bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of the adjacent-joint osteoarthritis after arthroscopic ankle arthrodesis
Authors: Minokawa So , Yoshimura Ichiro , Hagio Tomonobu , Yamamoto Takuaki 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Arthroscopic ankle arthrodesis (AAA) is a good clinical outcome, because the arthroscopic method has been deemed to have shorter union time, less blood loss, less morbidity, shorter hospital stays, and more rapid mobilization. However, it is unclear about the relationship between progression of adjacent-joint arthritis and clinical outcome at long-term follow-up. The purpose of this study was to investigate the relationship between AAA and adjacent-joint arthritis at 2 years postoperatively. Methods: We evaluated 17 feet of 17 patients at a minimum of two years after surgery that were able to be followed, from among 59 feet in 55 patients with ankle osteoarthritis who underwent AAA between January 2006 and April 2015. The mean age was 66.1 ± 8.1 (range, 57-79) years, and postoperative follow-up was performed at a mean of 4.5 ± 2.3 (range, 2-10) years after surgery. The radiographic evaluation examined a union rate of the ankle, and a progression of adjacent-joint osteoarthritis (OA) change. We examined the relationship between the presence of adjacent-joint OA and Japanese Society for Surgery of the Foot (JSSF) score before surgery and last follow up. Additionally, we examined the relationship between the presence of adjacent-joint OA and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) at last follow up. Results: JSSF score was improved to 56.9 points before surgery and 89.2 points last follow up, and the union rates was 17 feet of 17 feet (100%). At the last follow-up, radiographic signs of developed or progressing arthritis were observed in ten feet at subtalar joint (58.8%) and in three patients at talonavicular joint (17.6%). The postoperative JSSF scale regarding the presence or absence of the adjacent joint OA, there were no significant differences (89.3 ± 6.0 points in the absence group and 89.2 ± 6.1 points in the presence group). Postoperative SAFE-Q was not significantly different, pain and pain-related physical functioning and daily living, social functioning, shoe-related, and general health and well-being. Conclusion: There was no significant difference in the JSSF score of presence or absence of the adjacent-joint OA before surgery and at the final follow-up. Additionally, there was no significant difference in the SAFE-Q of presence or absence of the adjacent-joint OA at the final follow-up. The adjacent-joint OA was progressed after AAA, however clinical outcome was relatively maintained.
Mid-term Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis with Bulk Femoral Head Allograft
Authors: Rogero Ryan , Tsai Justin , Shakked Rachel , Raikin Steven 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis with bulk femoral head allograft has previously been reported as a way to fill large osseous hindfoot deficits in order to restore limb length, but few studies have been performed evaluating outcomes and prognostic factors. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: A retrospective review of patients undergoing TTC arthrodesis with bulk femoral head allograft performed at an academic institution by a single fellowship-trained foot and ankle surgeon between 2004 and 2015 was conducted. Patient charts and operative reports were reviewed for patient and procedural variables, respectively. Radiographic union was assessed at the ankle and subtalar joints by another fellowship-trained foot and ankle surgeon not involved in any patient’s surgical care. Radiographic stability, defined as proper maintenance of hardware and graft positioning in the hindfoot, was also assessed. A procedure was “failed” if there was a need for revision surgery. Patients with a successful arthrodesis were contacted to score the Foot and Ankle Ability Measure-Active Daily Living (FAAM-ADL) questionnaire, visual analog scale (VAS) for pain, and Short Form-12 (SF-12) mental (MCS) and physical (PCS) components. 22 patients were identified, with average radiograph and functional follow-up times of 39.7 and 57.1 months, respectively. Results: Complete radiographic union of involved joints was achieved in 13 patients (59.1%) and in 72.7% (32/44) of all joints. Eighteen patients (81.8%) were assessed to be radiographically stable at final follow-up. Three patients (13.6%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 19 patients (86.4%) did not require additional surgery as of final follow-up. At an average of 57.1 months postoperatively, patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P<.001). The mean VAS for pain significantly improved from 76.8 to 32.9 (P<.001). The mean postoperative SF-12-MCS and SF- 12-PCS scores were 53.9 and 40.6. Additionally, 73.3% (11/15) reported being satisfied with their surgical outcomes. Male sex (P=.03) and a lateral operative approach (P=.03) both resulted in significantly worse outcomes. Conclusion: The utilization of a femoral head allograft with TTC arthrodesis in patients with large hindfoot defects is an acceptable method that can offer improved functional and sustained radiographic outcomes and patient satisfaction. Male sex and a lateral approach may be associated with an inferior prognosis.
