bluuebunny/crossref_metadata_2025_split huggingface dataset:
The outcome of a single percutaneous cannulated screw fixation in posterior malleolus fracture accompanied by medial or lateral malleolus fracture
Authors: Park Yoo Jung , Won Yougun 
Published: September 2018

Category: Trauma Introduction/Purpose: Posterior malleolus fractures occur most commonly in the setting of a rotational ankle fracture. In the treatment of posterior malleolus fractures, the indications for the surgical procedure are determined by the size of the fragment and the articular congruity of the tibiotalar joint. In general, the size of the bone fragment is known to be an indication of surgery if it involves more than 25% of the joint surface, and if it is less than that, anatomical reduction and fixation of only lateral or medial malleolus was suggested. We evaluate the clinical and radiological results of fixation and early range of motion exercise using a single cannulated screw when the fragment of the posterior malleolus fracture is less than 25%. Methods: Among 60 patients with SER stage 3 or 4 who had undergone surgery from March 2010 to March 2014, percutaneous cannulated screw fixation was performed for posterior malleolus in 30 cases (Group 1). In the other 30 cases (Group 2), we did not perform the fixation for posterior malleolus fracture and only cast immobilization was done after fixation for lateral or medial malleolus. Mean follow-up period was 14.8 weeks(12~18) for the Group 1, 12.9 weeks(12~18) for Group 2. Mean age of patients was 46.6(19~78) for Group 1, 50.2(19~74) for Group 2. The range of motion was checked at week 2, 4, 12, and at last follow-up. Results: There was no significant difference of time to union and union rate between two groups, and AOFAS score between two groups also showed no significant difference(91.94(83~100) vs 90.8(85~100), p = 0.45). The range of motion of ankle joint at the final follow-up showed significant difference (Ankle ROM 52.7’ (45’~65’) vs 45.3’(35’~65’), (p<0.01) and complications between two groups also showed no significant difference. Conclusion: A single percutaneous cannulated screw fixation in posterior malleolus fracture accompanied by medial or lateral malleolus fracture can be performed in fractures with small fragment size and minimal displacement. We found that it can be a effective method to achieve early and wide range of motion of ankle joint after posterior mallolus fracture.
Improvement in Quality of Life Following Surgical Correction of Midtarsal Charcot Foot Deformity
Authors: Pinzur Michael , Kroin Ellen 
Published: September 2018

Category: Diabetes Introduction/Purpose: Patients with Charcot Foot Arthropathy objectively report a poor quality of life following the development of deformity. It has recently been demonstrated that their quality of life is not improved with historic accommodative treatment. The recent interest in surgical reconstruction of the acquired deformity is directed at improving quality of life in addition to traditional goals of resolution of infection and limb retention. The Short Musculoskeletal Functional Assessment (SMFA) has been proven to be a valid tool for evaluating this complex patient population. Methods: Twenty-five consecutive patients undergoing surgical reconstruction for non-plantigrade midtarsal charcot foot arthropathy completed the SMFA patient reported outcomes instrument prior to surgery, with twenty-four completing it at one year following the surgery. One patient died during the year following surgery due to unrelated causes. Results: There was an 11.47 (95% CI: -19.70 to -3.23) point decrease in the standardized functional index. (p = .01) Similarly, there was a 12.38 (95% CI: -22.48 to -2.29) point de-crease in the standardized bother index. (p = .02) There was a 19.58 (95% CI: -30.53 to -8.63) point decrease in the standardized daily activity index. (p = .002), and there was an 14.68 (95% CI: -24.06 to - 5.31) point decrease in the standardized emotion index (p = .004). There was no meaningful change in the standardized arm/hand index. (p = .81) Conclusion: The results of this investigation demonstrate that successful surgical reconstruction of midtarsal Charcot Foot Arthropathy substantially improves quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity, to the modern approach of surgical correction to allow the use of commercially-available therapeutic footwear.
Open operative treatment of chronic ankle instability
Authors: Purcell Chad , Matsui Kentaro , Glazebrook Mark 
Published: September 2018

