complications and infection in 300 patients treated early or late with plate osteosynthesis for Weber B or C ankle fractures. This was conducted at a UK Trauma Unit. Methods: Between November 2013 and November 2016 consecutive patients with closed, isolated ankle fractures were included. Consent was obtained for entry into the study pre-operatively and they were followed up at 2 weeks post operation. Patients were categorised by time to surgery into the following subsets: < 24 hours, < 48 hours and > 48 hours. The 2 week consultation letters were reviewed retrospectively and reported wound complications recorded. The hospital microbiology database was used to identify any positive superficial or deep wound culture results. Comorbidity data and demographics were collected. Results: 208 out of 300 patients had a complete dataset. The mean age was 46 (range 16-95). The superficial infection rate at < 24 hours, < 48 hours and > 48 hours was 4%, 0% and 3% respectively. There were no suspected deep infections at 2 weeks. There were 7 (3%) positive deep wound cultures. The mean BMI was 28 and venous thromboembolism prophylaxis was instituted for all patients as per local guidelines. 3% had diabetes and 23% were smokers. Conclusion: This study has shown that timing of surgery has not shown any significant influence on early infection rates. Surgery may be safely delayed until soft tissue swelling has reduced. However, there may be other benefits of early surgery such as reduced venous thromboembolism and improved patient reported outcome measures.
Syndesmotic Fixation With Suture Button. Neurovascular Structures at Risk. A Cadaver Study
Authors: Shah Ashish , Patel Harshadkumar , Pinto Martim , Dahlgren Nicholas , Abyar Eildar , Stibolt Robert , ehtonen Eva , Johnson Michael , Naranje Sameer 
Published: September 2018

Category: Trauma Introduction/Purpose: Damage to distal tibiofibular syndesmosis occurs in 25% of operative ankle fractures. Syndesmotic stabilization is crucial to prevent significant pain, instability and degeneration of the joint. One operative method is insertion of suture buttons. Though effective, this method can result in entrapment and damage of the saphenous neurovasculature of the medial tibia. The purpose of this study was to describe the anatomic risk of direct injury to the saphenous nerve and greater saphenous vein during syndesmotic suture button fixation. Methods: This study was performed on 10 below knee cadaveric leg specimens. Under fluoroscopic guidance, syndesmotic suture buttons were placed from lateral to medial at 1cm, 2cm, and 3cm above the tibial plafond at an anterior angle of 30 degrees to the coronal plane. Dissection was performed through medial tibial incision to record the distance and position of each button from the greater saphenous vein and saphenous nerve. Statistical measurement and analysis was performed with SPSS. Results: The mean age of cadavers was 78.2 ± 6.9 years and mean BMI was 21.6 ± 2.2. The mean distance of the saphenous nerve to the suture buttons at 1cm, 2cm, and 3cm were 7.1 ± 5.6mm, 6.5 ± 4.6mm, and 6.1 ± 4.2mm, respectively. The saphenous nerve was compressed in 2 cadavers (20%) at 1cm, 2 cadavers (20%) at 2cm and 1 cadaver (10%) at 3cm by suture buttons. Mean distance of the greater saphenous vein from the suture buttons at 1cm, 2cm and 3cm were 8.6 ± 7.1, 9.1 ± 5.3, and 7.9 ± 4.9mm respectively. The great saphenous vein was compressed in 2 cadavers (20%) at 1cm, 1 cadaver (10%) at 2cm and 1 cadaver (10%) at 3cm by suture buttons. Conclusion: There was at least one case of injury to both the saphenous vein and nerve at every level of button insertion at a rate of 10-20%. The close proximity of the suture button to neurovasculature combined with significant anatomic variation in saphenous nerve anatomy suggest that neurovascular injury may be best avoided by direct visualization prior to suture button placement. Great care should be taken to avoid injury to saphenous neurovascular structures during suture button insertion. Keeping an eye on close proximity of neurovasculatures, we recommend medial incision for during syndesmotic suture button fixation.