Surgical Fixation of Type 2 Navicular Fractures
Authors: Smith George 
Published: September 2018

Category: Trauma Introduction/Purpose: The navicular plays a vital role in maintenance of the medial column of the foot and provides a pivotal function in hind foot biomechanics. Type 2 fractures demonstrate a primary fracture line from dorsolateral to plantar medial where the major fracture fragment is displaced medially. They are typically the result of high energy and are associated with poor outcome. This study reports on the demographics of a series of Type 2 navicular fractures, the operative technique employed and the subsequent outcome. Methods: Six patients with a Type 2 navicular fracture were identified from the theatre records. The study period was June 2014 to February 2016. All patients sustained their injuries in either high speed MVAs or motocross accidents. All patients had surgery performed after the soft tissue envelope had settled (mean 7 days after injury). The key component to the surgical procedure was the reduction of the constant large medial fragment. This allowed simple access to the navicular for fracture reduction. The construct was supported with a bridge plate. The bridge plate was removed approximately 9 months post surgery. Final radiological follow up was at 12 months post surgery. Clinical follow up included the AOFAS midfoot score by phone questionnaire at a mean of 15 months’ post injury. Results: The study comprised 5 males and one female with a mean age of 22 years. In 5 patients the navicular fracture was an isolated injury, in one there was an associated cuboid fracture. None of the patients experienced any significant complications. All patients returned to work, one as a roofer and two to motocross. AOFAS midfoot scores were obtained from all patients via a telephone conversation at a mean of 15 months’ post injury. The mean score was 70 (range 65 - 80). Radiographs at a mean of 12 months showed no loss of position and maintained alignment. Conclusion: Acute fractures of the navicular are uncommon and they typically result in significant long-term morbidity. Our series demonstrate a technique which is reproducible in both maintaining the length of the medial column but also providing good access to the navicular for fracture reduction. It also results in good clinical outcomes in the short term. All our patients returned to their previous occupations with minimal symptoms.
Viscoelastic Properties of the Hindfoot Bones
Authors: Son Michelle , Munroe Brent 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Obtaining and maintaining compression at an arthrodesis site is a key factor in achieving successful bony union. Bones, like other collagen containing tissues, are known to exhibit viscoelastic properties that may lead to stress relaxation at the arthrodesis site. The viscoelastic properties of the hindfoot bones when subjected to compression (as occurs during fusion surgery) are not known. The objective of this study was to quantify the viscoelastic properties of hindfoot bones under compression by measuring the time course of stress relaxation. Methods: 19 cadaveric human bone cubes 10 mm on each side consisting of trabecular and subchondral bone were cut from the hindfoot bones including the talus, calcaneus, and distal tibia. Each cube was scanned with micro computed tomography (µCT) to quantify bone volume/total volume ratio (BV/TV), trabecular thickness, trabecular separation, trabecular number, and connectivity density. Each specimen was then immersed in a saline bath and compressed 1 mm at a strain rate of 1 mm/s using an MTS machine (Fig 1). This compressed position was then held for 3 hours while the load was recorded. Following the compression test, each specimen was re-scanned with µCT. Results: Two distinct patterns of load relaxation were found. The first consisted of a uniform exponential decay. The second had a similar exponential decay but included a plateau occurring between 1-6 minutes. This second pattern was reflected in the average fractional load relaxation graph (Fig 2). The average peak load was 24.14 kg (SD ± 15.07 kg) and average end relaxation was 2.93 kg (SD ± 3.81 kg). The average time to achieve 95% decay in total load was 34.7 min (SD ± 29.1 min) although removing some outliers, it decreased to 24.9 min (SD ± 18.4 min) which is more representative of the overall data. Averages of BV/TV, trabecular thickness, and trabecular separation increased after stress relaxation while average connectivity density and trabecular number decreased. Conclusion: These data suggest that, due to the viscoelastic properties of bone, approximately 95% of an applied compressive load generated by a fixed displacement is lost within the first 30 minutes. Applied clinically, these findings may have a significant impact on the optimal surgical technique used for osteosynthesis and arthrodesis. Specifically, these data call into question whether the compression applied during surgery can be maintained throughout the healing phase without the application of continuous compression via an external fixator or internal continuous compression device. At minimum, these data suggest that lag or compression screws should be retightened prior to wound closure.
