bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of Charcot’s arthropathy of the midfoot treated by internal fixation as per PROMIS scoring system
Authors: Moonot Pradeep , Bal Arun , Sharma Gaurav , Tadepalli Kalyan 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Charcot’s neuropathy is a chronic and destructive condition primarily affecting the joints of foot and ankle which can lead to severe disability sometimes even requiring amputation. Midfoot charcot’s can alter the normal biomechanics of the foot leading to point loading and ulcer formation. Different modalities with variable results have been proposed for this devastating condition. Patient reported outcome measurement information system (PROMIS) is a patient, fast and reliable validated tool with different clinical domains to assess the post-operative outcome measures in various aspects of foot and ankle surgery. The aim of the present study was to assess the Pre and post-operative PROMIS scoring of three parameters (Physical function, fatigue and social role) in diabetic patients with Charcot’s neuropathy affecting the midfoot. Methods: A prospective study was conducted at a tertiary care diabetic centre on 13 patients with Charcot’s midfoot treated with internal fixation by a single surgeon. Out of 13 patients who met the inclusion criteria, 3 patients had ulcer over the plantar aspect of the foot which was initially treated with contact cast for 6 weeks following which 2 patients were operated using internal fixation and 1 was excluded. Pre and post-operative PROMIS scores were recorded and the final outcomes were measured. The midfoot was fixed with either locking plates or long cannulated screws. Results: The mean age of the patients were 53.2±9.6 years with a mean duration of diabetes since 7.3 years. The average hospital stay was 3.7±1.5 days. Union was achieved in 13.4±2.7 weeks. The mean RAW scores for physical function, fatigue and social role measured pre-operatively were 8.33±2.53, 16.83±2.44 and 16.75±2.80 which later improved post-operatively to 16.75±2.63, 6.91±2.31 and 6.16±1.58 respectively. There was an improvement between the pre and post-operative PROMIS scores which was statistically significant (P<0.001). Two (16.66%) cases had deep infection which required screw removal 8 months from the index surgery. However, the final outcome was a stable and plantigrade foot. One (8.3%) case had superficial infection which responded well to antibiotics. No patient required amputation in the present study. Conclusion: PROMIS scoring is a patient based scoring system which can assess the prognosis and apply the same clinically. Midfoot charcot’s neuroarthropathy can we managed well by internal fixation (locking plates &/or screws) providing adequate stability and plantigrade foot
Evaluation of articular cartilage injury using computed tomography with axial traction in ankle joint
Authors: Nakasa Tomoyuki , Ikuta Yasunari , Yoshikawa Masahiro , Tsuyuguchi Yusuke , Ota Yuki , Kanemitsu Munekazu , Adachi Nobuo 
Published: September 2018

Category: Ankle Introduction/Purpose: Although chondral or osteochondral injuries are usually assessed by MRI, its accuracy is reportedly low because of the relatively thin cartilage layer and its close apposition to the cartilage talus and tibial plafond. The subchondral bone plays a role in cartilage metabolism, therefore the evaluation of subchondral bone is crucial for cartilage treatment. A method which enables the simultaneous evaluation of cartilage and subchondral bone is useful for the treatment of cartilage injury. The purpose of this study was to assess the feasibility of CT imaging with axial traction for the diagnosis of articular cartilage injuries. Methods: Chondral lesion in 18 ankles of 17 patients were evaluated. These 18 ankles consisted of 11 ankles of osteochondral lesion of the talar dome (OLT), 5 ankles of osteoarthritis of ankle joints and 2 ankles of anterior impingement syndrome. Twelve males and 5 women were included, with a mean age of 33.7 years (range, 15 -70 years). An ankle distractor foot strap was placed on the ankle with 30 degrees flexion of the knee joint, and a traction force of 80 N was applied during CT scanning. Gray scale CT images were allocated colors to make it easier to evaluate the cartilage layer. The international Cartilage Repair Society (ICRS) grades on CT were compared with those in arthroscopic findings. Results: The respective sensitivity and specificity of CT imaging with traction compared to ICRS grading were 74.4%, and 96.3%. The level of agreement of the ICRS grading between CT images and arthroscopic findings showed moderate (kappa coefficient; 0.547). The diagnosis of grade 3 or 4 lesions had 80.0% sensitivity. Axial traction to CT enabled the delineation of the cartilage surface including chondral thinning, defect and cartilage separation more visible (Figure 1). Conclusion: CT with axial traction could obtain acceptable levels of sensitivity and specificity for the evaluation of articular cartilage injuries in addition to the assessment of subchondral bone.