Can Jones fracture be treated conservatively?
Authors: Shah Rajiv 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Operative management is the treatment of choice for Jones fracture. Situations are fought where operative management may not be possible or may not be accepted. Such situations being more common in developing countries, clinicians are forced to undertake conservative management. Pertain to this, many questions are still unanswered. Can conservative management succeed? If so, what should be the protocol? What all could be the possible complications? And how to overcome them? To answer all these questions, we undertook a study to evaluate results of conservative management of Jones fracture. The purpose of this study was also to suggest conservative management guidelines. Methods: Retrospective analysis of 32 conservatively treated Jones fracture cases over period of two years was done with average follow up of nine months. Only cases included were those between the ages of 20 to 50 years, not willing for operative management. Cases in the same age group, willing for surgery and cases lost to follow up were excluded. Conservative management comprised of full length below knee non weight bearing plaster cast in eversion and dorsiflexion for four weeks followed by short length below knee weight bearing plaster cast in neutral position of ankle and subtalar joint. Radiological evaluations were done at the end of 4, 8, 14, 20 and 26 weeks. Results of serial clinical and radiological assessments were analysed. Results: Thirty out of 32 cases went on to sound clinical as well as radiological union. With respect to average time to union, two major group of cases could be segregated. First group (20 cases) had a proximal fracture line nearer to zone 1 and took 11 weeks to unite. Second group (12 cases) had a distal fracture line nearer to zone 3 and took 18 weeks to unite. Both the nonunion cases were from this group. Clinical union preceded radiological union by average of 2 to 3 weeks. Conclusion: Jones fracture could be successfully treated conservatively even in young and active population provided specific protocol is followed. Initial full length below knee plaster in dorsiflexion and eversion neutralized deforming forces of peronei and plantar fascia while next short below knee walking plaster cast helped to regain muscle tone, increased perfusion and simulated walking leading to union. Fractures nearer the tuberosity had a faster union in comparison to distal fractures nearer the shaft. In view of short follow up with small numbers of present study, a multicentric prospective study comparing results of surgical versus conservative treatment is deemed.
Treatment of Pilon fracture malunion with distal tibiaI osteotomy and reconstruction
Authors: Shi Zhongmin 
Published: September 2018

Category: Ankle Introduction/Purpose: To evaluate the clinical outcomes of distal tibial osteotomy and alignment reconstruction for pilon fracture malunion. Methods: Between January 2010 and May 2012. 15 cases of pilon fracture malunion were treated with super-malleolar extra-articular osteotomy and alignment reconstruction. They were 12 males and 3 females with an average age of 30.8 years(from 24 to 39 years). The pre-operative X-ray and CT scan showed varus deformity in 9 cases anti valgus in 2 cases. There were 4 cases of anterior impact of the distal tibia and 4 cases of tibiotalar subluxation. All the patients complained about ankle pain, deformity, limited range of motion(ROM)and walking difficulty. X-ray was taken routinely to confirm the bone healing during post-operative follow-up. Scores of visual analogue scale(VAS), American Orthopaedic Foot & Ankle Society(AOFAS)and The Short Form-36(SF-36), ankle ROM and complications were also recorded. Results: 13 cases obtained all average follow-up of 23. 8 months (from 19 to 48 months)and 2 were lost to the follow-up. Bony union was achieved after an average of 3.8 months(from 3 to 7 months). The average VAS score declined significantly from 5.1±3.2 preoperatively to 1.4±0.8 postoperatively (P<0.05). A complete pain relief was achieved in 8 cases. The AOFAS ankle and hindfoot score, SF-36 score, ankle ROM at the last follow-up were improved significantly compared with the preoperative ones (P<0.05). No implant failure, soft tissue complications or occurred during the follow-up. Conclusion: Distal tibial osteotomy and alignment reconstruction is an effective treatment of Pilon fracture malunion, as this strategy can restore the lower limb alignment, relieve pain and decrease the rate of long-term post-traumatic arthritis.