Modified scarf osteotomy for hallux valgus
Authors: Tao Xu 
Published: September 2018

Category: Bunion Introduction/Purpose: To compare the elemental characteristics through a finite element (FE) model with an anatomically realistic geometry and structure of the metatarsophalangeal (MTP) joint. This model will estimate the biomechanical features and correction differences regarding dynamic loading and incidences of troughing. Methods: We retrospectively evaluated 40 patients who had undergone a modified rotational scarf osteotomy to correct for moderate to severe hallux valgus (HV) at our institution between January 2009 and December 2015. To compare the results and the elemental characteristics, we built a finite element model that included an anatomically realistic geometry and structure of the metatarsophalangeal (MTP) joint and estimated the biomechanical features and correction differences on dynamic loading as well as incidences of troughing. Results: Although the radiological outcomes remained unchanged within the first three months and moderately worsened over time as measured at the final radiographical assessment, all patients were satisfied with the results, including their visual analysis score (VAS) and American Orthopedic Foot & Ankle Society (AOFAS) score. The rates of troughing and recurrence were remarkably lower in our pilot because of the innate stability of the modified rotated fixation. Conclusion: Our pilot findings suggest that the modified rotational scarf osteotomy procedure offers sufficient stability, optimal corrections and variable options.
Increased Foot and Tibial Angles at Footstrike Decrease Vertical Loadrate in Runners
Authors: Tenforde Adam , Borgstrom Haylee Donaghe , Jamison Steve , Davis Irene 
Published: September 2018

Category: Sports Introduction/Purpose: It is well established that elevated vertical loadrates on footstrike are a risk factor for developing running injuries. Overstriding, or increased foot and tibial angles at footstrike, has been theorized to increase loading rate. Thus, it is often suggested that runners shorten their stride to reduce their injury risk. However, the relationship between landing alignment and loadrates has not been well established in current literature. Thus, we aimed to investigate the relationship between sagittal plane foot angle (FA) and tibial angle (TA) with vertical loadrates in both healthy and injured forefoot (FFS) and rearfoot strike (RFS) runners. It was hypothesized that as FA and TA increased, loadrate would increase for all runners. Methods: This is an ongoing study with 52 healthy runners (35 RFS, 17 FFS) and 24 injured runners (14 RFS, 10 FFS) for a total of 76 runners (51 M, 25 F; age34.3±11.4 yrs). Vertical average loadrate (VALR) and vertical instantaneous loadrate (VILR) were obtained while running at 2.68 m/s on an instrumented treadmill. All runners reported 0/10 pain during the assessment. Sagittal plane FA and TA at footstrike were measured from video recording using an open-source program. Positive FA designated RFS. Positive TA was defined as ankle anterior to the knee. Between-group differences were evaluated using paired two-tailed t-tests. Correlation coefficients (r) were computed for FA and TA with VALR and VILR (p=0.05; trend: p =0.10). Results: Healthy RFS - FA and TA were negatively correlated with VALR and VILR. Injured RFS – There was a trend toward negative correlation between TA and both VALR and VILR. Healthy FFS – TA was negatively correlated with both loadrates. Injured FFS – There were no significant correlations. Correlation coefficients, slopes, and p values are presented in Table 1. VALR and VILR were higher in RFS vs FFS runners (56±20 vs 40±10, 69±25 vs 54±12 BW/s, p<0.01), but were not significantly different for healthy vs injured runners (52±19 vs 56±26, 63±21 vs 67±27 BW/s, p=0.4). Conclusion: In contrast to current thought, preliminary results suggest that increasing FA and TA at footstrike are associated with decreasing vertical loadrates. This relationship was strongest for FA in the healthy RFS runners and weakest for FA in both the healthy and injured FFS runners. With increased FA, load attenuation may be due to increased eccentric activity of the tibialis anterior as well as increased knee flexion excursion and eccentric quadriceps activity with increased TA.