Plantar plating the modified Lapidus arthrodesis
Authors: Pellegrini Manuel , Cuchacovich Natalio , Cortes Aaron , Escobar Freddy , Becerra Eduardo , Doren Alfredo Núñez , Carcuro Giovanni 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Modified Lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the 1C-MTT joint. Complications of this procedure include delayed union and non – union. To prevent them, several rigid fixation methods have been proposed. Biomechanically, plantar plate fixation may be the best solution. Therefore, we sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis using two different plantar plate fixation systems. Methods: After IRB approval, we reviewed our prospectively collected database for patients operated on with a modified Lapidus arthrodesis. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum FU of 1 yr and agreed to participate in the study. Patients with neuropathy, previous surgery, concomitant midfoot/hindfoot procedures or those which fixation method was different from a plantar plate were excluded. Preoperative and postoperative IM angle was evaluated. Two independent musculoskeletal radiologists assessed consolidation under CT scan at 12 weeks postop. Triaxial 2-mm reformatted CT slices were used to calculate joint fusion percentage. Each patient was assigned to a consolidation group considering joint fusion percentage: 0-24%, 25-50%, 51-74%, 75-100%. Intra/interobserver coefficients of variability were calculated. SF-36, SMFA, FAOS and FAAM were obtained preoperatively and at one year follow up. t-test was performed to address for functional outcomes differences in-between groups. Results: Twenty-three patients (35 feet) met inclusion criteria. Mean age was 47 years (13-65), 83% female and 17% male. Eleven patients had bilateral surgery. Mean preoperative/postoperative IM angle were 16+3 and 9+2, respectively (p<0.001). Ten feet achieved <24% consolidation (33%) and 20 feet >25% (67%). With the numbers available, consolidation rate didn´t differ in patients undergoing unilateral/bilateral surgery(p=1.0) or plating system(p=0.22). One patient had an anterior tibialis tendon rupture and 1 patient presented an infected non-union, prompting revision. Mean preoperative/postoperative values for SF-36 physical and mental component were 49 and 76(p<0.001); and 43 and 68(p<0.001), respectively. FAOS-pain were 60 and 81(p<0.001);FAOS-daily-life were 59 and 96(p<0.001);FAOS-sport were 43 and 74 (p<0.001);and FAAM-Daily-life score were 67 and 87(p<0.001). No significant differences were found for SMFA. Conclusion: Despite a low consolidation rate at 12 weeks post op, patients with plantar plated Lapidus arthrodesis presented a significant increase in functional outcomes and a low revision/complication rate at 1 yr FU. Consideration should be given to delay evaluation under CT scan to 24 weeks post op.
Comparison of Arthroscopic to Open Tibiotalocalcaneal Arthrodesis in High-risk Patients
Authors: Polzer Hans , Braunstein Mareen , Baumbach Sebastian 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Patients undergoing tibiotalocalcaneal arthrodesis (TTCA) often suffer from co-morbidities increasing complications such as surgical side infections (SSI) and non-unions. High complications rates following open TTCA led to the development of arthroscopic techniques. Aim of this retrospective case-control study was to compare the results of open to arthroscopic TTCA in high-risk patients. Methods: Patient selection was based on the authors’ TTCA database. First, patients treated by arthroscopic TTCA (after 07/2013) using a curved intramedullary nail with a follow-up of >= 1 year were selected. Second, patients receiving open TTCA (prior 07/2013), with comparable co-morbidities and retrospectively suitable for arthroscopic TTCA were identified. Both techniques were conducted in a standardized technique with only the surgical approach differing. Primary outcome parameter were complications within a follow-up of 1 year. Eight open and 14 arthroscopic TTCAs (mean age 59±10 years, 91% male) were included. Patient demographics, indications, co-morbidities, and number of previous surgical interventions were similar for both groups. Three patients in the open and 4 in the arthroscopic group suffered from preoperative plantar ulceration. Results: Talar-declination (43°±8° vs. 30°±8°, p<0.001) and calcaneal-inclination angle (6°±10° vs. 18°±6°, p<0.001) improved significantly, comparably in both groups (p=0.183/p=0.393). No significant differences were observed for fusion-rates (75% vs. 64%; p=0.604) or time-to-fusion (15±7 vs. 11±4 weeks; p=0.285). Major complications occurred in 63% of open and 36% of arthroscopic TTCA. For open TTCA, 80% were SSI necessitating multiple revision-surgeries including one below-the-knee-amputation, for arthroscopic TTCA these were solely non-unions. Comparing patients with ulceration to those without, no relevant change in major SSI in open TTCA (67% vs. 60%) could be detected but a pronounced difference in non-union-rates for arthroscopic TTCA (75% vs. 20%). In patients without ulceration the union-rate was 80% for both, open and arthroscopic TTCA. Conclusion: Taken together, arthroscopic TTCA drastically reduced major surgical side infections compared to open TTCA in high risk patients. In patients without preexisting ulceration excellent union-rates (80%) for both, open and arthroscopic TTCA could be achieved.
