bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Are Coronal Alignments of the Knee and Hindfoot Correlated?
Authors: Lintz Francois , Dagneaux Louis , Dufrenot Maryama , Burssens Arne , Richter Martinus , Barg Alexej , de Cesar Netto Cesar 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Hindfoot and knee coronal alignments have shown to be related in previous literature suggesting that there might be some degree of compensation between the two. However, previous studies have focused on the effects of knee surgery on hindfoot alignment, not on the preoperative relationship. Recent 3D weight bearing imaging technology may help to investigate this. The objective of this study was to analyse the preoperative relationships between knee and hindfoot coronal alignments using bilateral weight bearing CT (WBCT) and biplanar low dose radiography (BLDR). We hypothesized that hindfoot valgus and varus respectively compensates knee varus and valgus. Methods: Relevant ethical approval was obtained for this retrospective comparative level 3 study including 124 limbs in 62 patients (32 female, 30 male), mean age 56 (23-84). Mean BMI was 27 (20-38). Cases included had been referred continuously according to diagnostic protocols in our institution, for a combined WBCT and BLDR investigation. Age, gender and BMI were recorded. Cases with a history of trauma or surgery, which may have caused a change in lower limb alignment, were excluded. Hindfoot alignment was measured using a semi automatic software (TALAS, Curvebeam, Warrington PA, USA) and given as Foot Ankle Offset (FAO). Knee alignment was measured using the EOS platform (EOS Imaging, Paris, France) and given as HKA. Distribution and demographics of hindfoot alignment in the varus and valgus knee groups were studied. Correlations were investigated using linear regression and Bland and Altman plots. Results: Incidence of Varus hindfeet was 15.8% in the Valgus knee group and 25.5% in the Varus knee group but the difference was not significant (p=0.82). Bland and Altman plots did not yield any additional result. No linear correlation was found between hindfoot and knee coronal alignments in the study population. Conclusion: Our results do not confirm prior findings regarding compensatory valgus in varus knees, and do not confirm the hypothesis according to which linear compensatory mechanisms may relate knee and hindfoot alignments. In practice, these results suggest that in cases where knee and hindfoot misalignments are associated, the causes for each should be analyzed independently before any assumption is made as to hypothetical interactions. Furthermore, subsequent studies are warranted to investigate whether other kinds of non-linear correlations way be found in selected populations.
Comorbidities associated with poor outcomes following operative hammertoe correction in a geriatric population
Authors: Maidman Samuel , Bariteau Jason , Boden Stephanie , Boden Allison , Tenenbaum Shay 
Published: September 2018

Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are one of the most common lesser foot deformities and are extremely prevalent in the geriatric population. When nonoperative treatment fails, surgical correction can improve functional status and pain. While complications following these surgeries are rare, older patients with comorbid conditions are often considered worse operative candidates due to an increased risk of adverse outcomes. The aim of this study is to determine if specific comorbidities or perioperative variables are associated with increased complications or unsuccessful outcomes following operative hammertoe correction in geriatric patients. Methods: Prospectively collected data was reviewed on 31 consecutive patients aged 60 or older who underwent operative correction of hammertoe deformity. Patient demographics, comorbidities, perioperative variables, and postoperative complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component Score (SF-36 PCS) with a minimum of six-month follow-up. Data was examined using Fisher’s method and multivariable analysis. Results: 29.0% (9/31) of patients had a history of smoking, 61.2% (19/31) were on anticoagulant therapy, 19.4% (6/31) had osteoporosis, 16.1% (5/31) had rheumatoid arthritis, and 9.7% (3/31) had diabetes mellitus. The mean tourniquet and operative times were 65.7 (SE=6.2) and 95.4 (SE=7.4) minutes, respectively. Postoperative complications occurred in 12.9% (4/31) of patients with the most prevalent being wound infections that were treated with antibiotics in 9.7% (3/31). Impaired wound healing, joint nonunion, and the need for revision surgery each occurred in 3.2% (1/31) of patients. Mean 6-month improvement in VAS was 2.1 (SE=0.5) and mean improvement in SF-36 PCS was 10.2 (SE = 3.4). No significant association was found between comorbidities or perioperative variables and postoperative complications or improved outcomes. Conclusion: No specific comorbidities or perioperative variables were identified that increase the risk for unsuccessful surgical correction of hammertoe deformities. While comorbidities in the geriatric population have traditionally been thought to increase complication rates and lead to poor outcomes, further research in this area is warranted. Comorbidities should not necessarily be a deterrent for geriatric patients pursuing operative hammertoe correction.