Whether need to repair deltoid ligament injuries in Supination-external Rotation type Ⅳ ankle fractures
Authors: Yang Yunfeng 
Published: September 2018

Category: Ankle Introduction/Purpose: To evaluate the effect of repairing deltoid ligament in patients with supination-external rotation type? ankle fractures. Methods: Between January 2013 and June 2016, 35 patients of supination-external rotation type? ankle fractures associated with deltoid ligament injury had complete medical records and were included in this study. Among all, 30 cases involved pure deltoid ligament injuries while others also included medial malleolus fractures. All fractures were treated by open reduction and internal fixation. Patients were assigned to the repaired group (21 patients) or the non-repaired group (14 patients) according to whether deltoid ligament injuries were treated during the surgery. No significant difference was found in gender, age, injury pattern, time from injury to operation(P>0.05), which was comparable. Medial clear space, visual analogue scale(VAS) score, and American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score(6 months, one year, two years after surgery), Baird-Jackson scoring system and complications were recorded. Results: Thirty-five patients were followed up 21-28months.The mean duration of operation in the repaired group was significantly longer than that of the non-repaired group.Baird-Jackson scoring system: the excellent rate of the repaired group was 90.5% while the non-repaired group was 85.7% . The VAS scores and the medial clear space of preoperative and final follow-up were significantly improved. At the last follow-up,2.85 percent of the patients presented with ankle instability while 8.5 percent of them occured traumatic arthritis. The AOFAS scores at 6, 12, and 24 months after operation were (82.1 ± 6.6; 86.2 ± 5.9; 91.5 ± 5.8) and (78.1 ± 6.5; 83.9 ± 5.6; 90.3 ± 5.6). However, none of them showed significant difference between the two groups (P>0.05). Conclusion: It’s unnecessary to repair the deltoid ligament in patients with supination-external rotation type? ankle fractures when ankle mortise restores after the fractures are fixed.
Clinical results of capsular interposition arthroplasty for severe hallux rigidus
Authors: Yui Akiyama , Hirano Takaaki , Niki Hisateru 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: There is no established surgical treatment for severe hallux rigidus (HR). Hamilton suggested capsular interposition arthroplasty (CIA), performed using an articular capsule and extensor hallucis brevis as a biologic spacer, as an alternative to metatarsophalangeal (MTP) joint fixation to treat severe HR. CIA is a preservation procedure that relieves pain and maintains joint function. We present the results of CIA performed at our facility to treat severe HR. Methods: In the present study, we further divided Hattrup’s grade II HR into two subtypes on the basis of joint space narrowing of 1stMTP. We recorded the severity of patients’ condition using our modified Hattrup’s classification. In this study, we did a follow-up of 8 cases in which CIA was performed to treat severe HR. The cases were followed up for 1 year or longer. The mean age of patients at surgery was 63.8 years, and the mean follow-up period was 7.1 years. Surgery was performed using a modified Hamilton method, which involves making an incision on the dorsal instead of the medial side and a manipulating the articular capsule in a different manner. Clinical outcomes were evaluated using the Japanese Society for Surgery of the Foot standard rating system (JSSF) scale. We investigated the pre- and post-operative ROM of the MTP joints and verified the presence or absence of complications. Results: It was observed that pain had reduced significantly in all cases after surgery. Following CIA, the mean ROM at extension was noted to have improved from 27.5° to 48.8° and the mean ROM at flexion had improved from 11.9° to 21.9°. The mean JSSF scale score has improved from 59.5 to 97.5 points. No complications were observed. Conclusion: This procedure is beneficial for pain relief and acquisition or maintenance of articular ROM and is a better choice for patients desiring preservation of ROM and articular function. It is imperative that patients follow proper rehabilitation for ROM and muscular strength preservation.
