bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring fair decision-making rules in nursing: A qualitative study
Authors: Zahednezhad Hosein , Hosseini Mohammadali , Ebadi Abbas , Dalvandi Asghar , Tabrizi Kian Nourozi 
Published: September 2018

Background: The decision-making process should be done according to a set of rules and principles so as to be fairly understood. Objectives: The aim of this study was to identify the basic principles and rules used by nurses to understand justice in nurse managers’ decision-making processes based on a procedural justice model. Research design and participants: This research was a qualitative study based on directed content analysis, which was performed on a group of 15 nurses working in different hospitals in Tehran, Iran. An in-depth semi-structured interview was used as the method of data collection for this study. Ethical consideration: This research has been approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. The respondents were informed about the aim of the study, about voluntary participation, anonymity and confidentiality. Findings: The results of this study showed that in order to understand procedural justice, nurses use several rules, including: duties organization, managerial support, consistency, bias-suppression, accuracy, correctability, representativeness, and ethicality. Conclusion: Nursing leaders must consider the importance of justice rules as one of many strategies to ensure the nurses’ perception of fairness in decision-making processes.
Improvement in Health-related Quality of Life After Total Ankle Arthroplasty Compares Well to Other Successful Orthopaedic and Non-orthopaedic Procedures
Authors: Lachman James , Adams Samuel , DeOrio James , Easley Mark 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: End-Stage arthritis is one of the leading causes of chronic disability in the United States. Improvement in Health-Related Quality of Life(HRQOL) after total ankle arthroplasty(TAA) has been demonstrated in the literature. This improvement has not been compared to that of other common Orthopaedic and non-Orthopaedic procedures including Anterior Cervical Discectomy and Fusion(ACDF), Total Knee Arthroplasty(TKA), Coronary Artery Bypass Grafting(CABG), and Orthotopic Liver Transplant(OLT). Although TAA is noted to be effective in eliminating symptoms in end-stage arthritis, it is difficult to gauge the impact of TAA relative to other meaningful procedures that have been shown to have great impact on HRQOL improvement. The purpose of this study was to compare changes in HRQOL between TAA and other common procedures with large impacts on this outcomes measure. Methods: Five hundred consecutive patients with minimum of two-years follow-up after TAA were prospectively evaluated with the Short Form-36(SF-36) outcome instrument preoperatively, at six months, one year and two years post-operatively. An exhaustive literature review was conducted identifying studies with comparatively sample sizes comparing preoperative and postoperative SF-36 scores after ACDF, TKA, CABG, and OLT. The SF-36 Physical and Mental component scores were included in each cohort and compared for magnitude of improvement and significant differences between them. Results: Patients in all cohorts had preoperative SF-36 mental and physical function scores significantly lower than the general population scores. The preoperative physical function scores were lowest in the TKA group (average 31.1 +/-9.7) followed by TAA group (average 40.6 +/-16.3), ACDF group (average 41.5 +/-21.6), OLT group (average 51.9 +/-23.6) and CABG groups (57.8 +/-21.3), respectively. Improvement after surgery was greatest in the ACDF group (Mental +31.5, Physical +22.9), followed by the TAA group (Mental +13.9, Physical +26.8), TKA group (Mental +14.3, Physical +22.4), CABG group (Mental +7.6, Physical +15.4) and OLT group (Mental -4.47, Physical +9.8), respectively. The greatest improvement in physical function score occurred in the TAA group (see attached table). Conclusion: The mental and physical disability associated with end-stage ankle arthritis is as severe as that associated with many other Orthopaedic and non-Orthopaedic conditions. The improvement in HRQOL after TAA is greater than that obtained after TKA, CABG, and OLT but not as great as the improvement seen after ACDF; however, the improvement in physical function score was greatest in the TAA cohort. The HRQOL benefits of TAA are comparable to the benefits achieved after several other relatively common and successful surgical procedures.
