bluuebunny/crossref_metadata_2025_split huggingface dataset:
Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Classical CT
Authors: Burssens Arne , Barg Alexej , De Cock Laurens , Victor Jan , Buedts Kristian 
Published: September 2018

Category: Ankle Introduction/Purpose: Syndesmotic lesions of the ankle have shown to be challenging injuries towards diagnosis and surgical treatment. This could be mainly attributed to the limitations of 2D imaging, which make it difficult to accurately determine the extent of the lesion and to verify if peroperatively an anatomical reduction is achieved of the distal tibiofibular congruence. The aim of this study is therefore to develop a reproducible method to quantify the displacement in a syndesmotic ankle lesion in all six degrees of freedom based on 3D imaging. Methods: Eighteen patients were retrospectively included having a unilateral syndesmotic lesion. N=12 sustained a high ankle sprain and a bilateral weightbearing conebeam CT was obtained because of positive clinical syndesmotic tests. N=6 presented with a fracture associated syndesmotic lesion and were imaged by a bilateral non-weightbearing CT. The non-affected ankle was used as a template after being mirrored and matched on the contralateral ankle containing a syndesmotic lesion (Fig 1A-B). The distal fibula was marked by computer calculation of the most outer point of the anterior tubercle, posterior tubercle and apex malleolis lateralis. The change of these points towards the unaffected fibular position was used to quantify the syndesmotic lesion (Fig 1C). A control group of seven patients (N=7) was used to analyse if these changes differed from the normal variation in tibio-fibular congruency (Fig 1D). Results: The main findings consisted of a statistical significant difference in the mean mediolateral diastasis of both the sprained group (M = 1.60 mm, SD=1.02) and the fracture group (M = 1.69 mm, SD=0.62) compared to the control group (P<.001). The mean external rotation was statistically different when comparing the sprained group (M = 4.68°, SD=2.74) and the fracture group (M = 6.97°, SD=3.02) towards the control group (P<.05). The mean antero-posterior translation was only significantly different when comparing the fracture group (M = -4.73 mm, SD=4.53) towards the sprained group (M = -0.91 mm, SD=1.26) and the control group (M = -0.26 mm, SD=1.53) (P<.05). Conclusion: This study demonstrates an effective method to quantify a unilateral syndesmotic lesion of the ankle. The pathological measurements differed from the normal distal tibio-fibular configuration in the syndesmotic complex. This sequential analysis is of use for an accurate diagnosis and a pre-operative planning to know in advance which correction needs to be achieved to have the fibula at proper length correctly rotated, and reduced into the syndesmosis with no anterior, posterior or lateral displacement.
Comparison of Outcome of Osteosynthesis in Type II Accessory Navicular by Variable Fixation Methods
Authors: Jang Ho-seong , Park Hyun-woo , Park Kwang-Hee 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: To compare the outcomes of fixation methods for osteosynthesis of a type II symptomatic accessory navicular between screw and tension band wiring Methods: Forty-four patients (mean age, 29.2 years; range, 13 to 54 years; 21 males and 23 females) who had undergone operative treatment after failed conservative treatment were chosen for the study between 2007 and 2014. The patients were divided based on the osteosynthetic method: group 1 (screw) and group 2 (tension band wiring). Pre and postoperative evaluations were performed, using the midfoot scale from the American Orthopaedic Foot and Ankle Society (AOFAS), a visual analog scale, time to return to social activities, and plain radiography Results: The AOFAS midfoot and visual analog scale scores of both groups improved at the last postoperative follow-up. The times to return to social activities were 12.3 weeks in the screw group and 11.9 weeks in the tension band wiring group (p = 0.394). A broken screw was observed in one case in the screw group and a broken k-wire was detected in two cases in the tension band wiring group. Nonunion was observed in two cases in each group Conclusion: The tension band wiring technique could be another osteosynthesis treatment choice for fixation of the accessory navicular bone
Magnetic Resonance Imaging Findings of the Lateral Ankle Instability after Anatomical Ligament Reconstruction Using a Semitendinosus Allograft Tendon with Biotenodesis Screws
Authors: Jung Hong-Geun , Kang Hwa-Jun , Sun Mao-Yuan , Coruna Juan Agustin 
Published: September 2018