Definition of a Safe Zone for Screw Fixation of Posterior Talar Process Fracture by Three-dimensional Technology
Authors: Mao Haijiao 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Percutaneous screw fixation can provide stable fixation with a minimally invasive surgical technique for posterior talar process fracture . This surgical technique is limited procedure due to the complex anatomy of the posterior talar process and the varying narrow safe bony zone. The purpose of this study was to investigate the optimal posterior screw placement and the geometry of safe zones for screw insertion in the posterior talar process by analyzing with three-dimensional technology. Methods: One hundred adult who had feet CT scans were evaluated. CT data were imported into Mimics 18.01 software for three -dimensional reconstruction; Two 3.0mm-diameter screws were simulated from the posterior to anterior position for posterior talar process. The morphology parameters of posterior talar process was also quantitatively measured. The incidences of safe at different angles were investigated in order to determine optimal angle for screw direction. The safe zone and the length and entry point of screw were defined. Results: The safe zone was mainly between the 30% location and the 60% location; the width of each safe zone was13.6±1.4; the maximum height of each safe zone was 7.8±1.2. The height of the safe zone was lowest at the 30% location (4.5) and highest at the 50% location (7.3). The mixed safe zone of all talar was between the 50% location and the 60% location And inserting a 48.7 mm screw, 5.6 cm laterally and 7.4 cm superiorly from the lateral tubercle of the posterior process of the talus towards the talar head is safest. The second screw best position is the medial posterior process the talus. Conclusion: The zones for safe screw positioning are very narrow, making percutaneous screw fixation of the posterior talar process a challenging procedure. The predefined angles with computer-assisted three-dimensional techniques for the most frequently positioned percutaneous screws may aid in preoperative planning, shorten the operation time and reduce the incidence of surgical complications.
Comparison of Visual Analog Pain Score Reported to Physician vs. Nurse, Part II
Authors: Martin Kevin , McBride Trevor , Wake Jeffrey , Van Buren Jeffrey , Dewar Cuyler 
Published: September 2018

Category: Ankle Introduction/Purpose: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as researchers and health care networks seek to define treatment outcomes. However, interpretation and clinical applications of PROMs are still under investigation. The visual analogue scale (VAS) is considered a reliable and validated measure of acute pain. In a previous study, it was found that in surgical candidates the VAS pain score was significantly higher when reporting to the surgeon as opposed to the nurse. The aim of this current study is to examine whether this phenomenon occurs in patients that do not ultimately go on to have a surgical procedure. We hypothesize that there will be no difference in patient reporting to the surgeon versus the nursing staff. Methods: This study is a retrospective cohort of 201 consecutive non-surgical foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from “no pain” to worst pain.” Differences in reported pain levels were analyzed. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the Surgeon was 4.2 (p<.001). Contrary to our hypothesis, there was a statistically significant difference in pain scores reported to the surgeon compared to the nurse. We then analyzed the mean difference of pain scores reported to surgeon and nurse for surgical versus non-surgical patients. The mean difference in VAS scores reported to physician and nurse for surgical patients was 2.87 whereas the mean difference for non-surgical patients was 1.00 (p < .001). Conclusion: The current study found statistically significant differences between VAS pain scores reported to the surgeon versus the nurse in non-surgical patients. These results support the trend found in our previous study which demonstrated discrepancies in patient pain reporting, with surgical patients reporting significantly higher pain scores to the surgeon versus the nurse. However, the mean difference between reported pain scores, to the providers, is significantly higher for surgical patients as compared to non-surgical patients. The cause of this phenomenon remains unclear, however, this study provides more information regarding patient reported VAS pain scores in an outpatient clinical setting.
Safe Zone for Insertion of a Fibular Lag Screw in Ankle Fracture Fixation
Authors: Mason Lyndon , Kaye Angus , Marlow William , Williams Geraint , Molloy Andrew 
Published: September 2018

Category: Ankle Introduction/Purpose: Fibular lag screw placement during ankle fracture fixation is not without risk. The screw placement endangers either the tendons of the peronei or the posterior rim of the incisura if misplaced. Our aim was to identify a predictable safe zone for screw placement. Methods: 45 radiographs of Weber B fractures were reviewed to determine the typical height of lag screw entry and exit points. 63 MRI scans of anatomically normal ankles were reviewed to evaluate tendon position and syndesmosis location. The safe zone could then be determined using composite images. Results: On review of the 45 ankle fracture radiographs; the typical lag screw exit point was found to be 14.2 mm above the ankle joint (95% Confidence Interval: 11.3-17.1 mm). Using the composite MRI images, there was a consistent flat anterior aspect of the fibula at this level. A safe zone trajectory was seen to occur between 31 and 45 degrees taken from the anterior aspect of the flat fibular surface at this level. The minimum distance to at-risk structures using this trajectory was 4 mm. If this consistent entry point is used, the MRI scans demonstrated that if the drill was aimed towards the medial edge of the Achilles tendon, the correct trajectory would be performed. Conclusion: The flat surface of the fibula is a constant landmark on MRI and is visible during surgery. The peroneal tendons and posterior rim of the incisura have a constant predictable position related to this. The safe zone for insertion of a lag screw is between 31 and 45 degrees medial to the anterior aspect of this flat surface. This represents aiming the drill towards the medial aspect of the Achilles tendon.