Is it justifiable to perform tibio-talar arthrodesis rather than fixation as the treatment for severe pilon fractures?
Authors: Ramaskandhan Jayasree , Siddiqu Malik , Qasim Sultan 
Published: September 2018

Category: Trauma Introduction/Purpose: The purpose of this study was to compare functional outcome at minimum 2 years follow up post fixation of pilon fractures to that of patients undergoing elective procedure (in the form of TAR or ankle arthrodesis) for primary osteoarthritis of the ankle to assess whether pilon fracture patients would benefit from tibio-talar arthrodesis as a primary procedure rather than fixation to avoid significant functional disability between primary fixation and subsequent arthrodesis. Methods: This is a retrospective study of prospectively collected data of patients operated between April 2012 and December 2015. All patients with primary osteoarthritis undergoing elective TAR/arthrodesis (Group A) had pre-op functional scores recorded (MOX-FQ, EQ-5D and Foot and ankle outcome score FAOS). Patients with bilateral ankle arthritis, previous reconstructive surgery, inflammatory arthritis, hip and knee arthritis, spinal pathology and underlying neurological conditions were excluded from Group A. Patients in Group B (post Pilon fracture fixation with a minimum 2 year follow up) completed a postal questionnaire with the above scores. Outcomes between groups were compared using inferential statistical tests using SPSS. Results: Mean age of patients in Group A and Group B were (62.6 ± 10.9 years) and (46.4 ± 15 years) respectively; p<0.001. In group B, 9 patients (16.6%) had associated injuries and 45 patients (83.3%) had isolated injuries. 49 patients underwent an open reduction and internal fixation vs. 5 patients with hybrid fixator as a definitive management in Group B with 2 patients having significant infection (1 in each group). The results of functional scores comparing Group A to Group B (including sub-group analysis) are awaited and will be submitted subject to acceptance of this abstract. Conclusion: The outcomes of pilon fracture are well known to be poor with high rate of secondary osteoarthritis and significant functional disability associated with it in young individuals in active employment. The gold standard treatment for patients with significant osteoarthritis of the ankle is tibio-talar arthrodesis. However, a group of these patients continue to have high functional disability between initial injury and to the point of tibio-talar arthrodesis. The results of this study will highlight the justification to perform tibio-talar arthrodesis as a definitive treatment at the time of injury, rather than fixation.
Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail
Authors: Reilly Megan , Darvish Kurosh , Assari Soroush , Cole John , Wilps Tyler , Gokcen Eric 
Published: September 2018

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.