The Role of Axial Rotation in Total Ankle Replacement
Authors: Najefi Ali-Asgar , Goldberg Andrew 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: The importance of implant orientation in the axial rotational plane is ill understood. No Total ankle replacement (TAR) implant deals specifically with rotation as part of the surgical technique. Preoperative computed tomography (CT) scan–derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis, TN) have been developed for TAR scanning the knee and ankle for the purposes of patient specific instrumentation. The objectives of this study were to establish the range and relationship between the transtibial axis at the knee, the tibial tuberosity, and the transmalleolar axis using these CT scans in an adult population with ankle arthritis. Methods: 150 CT Scans of patients with end stage ankle osteoarthritis undergoing Psi, we measured the relationship between the transtibial axis, the tibial tuberosity and the transmalleolar axis (Figure 1). All CT scans were analysed using the Solidworks software (Dassault Systèmes). Varus or valgus arthritis, tibiotalar angle and presence of deformity was also recorded. Results: The mean difference in the axial plane between the transmalleolar axis and the tibial tuberosity was 17.9 ± 9.3 degrees externally rotated. There was a large range which was between -5 and 53 degrees of external rotation. The mean foot angle was 15.4 ± 11.1 degrees relative to the implant position. All planned implant positions were mean 1.0 ± 1.8 degrees (range -3.8 – 1.7 degrees) internally rotated to the transmalleolar axis. Varus or valgus ankle arthritis did not correlate with rotation of the tibial axis (p=0.4). Conclusion: There is a wide variation in rotational alignment of the tibia, which cannot be accurately assessed clinically or using plain radiographs. Surgical techniques that reference the tibial tuberosity to plan component alignment can be misleading and lead to implant malalignment. We recommend routine preoperative CT scanning prior to ankle replacement surgery and recommend research to assess the effects of axial rotation of implant performance and survival.
Stem Cells Isolated from the Sheath and Core Tissues of Human Plantar Fascia Exhibit Differential Biological Properties
Authors: Zhang Jianying , Nie Daibang , Hogan MaCalus , Wang James 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Plantar fasciitis is a very common ligament disease which affects more than 3 million patients in the United States every year. However, there is no effective treatment in clinics because its pathogenesis is largely unknown. Although PF has been studied quite well from a biomechanical viewpoint, little has been done on PF biology. To better understand the cellular mechanisms of plantar fasciitis, in this study we aimed first to characterize biological properties of stem cells isolated from the sheath and the core of human PF tissues. Their biological responses to mechanical loading are also studied. Methods: Two stem cell populations isolated from the sheath (PF-S) and core (PF-C) parts of human PF tissues were investigated by characterizing their colony formation, stem cell marker expression, population doubling time (PDT), multi-differentiation potentials, and biological responses to mechanical loading. One-way ANOVA followed by Fisher’s PLSD for multiple comparisons was used for statistical analysis. A p-value < 0.05 was considered to be statistically significant. Results: PF-S grew quicker and formed larger colonies than PF-C cells (Fig. 1). More PF-S expressed nucleostemin (Fig. 2A), Oct- 4 (Fig. 2C), SSEA-4 (Fig. 2E) than PF-C cells (Fig. 2B, 2D, 2F). More PF-S were stained by collagen type IV (Fig. 3D), CD31 (Fig. 3A), and vimentin (Fig. 3B), and less stained by collagen I (Fig. 3C) than those of PF-C cells (Fig. 3E-I). More PF-S were differentiated into adipocytes (Fig. 4A), osteocytes (Fig. 4B), and chondrocytes (Fig. 4C) than PF-C cells (Fig. 4D-F). PF-S and PF-C respond to intensive mechanical stretching differentially in terms of gene expression levels of collagen I (Fig. 5A), IV (Fig. 5B), CD105 (Fig. 5C), non-tenocyte related genes (Fig. 5D-F), MMPs (Fig. 5G-H), and inflammation-related genes, COX-I and COX-II (Fig. 5I-J). Conclusion: This study characterized plantar fascia in detail at histological, cellular, and mechanobiological levels. Our results showed that plantar fascia consists of two distinct tissues sheath and core with differential structural and cellular properties. The cells isolated from sheath and core of human PF also differ in their response to mechanical loading. This information may be useful in determining the respective contributions of the sheath and core stem cells to the development of plantar fasciitis and in devising new biologic approaches for effective repair of injured PF in clinics.