Anatomy of the Lateral Plantar Ligaments of the Transverse Metatarsal Arch
Authors: Mason Lyndon , Jayatilaka Lara , Fisher Lauren , Fisher Andrew , Swanton Eric , Molloy Andrew 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: The anatomy of the Lisfranc complex is well understood. In contrast, the lateral tarsometatarsal ligamentous structures are under-investigated. Our study aimed to identify the plantar ligamentous structures of the lateral tarsometatarsal joints and their significance in transverse metatarsal arch injuries. Methods: We examined 10 cadaveric lower limbs that had been preserved for dissection at the Human Anatomy and Resource Centre at Liverpool University in a solution of formaldehyde. The lower limbs were carefully dissected to identify the ligamentous structures of the plantar aspect of the transverse metatarsal arch. Results: In all specimens, the long plantar ligament blended with a transverse metatarsal ligament spanning from the 2nd to the 5th metatarsal. This transverse metatarsal ligament formed the basis of the roof and distal aspect of the peroneus longus canal. The separate long plantar ligament formed the floor of the peroneus longus canal. In addition, separate intermetarsal ligaments were identifiable connecting each metatarsal. The long plantar ligament provides a connection through the transverse metatarsal ligament, connecting the transverse and longitudinal arches of the foot Conclusion: The plantar ligamentous structures of the lateral tarsometatarsal joints are a combination of individual intermetatarsal ligaments and a transverse metatarsal ligament. This explains the homogenous nature of a divergent tarsometatarsal joint injury and why middle and lateral columns move as one. It also has clinical significance in the observation that in some cases lateral column instability can be overcome when the middle column is stabilised.
Clinical usefulness of acellular dermal matrix combined negative pressure wound therapy in diabetic foot amputee
Authors: Moon Youngseok , Ahn Ji-Yong 
Published: September 2018

Category: Diabetes Introduction/Purpose: Negative pressure wound therapies (NPWT) have been useful to prevent further amputation by filling defect with granulation in diabetic foot amputee. However the hospitalized period have been prolonged to complete filling defect with NPWT. There were many efforts to accelerate rate of granulation filling using dermal matrix in NPWT. We hypothesized outcomes of acellular dermal matrix combined negative pressure wound therapy (NPWT) can be useful in comparison of exclusive usage of NPWT. The aim of this study was to investigate clinical outcomes of acellular dermal matrix of combined negative pressure wound therapy in DM foot amputee. Methods: This study included 40 patients of 40 ischemic diabetic feet. We divide these diabetic feet into two groups: 20 cases of acellular dermal matrix combined NPWT and 20 cases of exclusive usage of NPWT. We performed the amputation and combined NPWT at a mean age of 50.7 years (26 to 75) with the mean 12 months follow-up between June, 2014, and January, 2017. FTSG was performed after sufficient granulation healing of DM foot amputee in case of need. We evaluated multiple risk factors preoperatively and postoperatively. The wound healing after FTSG was evaluated during the followup. Number of NPWT was checked during the hospitalized period. Necessity of further amputation was decided as failed cases. Success rate of NPWT was evaluated in two groups. Multiple risk factors were evaluated. Results: Failed case was 3 cases (exclusive usage of NPWT) and 2 cases (acellular dermal matrix usage combined NPWT). Other feet showed complete healing of wound. Mean NPWT number of times to complete filling of granulation were significantly lesser in acellular dermal matrix combined NPWT group. Decreasing rate of wound defect was significantly shorter in acellular dermal matrix combined NPWT group. There were no significant correlations between wound healing and risk factors (CRP, HbA1C) (p=0.223, p=0.175). Conclusion: Acellular dermal matrix usage combined negative pressure wound therapy in DM foot amputee can be helpful to improve filling granulation filling rate with NPWT than exclusive usage of NPWT.