Category: Ankle Introduction/Purpose: Surgery for lateral ankle instability is indicated in patients who have repetitive inversion ankle sprains despite conservative therapy. There have been many reconstruction procedures performed for the lateral ankle ligament instability. However, there has not been any report of postoperative MRI findings of lateral ankle instability after ligament reconstruction using a free tendon and biotenodesis screws. Therefore, this study was to analysis the MRI finding of the postoperative lateral ankle reconstruction using semitendinosus allograft tendon and the correlation with clinical outcome. Methods: The study is based on 34 ankles (33 patients) of chronic lateral ankle instability which underwent anatomical lateral ankle ligament reconstruction using a semitendinosus allograft tendon with bio-tendosis screws from July 2009 to April 2017 with at least 6 month postoperative ankle MRI checked (mean follow-up 16.5mo). In addition, clinical outcomes were evaluated using VAS pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson-Peterson score, ankle stress views and subjective patient satisfaction. Results: Six ankles (17.6%) showed normal signal intensity(SI) while 28 ankles (82.4%) showed high SI on reconstructed allograft tendon area. High signal was shown around the biotenodesis screws. Eleven ankles showed synovitis (39.3%), partial tear of reconstructed allograft tendon 6 ankles (21.4), 5 osteolysis of the bone tunnel (17.9%), 4 screw pulled-outs (14.3%), 2 tendon complete tear (7.1%), 2 mucoid changes (7.1%), 2 cystic changes (7.1%). One ankle showed post-op MRI findings of reconstructed tendon infection (3.6%). The mean VAS pain score significantly decreased from 5.7 to 1.5. The mean AOFAS score improved from 72.0 to 89.1, while the Karlsson-Peterson score significantly improved from 54.7 to 85.7 (p<0.01) with 88% patient satisfaction. Stress talar tilt angle improved from 15.7o to 5.4 o. Conclusion: In the current study, various postoperative MRI findings were found after lateral ankle ligament reconstruction using allograft tendon and biotenodesis screws including high signal change of tendon, synovitis, tunnel osteolysis, screw pull-outs, tendon tears and etc. However, these MRI findings did not present as clinical complications and did not correlate with poor clinical outcomes.
NEMISIS for diabetic forefoot pathology
Authors: Miller Roslyn 
Published: September 2018

Category: Diabetes Introduction/Purpose: The most common cause of Charcot Neuroarthropathy is diabetes. The incidence of diabetes continues to rise globally, with a significant socio-economic burden to both patient and society. Despite good total contact casting techniques, deformity and subsequent ulceration still occurs in this patient group. This make shoe-fitting challenging and the risk of subsequent ulceration increases. This in-turn increases the patients risk of amputation and mortality at five years. Conservative treatment is often protracted, with multiple clinic visits. The has a significant impact on the patients ability to work and quality of life. Open surgery carries a significant risk of poor wound healing and infection again with risk of ulceration. NEMISIS for mid-foot Charcot provides surgeons with a surgical technique for osteotomy, that protects the soft tissues. Methods: 15 patients had NEMISIS Minimally Invasive Surgery to their forefoot for management of diabetic foot ulceration. 8 patients (11 metatarsal heads)had debridement of a metatarsal head with Minimally Invasive Shannon and Wedge Burrs. 1 patient had 3 separate debridements, but of different metatarsal heads. 2 patients had surgery to the 1st metatarsal. 1 patient had minimally invasive debridement of sesamoids. All patients had their Achilles tendon assessed for increased tension. Percutaneous tenotomy was performed if the Achilles was found to be tight. Only the patients with surgery to the 1st Metatarsal required screw fixation. All cases were performed as day cases. Results: Patients were able to be discharged the same day, with weekly follow-up for dressings. Patients were allowed to fully weight bear as tolerated. Ulcers healed within six week on average. There were no recurrences of ulcer on the same metatarsal head within the time period. Patients had often had ulcers present, in excess of six months prior to being referred for surgery. All patients were delighted with the result. Conclusion: NEMISIS Minimally Invasive Surgery for diabetic forefoot pathologies provides rapid healing for patients with chronic ulceration. Their biomechanics should be assessed pre-operatively to check if there is significant forefoot overloading. If so, the Achilles tendon should also be addressed. Early intervention with NEMISIS Minimally Invasive Surgery, could reduce the number of visits the patient has to make to the clinic and also facilitate the firing of easier constructed shoes. This potentially will allow the patient to return to normal function as quickly as possible and thus potentially has significant cost benefit implications also.