Sesamoidectomy for the Hallux Sesamoid Disorders
Authors: Shimozono Yoshiharu , Hurley Eoghan , Kennedy John 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Studies have shown that sesamoidectomy provides good clinical outcomes and quick return to sporting activities, however, there is concern regarding the complications following resection of one or both sesamoid bones. The purpose of the current systematic review was to evaluate the current evidence on sesamoidectomy for the treatment of the hallux sesamoid disorders. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases was performed based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Results: Ten studies with total 196 feet were included. The weighted mean age was 36.6 ± 11.0 with a mean follow-up of 45.1 ± 19.3 months. The mean Visual Analogue Scale score improved from a mean score of 6.5 ± 0.3 to 1.2 ± 0.5. The mean postoperative AOFAS score was 92.7 ± 2.7. Six studies demonstrated that 94.4% of patients returned to sport, with 90.0% returning to previous level, at a mean of 11.8 ± 1.8 weeks. The mean hallux valgus angle increased from 13.1 ± 2.1 preoperatively to 14.8 ± 3.7 postoperatively (p=0.470), and the mean intermetatarsal angle increased from 8.7 ± 0.8 to 9.7 ± 0.8 (p=0.180) following medial sesamoidectomy. The overall complication rate was 22.5%, and further surgeries were required in 3.0%(Table). Conclusion: The current systematic review demonstrated that sesamoidectomy for the hallux sesamoids disorders yields good clinical outcomes and a high rate of return to sports activity in the short-term. It is important to note however the high complications rate after sesamoidectomy, with a 22.5% complication rate in the short-term follow-up.
Does Hallux Rigidus produce worse functional disability than Hallux Valgus?
Authors: Siddique Malik , Ramaskandhan Jayasree , Qasim Sultan 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Hallux Valgus and Hallux Rigidus. We aimed to compare foot specific patient reported disability and general health status including higher functional activities and quality of life reported between patients presenting with Hallux Valgus and Hallux Rigidus. Methods: All patients who presented at our hospital foot and ankle clinics (between June 2016 and December 2017) with a diagnosis of primary Hallux Valgus or Hallux Rigidus were included in this prospective study. Patients with associated foot problems, bilateral presentations, h/o previous reconstructive surgeries, and underlying neurological conditions were excluded. These patients were grouped based on diagnosis into Group A (Hallux Valgus) and Group B (Hallux Rigidus). In these patients, differences were studied between groups for scores of MOX-FQ Manchester-Oxford foot questionnaire (Domains: Pain, Walking/Standing, Social activities), EQ-5D EuroQol (UK) and Foot and Ankle outcomes scores (FAOS) (Domains: Pain, symptoms, ADL, Recreation, Quality of Life). Statistical tests between groups included tests for normality, student t’tests and chi square tabulation tests using SPSS software. Results: MOX-FQ differences: -  Both groups reported similar level of pain (59.6 ± 22.6 vs. 58.2 ± 23.3); p=0.776; Difficulty with walking/ standing (61.6 vs. 61.4 ); p= 0.960; and restriction with social activity because of foot symptoms (61.6 vs. 59.7 ); p=0.683 EQ-5D: -  For mobility, both groups reported no (21.7% vs. 26.8); slight (28.2% vs. 29.2%) or moderate (34.7% vs. 31.7%) problems; p=0.931. For self-care, pain/discomfort, anxiety/ depression levels, there was no differences between groups; p>0.05. Mean overall general health scores was (71.3 ± 22.8) and (69.5 ± 20.8); p=0.663 FAOS: -  There was no difference in mean pain score (59.6 vs. 58.2; p=0.776), symptoms (70.3 vs. 63.8; p=0.104), ADL score (p=0.587), difficulty with sport/ recreation (p=0.907) or Quality of Life (p=0.662) between groups Conclusion: -  There is no difference in foot related quality of life, general health status and higher functional disability levels between patients presenting with Hallux Valgus vs. Hallux Rigidus. -  The impact of these conditions on disability levels remain the same, amidst the difference in pathology