Physician treatment preferences in non-displaced distal fibula fractures
Authors: Neufeld Steven , Merenstein Dan 
Published: September 2018

Category: Trauma Introduction/Purpose: Background: Several studies have demonstrated equivocal long-term functional outcomes for both operative and nonoperative treatment of Weber-B fractures, however there are currently no evidence-based practice guidelines. The purpose of this study was to determine which treatment modality was preferred by orthopedic surgeons in the United States and Internationally, despite the lack of accepted guidelines. Methods: Methods: A survey of 428 practicing orthopedic surgeons was conducted to evaluate physician treatment preferences for non-displaced Weber-B fractures. Analyses were performed to determine physician preference for operative versus nonoperative fracture treatment, as well as to determine group differences between U.S, international and foot and ankle orthopedic surgeons compared to all other orthopedic surgeons. A cost effective analysis was conducted to compare differences among nonoperative and operative preferences. Results: Nonoperative treatment of non-displaced Weber-B fractures was preferred by 90.4% of orthopedic surgeons compared to operative treatment (9.6%; P<0.0001). Internationally-based orthopedic surgeons chose operative management at a higher rate (30/129) than U.S.-based surgeons (11/299; P<0.0001). General orthopedic surgeons were not more likely than subspecialty orthopedic surgeons to choose operative management, but foot and ankle subspecialists chose operative treatment at a higher rate compared to all other orthopedic surgeons (11/61 versus 29/362; P=0.0185). The direct medical costs and the indirect societal costs are likely to be 249 percent greater if managed operatively. Conclusion: Our findings suggest that while the vast majority of practicing surgeons choose to non-operatively manage non-displaced Weber-B fractures, there still exist a significant percentage of physicians who prefer to operate on these fractures. Given the existing literature suggesting equivalent outcomes for operatively and non-operatively treated Weber-B fractures, the current data suggests the need for further research into the reasons behind such differences in treatment preferences, as well as the evolution of evidence-based practice guidelines to guide the management of this very common fracture.
The Infinity Total Ankle System
Authors: Penner Murray , Davis W. Hodges , Bemenderfer Thomas , Waly Feras , Anderson Robert 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Background: Increasing interest in 2-component total ankle arthroplasty (TAA) designs and the increased use of TAA overall has led to the development of a new generation of 2-component TAA implants. The first of these to become available was the Infinity Total Ankle System (Wright Medical Technology, Memphis, TN), introduced in 2014. Despite it currently being the most commonly used TAA implant in the UK and among the most commonly used in the USA, published clinical results are lacking. Purpose: This study presents the first report of the clinical and radiographic outcomes of the Infinity Total Ankle System with minimum 2 year follow-up Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. Results: The overall implant survival rate was 97% (65 of 67 implants) at mean follow up of 3 years (range 27-47 months). Two cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a non-revision reoperation. Mean FFI and AOS scores at latest follow up improved from preoperative by 21.6 (p<0.0001) and 34.0 (p<0.0001), respectively. No radiographic loosening of any talar or tibial components was identified in the 65 non-revised cases. Conclusion: Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those reported for both fixed- and mobile-bearing third generation TAA designs, even when used in cases with deformity and increased case complexity.
Proximal fragment intermetatarsal angle (PFIA) increases after SCARF osteotomy
Authors: Prudente Henrique , Baumfeld Daniel , Nery Caio 
Published: September 2018

Category: Bunion Introduction/Purpose: Instability of the joint between the medial cuneiform and the first metatarsal is considered as one of the progression factors of Hallux valgus and its recurrence in some cases. We believe that we must increase the intermetatarsal angle of the proximal fragment during the correction by the SCARF osteotomy, seeking the greater degree of instability of this joint. Doing that, we can prevent further varus displacement, as we have reached the greater degree of instability. The purpose of this study was to evaluate if the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal. Methods: This is a retrospective study with 32 patients with mild, moderate and severe hallux valgus, who were submitted to surgical treatment by the SCARF technique. All patients were operated by the same surgeon. Anteroposterior radiographs of the loaded foot were analyzed in the pre and postoperative (3 months) moments. We developed two measures to evaluate the position of the base of the first metatarsal: The Proximal Fragment Intermetatarsal Angle (PFIA), and the distance between the lateral cortex of the first metatarsal and the medial cortex of the second metatarsal (3 cm from the base of the first metatarsal). All measurements were made with a virtual ruler on magnified digital images and rounded to the nearest 0.1 mm. A 95% confidence interval was considered for statistical significant results (p<0,05). Results: The mean age of the sample was 44 years, with a predominance of females (62%). The mean pre-operative intermetatarsal angle was 14.9°, while in the postoperative period it was 5.2°, showing that there was correction of the metatarsal positioning. However, the PFIA increased to 17.8° at the post-operative period (p<0,05), showing a greater instability of the first metatarsal cuneiform joint, as the base of the first metatarsal was positioned in a more varus condition. In addition, we observed that there was an increase in the distance between the base of the first metatarsus and the second metatarsus after the surgical procedure, from 13.7 to 16 millimeters (p<0,05). Conclusion: We concluded that the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal, leading to more instability at the first metatarsal cuneiform joint, and, in our opinion, less chance of recurrence in the long-term. A prospective and long-term is needed to prove this statement.