Postoperative Achilles Pull-out Strength after Calcaneoplasty for Haglund’s Syndrome
Authors: Pfeffer Glenn , Gonzalez Tyler , Nelson Trevor , Metzger Melodie 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Haglund’s syndrome involves a prominent posterior superior prominence of the calcaneus, in conjunction with pain caused by local inflammation. Nonoperative management includes orthotic inserts, immobilization, shoe modification and physical therapy. If non-operative management fails, surgical management with calcaneoplasty is often needed. No study has assessed Achilles tendon pull-out strength after a calcaneoplasty for Haglund’s syndrome. The purpose of this study was to investigate those changes in a cadaveric model and provide objective data upon which to base postoperative recovery. Methods: 8 matched pairs of cadaveric specimens (mid-tibia to toes) were divided into two cohorts. The matched pairs compared Achilles pull-out strength between intact and open calcaneoplasty specimens. Prior to testing, BMD was determined and lateral X-ray images were obtained before and after surgery to quantify bone removal. The distal aspect of each calcaneus was potted and held at a 20 degree angle. The Achilles tendon was secured in a freeze-clamp, which was attached to a mechanical testing system. Specimens were then loaded to failure. Outcome measures include: Height of bony resection, angle of bone resection, load to failure, and mode of failure. Results: Specimens with open calcaneoplasty had a 45% reduction in strength (failure load: 742 N) compared to their intact counterpart (1341 N), p<0.05. Load to failure was significantly correlated with BMD (r=0.64, p<0.05). Conclusion: Traditional open calcaneus resection demonstrated a potentially catastrophic weakness of the Achilles tendon insertion. Mineral density further affects weakening of the Achilles insertion. . Biomechanical evidence presented above supports the practice of protected weight bearing and cautious return to activity after open calcaneoplasty for Haglund’s syndrome.
Plantar Plate Reconstruction for Stage IV Plantar Plate Tear Using Flexor Tendon Tenodesis
Authors: Reilly Megan , Darvish Kurosh , Assari Soroush , Cole John , Gokcen Eric 
Published: September 2018

Category: Lesser Toes Introduction/Purpose: Outcomes of the surgical treatment of dislocated lesser toes have improved significantly over the past few years due to the development of techniques to repair plantar plate tears through a dorsal incision. However, treatment of stage 4 tears with no reparable plantar plate can be challenging. The current treatment involves flexor to extensor tendon transfer, requiring multiple incisions and surgical time. An alternative approach is presented, using the same modern techniques of plantar plate repair, but reconstructing the plantar plate using a flexor tendon tenodesis to the plantar base of the proximal phalanx. Methods: Four fresh frozen cadaver foot and ankle specimens were used to determine the stability of this new technique. A simulated Lachman’s test was performed on the 2nd, 3 rd, and 4th metatarsophalangeal joints utilizing a force measurement instrument with displacement control on specimens with an intact plantar plate, an excised plantar plate, and following a flexor tenodesis reconstruction. Results: The intact plantar plate force was 9.0+2.6kN for 2 mm displacement, and following excision of the plantar plate, the force reduced to 1.3+0.4kN. The flexor tenodesis reconstruction improved the force to 6.0+1.9kN. Conclusion: Plantar plate reconstruction with a flexor tenodesis to the proximal phalanx resulted in stability equal to 53% of the intact plantar plate, for the shear displacements between 2 to 6 mm. This procedure may be an alternative treatment option in patients with Stage 4 irreparable plantar plate tears.