Gastrocnemius Recession to Treat Chronic Insertional and Noninsertional Achilles Tendinopathy
Authors: Graham Robert , Innis Collin , Stevens Benjamin 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Small studies on gastrocnemius recession for Achilles tendinopathy with associated contracture of the gastrocnemius muscle are encouraging. The analyses have demonstrated fewer postoperative complications, shortened recovery time, and earlier return to work as compared to traditional surgical management of Achilles debridement and repair. Investigators have reported good patient satisfaction, substantial pain reduction, and restoration of dorsiflexion. However, there have been no large studies specifically looking at the outcomes of gastrocnemius recession for either chronic insertional or noninsertional Achilles tendinopathy. The purpose of this study was to review the efficacy of the gastrocnemius recession in mitigating pain for patients who have chronic Achilles tendinopathy with isolated gastrocnemius contracture and have failed nonoperative management. Methods: The records of patients with isolated gastrocnemius contracture were retrospectively reviewed who underwent an isolated gastrocnemius recession to treat insertional or noninsertional Achilles tendinopathy as performed by a single surgeon spanning from 2011 to 2017. Minimum follow-up time required was 6 months with an average of 25.5 months follow-up among all responders with a range from 6 to 63 months. Patients were excluded by the criteria of any other concomitant foot deformities, diagnoses, or surgical procedures performed. Clinical outcome was evaluated using a mail-in patient satisfaction questionnaire. One hundred and thirty-nine patients were identified to have underwent an isolated gastrocnemius recession to treat chronic insertional or noninsertional Achilles tendinopathy that was refractory to conservative management for a minimum of six months. Sixty-six patients (76 legs) of those eligible responded. Results: Sixty-three out of 66 patients (95.5%) were satisfied with the results of the procedure overall. Sixty-two out of 66 patients (93.9%) would elect to repeat the surgery if they knew their results in advance. Sixty-one out of 66 patients (92.4%) would recommend the surgery to a family or friend with the same diagnosis. The most frequently reported postoperative complication was 9 accounts of swelling (out of 76 legs; 11.8%). There were no reports of sural nerve injury. Responses for Visual Analogue scale (VAS) for pain were only eligible if they had reported a preoperative VAS score on their preoperative intake form. This made 23 patients eligible with an average preoperative pain of 8.43/10 and an average postoperative pain of 0.91/10. Conclusion: Gastrocnemius recession for treating chronic Achilles tendinopathy was found to be an effective procedure to mitigate pain in patients with isolated equinus contracture. To our knowledge, this is the largest study assessing gastrocnemius recession for treatment of chronic Achilles tendinopathy.
Analysis of Gait and Footprint in Patients with Hallux Valgus
Authors: Ito Naoya , Nishimura Akinobu 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is one of the most common forefoot problems. HV is defined as a hallux valgus angle of more than twenty degrees. HV can lead to alterations of the plantar pressure pattern and clinical gait. This study examined the relationship between gait alterations and HV deformities. Methods: We examined 500 residents (161 men and 339 women; >50 years of age) of Miyagawa village in Mie, Japan in 2009, 2011 and 2013. They performed a 6-meter walk test at normal and maximum speed. We examined gait speed, the number of steps, and footprint between patients with normal (HV angle <20; n=350) and HV (HV angle >20; n=150), and between normal-to-mild (HV angle <30; n=436) and moderate-to-severe (HV angle >30; n=64). Their plantar pressure patterns were measured using a gait analyzer (Walk Way MW 1000; Anima, Tokyo, Japan, Figure.1). Statistical analyses were performed using the chi-square test according to sex and use of the hallux ball; the t-test according to age, height, and weight; and logistic regression analysis adjusted for age, sex, and height according to gait speed and the number of steps. P value less than 0.05 was considered significant. Results: With regard to the plantar pressure pattern, the percentage of subjects in the HV group who left a footprint of the hallux ball was significantly lower than that in the normal group. The percentage of subjects in the moderate-to-severe group who left a footprint of the hallux ball was even lower. Analysis of the footprint revealed that the HV group used the hallux ball significantly less during toe-off than the normal group. At both normal and maximum speed, the number of steps and gait speed did not differ significantly between the normal and HV groups. However, when we compared normal-to-mild and moderate-to-severe groups, the number of steps in the moderate-to-severe group was significantly greater than in the normal-to-mild group at maximum walking speed. Conclusion: Analysis of the footprint revealed that the percentage of subjects in the HV group who was able to use the hallux ball during toe-off was significantly less than that in the normal group. The percentage of subjects in the moderate-to-severe group who could use the hallux ball in toe-off was even lower. HV can cause footprint alterations. Moderate-to-severe HV can cause not only footprint alterations but also gait alterations, especially when walking at maximum speed.
Sinus tarsi approach vs. extensile lateral approach for intra-articular calcaneal fracture
Authors: Khongphaophong Methee 
Published: September 2018

Category: Trauma Introduction/Purpose: The options of operative treatment for intra-articular calcaneal fracture still remains controversial. Extensile lateral approach allow excellent exposure to fracture, but bring high rate of wound complications. The aim of this study was to compare the outcome of intra-articular calcaneal fracture treated with open reduction and internal fixation via an extensile lateral versus. Sinus tarsi approach Methods: Prospective study of 62 intra-articular calcaneal fractures treated by open reduction and internal fixation between 2014, October to 2017, June. 29 were treated with extensile lateral approach with calcaneal locking plate(Wright medical, Tennessee), 33 sinus tarsi approach(4 cases need additional mini medial incision approaches for SanderIII AC, BC) with mini-calcaneal locking plate(Normed, Florida). Durations until operation, operative time, foot functional index(total score), visual analog scale, SF-36, Bohler’s angle, angle of Gissane, wound complications and duration of hospital stay were recorded post-operatively and minimal 6 months follow up. Results: Compared 2 groups with demographic datas.Average duration until operation; extensile group was 13.32 days, sinus tarsi group was 6.08 days, p <0.001. Operative time; extensile group was 123.41minutes vs. sinus tarsi group was 91.20 minutes, p <0.001. Wound complications was 24.13% in extensile group vs. 6.06% in sinus tarsi group, p =0.045, Duration of post-operative admission was 6.68 days in extensile group vs. 3.10 days in sinus tarsi group p <0.001 FFI last visits was 25.36 in extensile group vs. 25.65 in sinus tarsi group, p =0.969, VAS activity was 29.68 in extensile group vs. 28.54 in sinus tarsi group, p=0.271. Conclusion: Sinus tarsi approach with mini-calcaneal locking plate was a great option for treatment of intra-articular calcaneal fracture. This approach brought lower rate of wound complications, earlier operations, shorter operation times and shorter hospital stay compared to extensile lateral approach.
