bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screw fixation of the posterior malleolar fracture
Authors: Lee Gi-Soo , Kang Chan , Cho Byung-Ki , Won Yougun 
Published: September 2018

Category: Trauma Introduction/Purpose: Posterior malleolar fracture is known to be an indication for surgery when the size of the fragment is greater than 25% to 30% of the joint surface. The purpose of this study was to compare the results of cannulated screw fixation and early joint motion in patients with ankle fracture with posterior malleolar fracture of less than 25%, and we do cadaver experiments. Methods: The clinical portion of the study evaluated 70 patients with fracture of the posterior malleolus that comprised less than 25% of the articular surface. After fixation for lateral and/or medial malleolar fractures, cannulated screw fixation was performed for posterior malleolar fractures in 34 cases. (A group) In other 36 cases, fixation was not performed for posterior malleolar fractures. (B group) One week after the operation, ankle range of motion exercise was performed. Cadaver studies were evaluated both cannulated screw fixed and non-fixed in less than 25% fractures of the posterior malleolar. The stability of the ankle joint was measured in 12 cases. In 6 cases, the posterior malleolar was fixed and the other 6 cases were not fixed. Results: There was no significant difference in clinical outcome between Group A and B and functional score at 2 years follow up. However, the ankle function score at 6 months and 1 year after the follow - up was significantly higher in group A than in group B. In the cadaver study, the group with screw fixation was significantly stable in external rotation. Conclusion: In case of less than 25% posterior fracture, screw fixation is considered to have a significant effect on recovery and clinical outcome in the short term due to stability.
Effects of walking speed and slope on foot pressure in young healthy adults
Authors: Lee Kyoung Min , Min Byung-Cho , Koo Seungbum 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated regarding effects of walking speed and slope. This study examined pedobarographic findings in young healthy adults with regard to different walking speeds and slopes. Methods: Twenty young healthy adults (mean age 22.4 years, SD 1.2 years; 10 males and 10 females) were recruited. Dynamic pedobarographic data were obtained during treadmill walking with different walking speeds (3.2 km/hr, 4.3 km/hr, and 5.4 km/hr) and slopes (-8°, -4°, 0°, 4°, and 8°). Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel. Distribution of foot pressure between medial and lateral sides, and between anterior and posterior aspects were calculated as varus/valgus index and forefoot/heel index, respectively. Walking speed of 4.3 km/hr on 0° of slope was considered as standard walking condition. Results: Varus/valgus index of peak pressure showed significant increase on the slope of 8° and the walking speed of 4.3 km/hr (p=0.036) and 5.4 km/hr (p=0.007). Forefoot/heel index of peak pressure significantly decreased on downhill walking. Varus/valgus index of pressure-time integral showed significant increase when uphill and downhill slope was greater and walking speed was faster compared with standard with walking condition. Forefoot/heel index of pressure-time integral showed significant increase in downhill walking while significant decrease was observed during uphill walking. Conclusion: Changes of walking speed and slope caused those of foot pressure distribution. Therefore, combination of walking speed and speed might be associated with pressure related symptoms and disorders of the foot.
Transfixing Screw Placement for Syndesmotic Injury
Authors: Lee Si Wook 
Published: September 2018

Category: Trauma Introduction/Purpose: The strategy of transfixing screw fixation including screw number, size, material, the number of cortex involved, and penetrating angle is controversial. The purpose of this fresh frozen cadaveric study is to demonstrate the optimal degree of transfixing screw insertion after syndesmotic reduction in the Pronation External Rotation (PER) type ankle fractures, and to study reliable parameters to evaluate the syndesmotic reduction. Methods: Twenty paired fresh frozen anatomic specimens of the ankles were obtained. Before dissection, CT scans were taken preoperatively. Then, preparation was performed by cutting and dissection of anterior interior tibiofibular ligament (AITFL), interosseous ligament and membrane. Two types of screw placement were set. Ten screws were inserted into right ankle at an angle of 25 to 30 degrees from neutral position. The other 10 screws were inserted into the left ankle at a 0 degree angle from neutral position. Postoperative CT scan was performed after screw insertion. Anterior fibular distance(AFD), posterior fibular distance(PFD), anterior translation distance(AT), diastasis, anterior-posterior translation(APT) were measured in 2D axial section and volume of the syndesmotic space were measured in 3D reconstruction data of preoperative and postoperative CT scan. Results: The transfixing screw fixation induce the significant difference in syndesmotic space regardless of insertion angle. There was significant difference only in fibular diastasis between both ankle model. There was no statistically significant difference in AFD, PFD, AT, APT and 3D reconstructed volume according to transfixing screw insertion angle when each measured value was compared through left and right ratio and absolute volume value. Conclusion: In ankle syndesmotic injury, transfixing screw insertion should be considered for the ankle stability. But, regardless of the insertion angle, transfixing screw insertion would have a significant therapeutic effect on ankle syndesmotic injury. Fibular diastasis would be the reliable parameters to evaluate syndesmotic reduction.
Hallux MTP Arthrodesis for Treatment of Severe Hallux Valgus Using a Dorsal Locking Plate
Authors: Lee Wonyong , Truitt Cooper M. , Perumal Venkat , Park Joseph 
Published: September 2018