Hiflex Foot Gear improves Quality of life in patients with osteoarthritis of the ankle
Authors: Yui Akiyama , Hirano Takaaki , Niki Hisateru 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: There are few reports describing conservative therapy for ankle osteoarthritis. Hiflex Foot Gear (HFG) is a custom-made polyethylene ankle–foot orthosis developed to permit slight mobility of the ankle while providing adequate ankle support. The purpose of this study was to validate the hypothesis that HFG improves the quality of life (QOL) in patients with ankle osteoarthritis.Subjects and methods. Methods: Ten ankles from eight patients (one man, seven women) diagnosed with ankle osteoarthritis at this hospital, prescribed an HFG, and observed for follow-up for at least 3 months were included in this study. The patients’ mean age was 69.9 (range: 46?85) years. Patients were classified as Takakura–Tanaka stage IIIa (2 ankles), stage IIIb (2 ankles), stage IV (6 ankles), with a mean observation period of 8.9 (range: 3?13) months. Clinical evaluations were made before and 3 months after wearing the orthosis. The ankle/hindfoot scale of the Japanese Society for Surgery of the Foot (JSSF) Standard Rating System and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) subscale of the Japanese Orthopaedic Association/Japanese Society for Surgery of the Foot, respectively, were used for making evaluations. Scores were compared using a paired t-test. Results: JSSF scores improved from 55.1 points at baseline to 71.4 points after wearing the HFG (p < 0.001). According to the SAFE-Q subscales, changes after wearing the HFG were as follows: 28.9 to 61.9 points for items related to pain (p < 0.001), 36.9 to 53.7 points for those related to physical function and daily life (p = 0.001), 31.3 to 58.9 points for those related to social functions (p = 0.002), and from 31.3 to 65.0 points for those related to overall perception of health (p < 0.001); items related to shoes showed no substantial change (from 52.1 to 53.6 points). Conclusion: Our results revealed that wearing the HFG improved pain in patients with severe ankle osteoarthritis. Retained flexibility in the ankle range of motion was believed to be the factor underlying improvements in physical function and daily life, social functions, and overall perception of health. HFG is a potential option for conservative therapy in patients who cannot obtain sufficient pain control during the preoperative waiting period or in those who do not wish to undergo surgery.
Treatment outcomes of buttress plating for posterior pilon fractures
Authors: Zhang Ming-Zhu , Yu Guang-rong 
Published: September 2018

Category: Ankle Introduction/Purpose: The purpose of current study was to retrospectively analyze the clinical outcomes of buttress plate treatment of posterior pilon fractures. Methods: Between January 2005 and December 2016, 58 patients with posterior pilon fractures underwent buttress plate fixation. There were 32 males and 26 females and the mean age was 40.2years (range, 23 to 73 years). Preoperative radiographs, CT scans and three dimensional reconstructions were used to evaluate the fracture patterns. On the basis of the extension of the fracture lines presented on the CT scans, a posterolateral approach or a combination of both posterolateral and posteromedial approaches were used to reduce and fixate the posterior malleolar fragments. Clinical and radiographic examinations were used for postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Visual Analogue Scale (VAS) were used to evaluate the functional outcomes. Results: According to the CT scan images, the posterior pilon fractures were classified into 3 types. 51 patients were available for follow-up. The mean time of follow-up was 44.8 months. The mean AOFAS score was 84.3 points, and the mean VAS score was 1.6 points. One patient was found with ankle joint swelling and long term walking discomfort at 2-year follow-up. Other patients received favorable functional outcomes. No hardware failure occurred. Conclusion: The clinical outcomes of buttress plate treatment of posterior pilon fractures were satisfactory. Buttress plating availed the patients to return to earlier weight-bearing and functional exercises.