Influence of Foot Position on the Measurement of First Metatarsal Pronation Using the First Metatarsal Axial Radiographs
Authors: Sadamasu Aya , Yamaguchi Satoshi , Nakagawa Ryosuke 
Published: September 2018

Category: Other Introduction/Purpose: In hallux valgus (HV) surgery, the importance of correcting first metatarsal (1MT) pronation, as well as correcting adduction, has been increasingly recognized. A 1MT axial radiograph is a simple method to quantify 1MT pronation (see figure). However, this view does not provide the exact axial projection, and 1MT is angled on the image. Furthermore, the 1MT angle is dependent on the foot position and alignment. Therefore the measured pronation angle on the radiograph may not be the same as the “true” pronation along the 1MT long axis. The purposes of this study were to 1) quantify the difference between the measured 1MT pronation on the axial radiograph and the true pronation angle, and 2) determine the influence of foot position on the measurement. Methods: CT images of 10 feet from HV patients (HV group; age, 58 years; HV angle, 44°) and 10 feet from those without HV (non-HV group; age, 47years; HV angle, 12°) were obtained. Digitally reconstructed radiographs of the 1MT were generated from the CT images in a three-dimensional virtual space (see figure). 1MT was pronated along the long axis (true pronation angle). Then, images with different plantarflexion (25° to 35° in 5° increments) and adduction (-10° to 10°) angles were created. This procedure was repeated for different pronation angles (-10° to 30°), and 135 simulated 1MT axial radiographs were obtained from each bone. We measured the 1MT pronation angles in all images. Differences in the measured pronation angle and true pronation angle were calculated for each group. Correlations between the measurement difference and 1MT plantarflexion/adduction angles were assessed using the Spearman correlation coefficient. Results: The mean measurement differences were 0.7° and 1.0° for the HV group and non-HV group, respectively. The standard errors of the measurement were 0.5° and 0.6° for the HV group and non-HV group, respectively. There was no significant correlation between the measurement difference and plantarflexion angle (P = 0.92 and P = 0.92 for the HV group and non-HV group, respectively), nor between the measurement difference and adduction angle (P = 0.82 and P = 0.74). Conclusion: The measurement differences were low in both HV and non-HV feet, indicating that the 1MT pronation angle measured on the axial radiograph represented the true pronation angle along the long axis of 1MT. The measurement differences were consistent regardless of plantarflexion and adduction angles. Therefore, a variation of 1MT angle on the image, which can be caused by the misalignment of foot position while taking the radiograph and difference in foot alignment (such as flatfeet and cavus feet), did not affect the measurement. 1MT axial radiograph could be used as a valid and robust method to quantify 1MT pronation.
Frequency and Impact of Adverse Events in Patients Undergoing Surgery for End-stage Ankle Arthritis
Authors: Sangeorzan Bruce , Coetzee J. Chris , Bohay Donald , Anderson John , Davitt James , Houghton Michael , Maskill John , Brage Michael , Norvell Daniel , Shofer Jane , Ledoux William 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Patients seeking surgical treatment for ESAA have two primary treatment options: arthrodesis and arthroplasty. While there are comparative trials that address treatment options, neither the complication risk or the relative effectiveness is clearly established. The focus of this study was to report the magnitude of all AEs (as defined by DSMB) in the peri operative and early healing period after ankle surgery and evaluate the impact of these AEs on patient functional outcomes Methods: We report data from a multi-site prospective cohort study performed to compare ankle arthroplasty to ankle arthrodesis in the treatment of ESAA among six participating sites that required AE reporting under FDA required defintions. We compared the risk and impact of non-ankle AEs and ankle-specific AEs versus no AEs controlling for potential confounding factors including surgical procedure using multinomial logistic regression. We estimated differences in post-op functional outcomes by AE occurrence using linear mixed effects regression. Results: Among 517 patients who had surgery from 2012 to 2015 and completed the full baseline assessment, follow up was available in 494 (95%) patients. There were 628 reported AEs (477 in the arthroplasty group and 151 in the arthrodesis group), occurring in 261 (63%) arthroplasty patients and 67 (65%) arthrodesis patients. There were 50 (8%) ankle specific AEs. The odds ratio for the risk of an ankle specific AE and non-ankle specific AE versus no AE was 1.84, 95% CI (.85, 3.98) and .96, 95% CI (.57, 1.61), respectively, for those receiving arthrodesis compared to arthroplasty. Patients experiencing ankle-specific AEs had significantly less improvement in FAAM Sports and ADL subscores and worst pain outcomes; however, both groups improved significantly in all measures except mental health. Conclusion: Ankle specific AEs were infrequent and only weakly associated with surgical procedure (slightly more in arthrodesis). While patients improved in all functional outcomes except mental health, regardless of AE occurrence, ankle-specific AEs negatively impacted patient improvement compared to those with no AEs or a non-ankle AE.