Category: Ankle Introduction/Purpose: Ankle sprains are one of the most common musculoskeletal injuries. Though most patients recover fully without intervention, 10-30% will develop chronic ankle instability and require conservative or surgical management. The aim of this article is to provide an evidence-based literature review and assessment of the quality of literature regarding open operative interventions for chronic ankle instability. Methods: A comprehensive evidence-based literature review of Pubmed, Embase, Cochrane and Web of Science databases, conducted March 9, 2016; and updated February 22, 2017 identified 1635 articles, of which, 71 were relevant in assessing the efficacy of common open operative interventions for treatment of chronic ankle instability. The open operative procedures described in included articles were classified into the following four main categories: Anatomic repair, Non-anatomic repair, Anatomic reconstruction and Non-anatomic reconstruction. The 71 studies were then assigned a level of evidence (I-V) to denote quality. They were then reviewed to provide a grade of recommendation (A-C, I) in support of or against the operative intervention in treatment of chronic ankle instability. Results: Among the open operative treatment options available for chronic ankle instability, there is good evidence (Grade A) in support of anatomic reconstructive procedures. There is fair evidence (Grade B) from level II and III studies in support of anatomic repair and non-anatomic reconstruction procedures. Insufficient evidence was available to grade internal brace and non-anatomic repair procedures. Conclusion: Good quality evidence exists in support of open operative treatment of chronic ankle instability. Future studies should aim to elucidate roles for each of the classifications of open operative intervention in specific circumstances and patient populations. Furthermore, with good evidence to support more traditional techniques for repair of chronic ankle instability, high quality studies should be conducted on more novel minimally invasive and arthroscopic operative techniques to assure equal efficacy and safety to open techniques summarized here.
Mid-term Prospective Follow-up of Ankle Fracture Fixation Using Patient Reported Outcome Measures
Authors: Rai Paul , Mangwani Jitendra 
Published: September 2018

Category: Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) is a common procedure to stabilise unstable ankle fractures. Anatomical reduction and stable fixation is desirable to achieve good clinical and radiological outcome after this injury. This prospective study examines the correlation between mid-term patient reported outcome measures (PROMs) and quality of fracture reduction of adult patients with ankle fractures treated with ORIF. Methods: A total of 100 patients with unstable ankle fracture who underwent ORIF were prospectively entered into the study between Nov 2013 to Oct 2014. Exclusion criteria were: age <18 years, pathological or open fractures and patients with cognitive impairment. Two independent observers assessed fracture patterns and quality of reduction. Fixations were analysed using Pettrone’s criteria including assessment of fracture displacement, medial clear space and tibiofibular overlap. Patients were followed up at two years post-operatively with postal questionnaires. Validated PROMs, Olerud-Molander Score (OMAS) and the Lower Extremity Functional Scale (LEFS) were used. For both scores a higher number indicated a better result. Co-morbidities and infection data were collated from Hospital records. Results: At 2 years post-op there were 5 deceased patients,17 did not have accessible radiographs and there was a 65% response rate to questionnaires. 46 patients were included in the final study group with a mean age of 45 (16-90). There was 1 Weber A fracture, 26 Weber B, 16 Weber C and 3 Medial malleolus fractures. 7% had Diabetes Mellitus, 22% were smokers. The mean OMAS score was 71.4(SD26.9) and LEFS score 56.7(SD25.9). There was no significant difference in PROM scores when fracture fragment reduction was optimised. There was a significant improvement in PROMs with low medial clear space and high tibiofibular overlap. Conclusion: This study reports a good correlation between quality of reduction and favourable PROMs at 2 years post ORIF ankle fracture. Reduced medial clear space and increased tibiofibular overlap were most associated with good outcome scores. Anatomical reduction of fracture fragments did not appear to affect PROMs on its own. There was very little infection in this cohort to confound the results. We would advise careful consideration of medial clear space and tibiofibular overlap in particular at time of fixation of unstable ankle fractures.
A Comparison of Foot Strengthening versus Minimal Footwear Use on Intrinsic Muscle Size and Strength
Authors: Ridge Sarah , Bruening Dustin , Jurgensmeier Kevin , Olsen Mark , Griffin David , Johnson A. Wayne , Davis Irene 
Published: September 2018

Category: Other Introduction/Purpose: The intrinsic muscles of the arch have been classified as the core of the foot. Intrinsic foot muscles (IFM) work as local stabilizers and extrinsic foot muscles (EFM) work as global movers to help control the pronation of the foot. These muscles prevent excessive strain of the MLA. Previous research has shown that strengthening IFM may reduce pain and improve function in people with plantar fasciitis. Additionally, habitual use of minimal shoes that lack support of the arch require greater demand on the intrinsic muscles. The purpose of this study was to determine the effectiveness of two different strengthening interventions on IFM and EFM size and strength. Methods: 57 healthy runners (avg 15-30 mpw) were randomly assigned to a foot strengthening (FS, n=19), a minimal shoe walking (MSW, n=19), or a control group (C, n=19). Baseline cross-sectional areas of abductor hallucis, quadratus plantae, flexor digitorum brevis, and flexor digitorum longus, and thickness of the flexor hallucis brevis, tibialis posterior, and tibialis anterior were obtained with ultrasound using a 10 MHz linear probe. Doming, great toe flexion and lateral toes flexion strength were also measured using a custom-built dynamometer. The FS group then underwent an 8 wk foot and ankle strengthening program. The MSW group progressively walked in minimal footwear from 2,500-7,000 over the course of 8 wks. All groups, including C, maintained normal running mileage in conventional footwear throughout the 8 wks. Size and strength measures were then repeated. A repeated measures ANCOVA with a post-hoc test was used to determine differences in size and strength between groups. Results: All muscles measured in the FS and MSW groups increased significantly in size from weeks 0-8. There were no changes in muscle size in the C group. The FS group experienced significantly greater size changes for the flexor hallucis brevis than the MSW group. All other changes in muscle size were not significant between the FS and MSW groups. The FS and MSW groups showed significant increases in strength in all 3 tests from week 0-8. Strength of the control group did not change at any time. The increases in strength in the FS and MSW groups were not significantly different than each other. Conclusion: Exercises that target the intrinsic and extrinsic foot muscles are effective in increased strength and size of the muscles. However, similar increases in strength and size can be obtained by progressive walking in minimal footwear. Combining both these approaches may have an even greater effect. Stronger feet may offer greater protection against overuse injuries such as plantar fasciitis.
Value of Supine Positioning in Repair of Achilles Tendon Ruptures
Authors: Rogero Ryan , Beck David , Nicholson Kristen , Shakked Rachel , Pedowitz David , Raikin Steven 
Published: September 2018