The efficacy of a diabetic educational program and predictors of compliance of diabetes mellitus patient’s
Authors: Stéfani Kelly , Borges Vinicius , Barbachan Aldo 
Published: September 2018

Category: Diabetes Introduction/Purpose: Diabetes mellitus has become a global public health problem. Not only has its incidence remained high in developed countries such as Japan and the United States, but, also, the number of cases has been growing alarmingly in developing countries such as Brazil. The concept of detection and management of diabetes mellitus in primary care centers is widely practiced in Brazil by the general physician. The purpose of this study was to evaluate the efficacy of our educational diabetics program for patients with diabetes mellitus and to determine the predictors of compliance. Since our patient orientation protocols and the insensitive footwear we provide reduce our hospital admission costs. Methods: A prospective study (2005-2017) was performed in a quaternary hospital where patients with diabetes were referred to the outpatient clinic of the diabetic foot group. The epidemiological profile of these patients under treatment in a specialized multidisciplinary outpatient unit was evaluated. A specific protocol included notes on the age, body mass index, length of disease, use of insulin, degree of sensation as evaluated by the Semmes-Weinstein monofilament test, deformity in feet, palpation of peripheral pulses, cigarette smoking, and previous operative procedure in foot an ankle.The same specialist orthopedic doctors in foot and ankle completed the protocol and performed the specific physical examination (reports were made on deformities regarded as risky for the incursion of ulcers such as plantar callosities, alterations of the hallux and lesser toes, loss of the longitudinal plantar arch, and all those related to Charcot arthropathy) and performed the same a guidelines for foot care. Results: Out of the 578 diabetic patients, the mean age of was 67 years, 69% being of the female gender. There was 53% made use of insulin, the time of disease was 14 years, and 85% patients were obese. Evaluation of protective sensibility showed that 68% were significantly decreased (from the 4.0 g monofilament). The ulcers was found in 64 patients, 57% had degree 1 in the Wagner classification, and 63% was affected in the forefoot. Charcot neuroarthropathy was diagnosed in 54 patients, 52% had the phase 3 in the Eichenholz classification, and 61% was affected in the midfoot. Fifty-three patients had amputations at the time of their first appointment, 66% on toes. 127 patients required surgery resulted from clinical complications: ulcers, osteomyelitis, and Charcot arthropathy. Conclusion: The costs related to the disease increase greatly with the appearance of the complications, especially if there is need of hospitalization and surgical treatment. The prevention of injuries, with adequate glycemic control and supply of protective shoes is essential.
Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture?
Authors: Yousaf Sohail , Hay Daniel 
Published: September 2018

Category: Trauma Introduction/Purpose: Differentiating stable isolated fibula fractures consistent with supination external rotation (SER) II ankle fractures from unstable SER IV fractures is essential in determining the need for surgical stabilisation. Stress radiographs are usually required to assess stability including gravity stress views (GSV) and external rotation views (ER). There is no clear consensus as to which modality is most useful to determine stability in a fracture clinic or emergency setting. In last, few years clinical uncertainty about the reliability has led researcher to focus on weight bearing radiographs (WB) .We aim to review recent literature regarding reliability of WB radiographs to estimate the stability of supination external rotation ankle fractures. Methods: A systematic review of the literature relating to radiological assessment of stability of supination external rotation ankle fractures was conducted according to PRISMA guidelines. The systematic review was prospectively registered with PROSPERO. It involved the following steps: Researching the question-Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture? Setting inclusion and exclusion criteria-All English language articles published in the including any Randomised controlled trials (RCT’s) and cohort studies. Data collection)– A literature search of Medline (PubMed), the Cochrane Bone, Joint, and Muscle Trauma Group trial register, the Cochrane central register of controlled trials, Embase and CINAHL was undertaken. The grey literature was searched. Key terms ‘supination external rotation fracture’, ‘stability’. Other variations to the key words were ‘weight bearing’, “axial load”, ‘stress x-rays’, ‘systematic reviews’ and ‘meta-analysis’. Results: A total of six studies met the inclusion criteria including 601 patients. No previous systematic review on stress radiographs including weight bearing was published. All studies concluded weight bearing radiographs is an easy, pain-free, safe and reliable method to estimate stability of isolated distal fibula fractures. No serious concerns or complications were reported. Conclusion: The evidence base contained many methodological limitations and most of the evidence was either level III or IV, and so any conclusion drawn from the research must be done so with caution. The studies suggest that GSV overestimates the instability which should be assessed with studies should focus on randomized controlled trials with narrow range of clinically useful outcome measures.