Arthroscopic Treatment of Flexor Hallucis Longus Tenosynovitis
Authors: Labrum Joseph , Harris Thomas , Shymon Stephen , Maiyuran Harinee 
Published: September 2018

Category: Arthroscopy Introduction/Purpose: Flexor Hallucis Longus (FHL) tenosynovitis is a common cause of posterior ankle pain, typically associated with repetitive plantar flexion activities. The purpose of this study was to report the results of patients with FHL tenosynovitis treated with posterior ankle arthroscopy using validated outcome measures and develop a zone-based classification of FHL tenosynovitis that demonstrates well correlated preoperative imaging and intraoperative findings. Methods: Posterior ankle arthroscopy was performed in 11 patients (12 ankles) with a diagnosis of FHL tenosynovitis, with patients followed for a minimum of two years (mean 44 months). Outcomes were evaluated using validated scoring measures, including visual analog scales (VAS) for pain, 12-Item Short Form Health Survey (SF-12), and the Foot and Ankle Ability Measure (FAAM). Results: A zonal classification scheme based on anatomic location was developed, divided into three zones: proximal to the ankle joint, posterior to the ankle joint, and from the fibro-osseous tunnel underneath the sustentaculum tali to the FHL insertion. Agreement between preoperative MRI and arthroscopic zonal involvement at time of surgery was present in ten feet (83%), and differed in two feet (17%). VAS scores improved significantly from 7.1 ± 1.4 preoperatively to 1.3 ± 1.3 postoperatively (p <0.001). Mean values for ADL and sports subscales of the FAAM at time of follow up were 87.1 ± 16.2 and 76.5 ± 28.8, respectively. Physical component summary (PCS) and mental component summary (MCS) of the SF-12 yielded means of 51.3 ±12.8 and 52.7 ± 5.0, respectively. Conclusion: FHL pathology can be classified using a zone-based classification scheme, which is highly correlative between preoperative MRI and intraoperative findings. Posterior ankle arthroscopy is an effective treatment option for FHL tenosynovitis, as evaluated using validated outcome measures.
Learning Curve in the Posterior Endoscopy of the Ankle
Authors: Pagnano Rodrigo , Dinato Mauro Cesar Mattos E. , Filho Miguel Pereira 
Published: September 2018

Category: Arthroscopy Introduction/Purpose: The Posterior Ankle Impingement Syndrome (PAIS) can be treated by the endoscopic technique with posterior portals and patient in prone position. There is discussion whether this would be the best method, given the possible difficulty in learning and applying this technique, risks of complications and prolonged time of surgery. We conducted this retrospective study to assess the time spent to perform the posterior endoscopy along the learning curve and the relationship of the duration of the procedure to the presence of complications. Methods: We evaluated 39 patients undergoing endoscopic treatment through posterior ankle portals technique and prone position, operated by a single surgeon between 2005 and 2014. We divided the patients into four groups of ten subjects according to the chronological sequence of the surgeries. We used the Jonckheere-Terpstra test to compare the surgery time between the four analyzed groups. We used the Mann-Whitney test to compare operative time and the occurrence of complications, and the relationship between surgical procedure time and presence of intraoperative fibrosis. We used the Wilcoxon signed-rank test to compare preoperative and postoperative AOFAS Ankle-Hindfoot Score. For all statistical analysis, p-values <0.05 were considered to be significant. Results: We found a significant decreasing of the surgery duration over time (p=0.0273) (Figure). Figure: Representing surgery time (in minutes) to groups of patients (Groups 1 to 4, being Group 1 patients 1-10, Group 2 patients 11-20, Group 3 patients 21- 30 and Group 4 patients 31-39).There were three complications not related to the duration of the surgery (p=0.6909). The presence of extensive fibrosis had an impact on the operative time (p=0.0387). The AOFAS Score evolved from 64.0±16.9 preoperatively to 93.7±8.9 postoperatively (p<0.0001). Conclusion: The time of the procedure decreased as the surgeon’s experience increased, and our complications showed no relationship with the surgery time.