Category: Hindfoot Introduction/Purpose: The optimal method of Achilles tendon repair remains undefined. Few previous studies have quantified the financial expenses of Achilles tendon repairs in relation to functional outcomes in order to assess the overall value of the accepted repair techniques. The purpose of this study is to demonstrate the value of supine positioning during open repair (OS) of acute Achilles tendon ruptures through the quantification of operative times, costs, and outcomes in comparison to the commonly performed percutaneous prone (PP) repair technique. Methods: A retrospective review was conducted on 67 patients undergoing OS and 67 patients undergoing PP primary Achilles tendon repair with two surgeons at four surgical locations. Total operating room usage times and operating times were collected from surgical site records. Total operating room times were used to estimate the costs of room usage and anesthesia, while costs of repair equipment were collected from the respective manufacturers. Patients undergoing OS repair completed the Foot and Ankle Ability Measure (FAAM) questionnaire, with activities of daily living (ADL) and sports subscales, Short Form-12 (SF-12), with mental (MCS) and physical (PCS) health subcategories, and the visual analog scale (VAS) for pain preoperatively and at final follow-up. Results: Even with a significantly longer mean surgical time (P=.035), OS repairs had a shorter duration of total operating room time when compared to that of PP repairs (58.4 versus 69.7 minutes, P<.001). Estimated time-dependent costs were lower in OS repairs ($739 versus $861 per procedure, P<.001), while the estimated average total per procedure cost was also lower for OS repairs ($801 versus $1,910 per procedure, P<.001). For patients undergoing OS repair, FAAM-ADL (P<.001), FAAM-Sports (P<.001), SF-12-PCS (P<.001) all increased and VAS grades (P<0.001) decreased from time of initial encounter to final follow-up and were comparable to reported outcomes in the current literature. The complication rate in OS repairs (6.0%) was lower than PP repairs (11.9%), with revisions only occurring in the latter technique. Conclusion: Performing open Achilles tendon repair in the supine position offers substantial value, or “health outcomes achieved per dollar spent”, to providers due to decreased total operating room times and costs with satisfactory functional outcomes.
Anterior tibial tendon repair with polycaprolactone-based polyurethane urea based graft (Artelon)
Authors: Sanders Thomas , Cuttica Dan , Neufeld Steven 
Published: September 2018