A Novel Kartogenin-Releasing Polymer Scaffold Promotes Wounded Rat Achilles Tendon Enthesis Healing
Authors: Zhang Jianying , Nie Daibang , Zhao Guangyi , Tan Susheng , Hogan MaCalus , Wang James 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Entheses have a special fibrocartilage transition zone where tendons and ligaments attach to bone. Enthesis injury is very common, and the reattachment of tendon to bone is a great challenge because healing takes place between a soft tissue (tendon) and a hard tissue (bone). We have now developed a kartogene (KGN)-containing polymer scaffold (KGN-P) that can precisely deliver KGN to damaged enthesis area. The effects of the KGN-containing polymer on the healing of wounded TBJ were investigated in vitro and in vivo. Methods: The proliferation and chondrogenesis of rat Achilles tendon stem cells (TSCs) grown in four conditions were measured: normal medium (Control); normal medium with 100 nM KGN (KGN); lysine diisocyanate (LDI)-glycerol scaffold with normal medium (LDI-P); LDI-glycerol-KGN scaffold with normal medium (KGN-P).A wound (1 mm) was created on each hind leg Achilles enthesis of all 8 rats (3 months old). The wounds were then treated either with 10 ul saline (Wound); or 10 ul of 10 uM KGN (KGN); or LDI polymer scaffold (LDI-P); or KGN-containing polymer scaffold (KGN-P). The rats were sacrificed on day 15 and 30 post-surgery, and their Achilles entheses were collected for gross inspection and histochemical analysis. Results: KGN-containing polymers have sponge-like structures (Fig. 1A-D), and release KGN in a time- and temperature-dependent manner (Fig. 1E). KGN-P scaffold induced chondrogenesis of TSCs (Fig. 2D, 2H) without changing cell proliferation (Fig. 2I), and enhanced fibrocartilage-like tissue formation (Fig. 3E). KGN (Fig. 3C) and LDI-P (Fig. 3D) treated groups exhibited unhealed wound areas as in saline group (Fig. 3B). Finally, KGN-P and KGN treated rat TSCs underwent chondrogenesis by upregulating collagen II, aggrecan, and SOX-9 expression (Fig. 3F). Conclusion: Our results showed that KGN-containing polymer scaffold enhanced wounded enthesis healing by inducing TSC chondrogenesis and promoting the formation of the fibrocartilage in the wound site. The KGN-P may be used for regeneration of wounded entheses in clinical settings. Future research will focus on optimizing KGN concentration and releasing rate in the polymer scaffold during enthesis healing.
Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis
Authors: Amin Elham E. , Bistervels Ingrid M. , Meijer Karina , Tick Lidwine W. , Middeldorp Saskia , Mostard Guy , van de Poel Marlène , Serné Erik H. , Otten Hans M. , Klappe Edith M. , Joore Manuela A. , ten Cate Hugo , ten Wolde Marije , ten Cate-Hoek Arina J. 
Published: September 2018

Key Points
Immediate compression therapy after DVT is associated with a 20% absolute reduction of RVO. The reduction of residual thrombosis is associated with an 8% absolute reduction of postthrombotic syndrome at 24 months.