Category: Sports Introduction/Purpose: Ruptures of the anterior tibial tendon are rare injuries usually occurring in patients over the age of 40. Delayed diagnosis is common and reconstruction often involves the use of autograft or allografts. This paper reports on the use of a polycaprolactone-based polyurethane urea (PUUR) hyperelastic polymer (Artelon) in the repair or reconstruction of anterior tibial tendon ruptures. Methods: Artelon® is a knitted textile matrix that is manufactured from fibers of polycaprolactone-based polyurethane urea (PUUR), a hyperelastic and creep-resistant polymer. Previous studies have demonstrated that Artelon integrates without immune reaction, has mechanical properties that resemble healing tendons and ligaments, and degrades benignly through hydrolysis over a 5-6 year span. This is a retrospective examination of the first 6 cases of anterior tibial tendon reconstruction using the Artelon PUUR graft. Patient outcomes are measured with AOFAS scores. In addition, range of motion and strength of the injured side is compared to the native, uninjured side. Results: There were no complications using the Artelon graft to augment anterior tibial tendon reconstruction and repair. Patient outcomes at 6 months were significantly improved compared to preoperative. Range of motion and strength were similar to the contralateral, uninjured side. Conclusion: Artelon is a safe, effective soft tissue augmentation device that can be used in the setting of anterior tibial tendon repaair or reconstruction.
Safe Zone for Percutaneous Screw Fixation - Talonavicular Fusion
Authors: Shah Ashish , Lee Sung , Naranje Sameer , Pinter Zachariah , Stibolt Robert , Patel Harshadkumar , DeBell Henry , Lehtonen Eva , Moon Andrew 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Talonavicular fusion has been established as a reliable intervention for degenerative, inflammatory, and traumatic joint lesions as well as hindfoot deformities. In order to achieve optimal fusion, various versions of the procedure have been introduced in literature and have remained a topic of contention, with the most common variation involving the insertion of 1 to 3 screws dorsomedially and dorsolaterally. Dorsolateral screw placements commonly cause neurovasculature injury. The purpose of our cadaveric study was first to establish the safety of the dorsolateral percutaneous screw insertion in relation to these dorsal neurovascular structures, and then subsequently to standardize the ideal placement of the dorsolateral screw by comparing two insertion sites based on consistent bony landmarks. Methods: Ten fresh-frozen cadaver legs amputated at the knee were used for this study. Percutaneous cannulated screws were inserted to perform isolated talonavicular arthrodesis. The screws were inserted at 3 consistent sites: “medial screw” at dorsomedial navicular where it intersected at the medial plane of the first cuneiform, “central screw” at the edge of dorsal navicular between medial and intermediate cuneiforms, and “lateral screw” at the edge of dorsal navicular between intermediate and lateral cuneiforms. Superficial and deep dissections were carried out to identify any injured nerves, arteries, and tendons. Results: The mean age at death in our sample of cadavers was 80.1 ± 7.5 years (range 68 to 92) and had the BMI of 21.8 ± 2.4 (range 18.1 to 25.1). There were 5 males (50.0%) and 5 females (50.0%). The medial screw injured the anterior tibialis tendon in 2 cases (20.0%), the central screw injured the extensor hallucis longus tendon in 3 cases (30.0%), and the lateral screw injured the anterior branch of SPN, lateral branch of SPN, and medial branch of DPN once each in a total of 3 cases (30.0%). Conclusion: TN fusion with central screw placement at the interspace between the medial and intermediate cuneiforms protects the neurovasculatures of the foot to a superior extent than lateral screws between the intermediate and lateral cuneiforms.
Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability
Authors: Shimozono Yoshiharu , Hurley Eoghan , Kennedy John 
Published: September 2018

Category: Ankle Introduction/Purpose: There has a been recent increase in the use of the arthroscopic approach to lateral ankle ligament repair for chronic lateral ankle instability. However, the clinical outcomes of this technique are still unclear. The purpose of this systematic review was to evaluate the current studies on arthroscopic lateral ankle ligament repair for chronic lateral ankle instability. Our hypothesis was that arthroscopic lateral ligament repair would result in excellent outcomes with a low complication rate. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases, based on the PRISMA guidelines, was performed during August 2017 by 2 independent reviewers. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. The weighted mean preoperative AOFAS score improved from 59.6 to 95.0 at a mean follow-up of 14.8 months in 8 studies. Five studies utilized Karlsson-Peterson scores with mean postoperative score of 88.5 at a mean follow-up of 21.2 months. Three comparative studies were reported. The comparative studies showed similar clinical outcomes between arthroscopic and open procedures. The overall complication rate was 13.4% in the included studies. . Only 2 studies reported patients returning to sport and demonstrated that 100% of patients returned to sport at pre-injury level. Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair yields favorable clinical outcomes in the short-term. However, there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure, and there is no long-term data currently available for the arthroscopic procedure. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates for both open and arthroscopic techniques.
First Metatarsal Pronation, Distal metatarsal articular angle and sesamoid reduction after Modified scarf osteotomy with single screw fixation
Authors: Sun Chao , Wang Zhi 
Published: September 2018

Category: Bunion Introduction/Purpose: Scarf osteotomy is a very popular procedure to hallux valgus surgical correction. No literature reported the correction of rotation of first metatarsal after a Scarf osteotomy. First metatarsal rotation correction is important for better results. A retrospective research shows that the modified single screw scarf osteotomy was powerful procedure to correct the rotation. Methods: We study 20 patients, 27 feet. All patients were hallux valgus and a modified scarf osteotomy was used for correction. Weight bearing radiographs of anteroposterior view and weight bearing sesamoid axis view were recorded. A retrospective review with patient follow-up for 3 months compared with the parameters before the surgery. All the data is analyzed with SPSS. Results: The radiographs measured and IMA, HVA, DMAA, first metatarsal rotation angle, the sesamoid grading from the AP view and sesamoid axis view has a significant difference between the before and the after follow-up. Conclusion: The modified single screw scarf osteotomy has an ability to change the rotation of first metatarsal. It is more powerful osteotomy than traditional scarf.