Category: Bunion Introduction/Purpose: First metatarsophalangeal (MTP) joint arthrodesis is widely accepted as a treatment option for severe hallux valgus deformities. Although successful results of first MTP joint arthrodesis for hallux valgus have been reported in previous studies, the reported rates of fusion have been lower than for the general hallux rigidus population. The purpose of this study was to demonstrate the failure rate of first MTP joint arthrodesis for severe hallux valgus deformities and to evaluate radiographic correction of hallux valgus parameters after the surgery. Methods: From January 2014 to June 2017, 34 patients underwent first MTP joint arthrodesis surgery for severe hallux valgus deformity and were included in this retrospective study. Severe hallux valgus was defined as having a hallux valgus angle (HVA) of greater than 40 degrees and an intermetatarsal angle (IMA) greater than 15 degrees. For radiographic evaluation, the patients were evaluated by measuring the IMA and HVA in preoperative and postoperative weight-bearing AP foot x-rays. We defined failure after first MTP joint arthrodesis as non-union, incomplete union, or implant breakage or migration leading to a symptomatic recurrence of hallux valgus deformity. Results: The mean preoperative IMA and HVA were 16.7 ± 4.2 degrees (range 8.4 to 26.5) and 45.2 ± 8.6 degrees (range 28.7 to 71.1) respectively, and the postoperative IMA and HVA were 11.3 ± 3.8 degrees (range 4.1 to 20.4) and 20.9 ± 11.8 degrees (range 0.4 to 51.1) respectively. The postoperative IMA and HVA were significantly improved after surgery (< 0.001). Among the 34 patients in this study, a 14.7% failure rate was reported (n=5). For fusion procedures performed without lag screw fixation, there was a 12.6-fold increase in failure risk when we used the small dorsal locking plate compared with the medium dorsal locking plate (Odds ratio = 12.571). Conclusion: First MTP joint arthrodesis is an effective and reliable option for severe hallux valgus correction. However, for this challenging cohort, the 14.7% failure rate in this study is consistent with other studies in the literature. For severe hallux valgus deformities, selection of implant may play a more significant role. The use of longer plates to gain additional purchase in the diaphyseal bone, lag screw augmentation, and utilizing flat cuts instead of cup and cone reaming to realign the joint may help mitigate the increased stresses placed on the fixation constructs for MTP arthrodesis.
The Common Peroneal (High Fibular) Nerve Block
Authors: Maiyuran Harinee , Harris Thomas 
Published: September 2018

Category: Ankle Introduction/Purpose: The bifurcation of the sciatic nerve results in the common peroneal nerve, along with the tibial nerve. A commonly block used before foot and ankle surgery is the sciatic block. This block requires an ultrasound or neurostimulation for accurate placement and can take time to administer effectively. We believe that the common peroneal, or high fibular nerve block, may be equivalent in some clinical circumstances to the sciatic block and does not require additional imaging for accurate placement. Methods: In this study, a mixture comprised of 5 mL 0.5% bupivacaine and 5 mL 1% lidocaine was used for each patient. Certain surface anatomic landmarks were used to place the block without ultrasound or neurostimulation. The time spent administering the block was recorded. Patients were not given pain medicines in the recovery unit unless the block did not work. A follow-up questionnaire was completed within 24 hours following surgery, and this was used to assess aspects of the patient’s post-operative experience. These include the number of hours following surgery that the patient: 1) first felt pain, 2) first took pain medication, 3) first felt tingling, 4) fully regained feeling in his/her leg, and 5) could wiggle his/her toes. Also, any complications were recorded. Results: This study involved 21 patients with an average age of 51. The most common procedures used with the block were hardware removal of the fibula and open reduction internal fixation of the fibula. The block took on average less than 3 minutes to administer and ultrasound was not used in any cases. No patients were given pain medicines in the recovery unit. None of the patients reported any complications, specifically, there were no cases of foot drop or any persistent paresthesias. The average time it took for patients to first feel pain after the block was approximately 8 hours. On average, patients first took pain medication approximately 11 hours after surgery, and regained sensation in their leg 15 hours after surgery. Conclusion: The benefits of the common peroneal block are multifold, as their clinical outcomes were positive and patients did not experience any complications. Also, from a surgeon perspective, the block is quick to administer and does not require ultrasound or neurostimulation.
Sport and physical activities in patients with Chronic Achilles tendon rupture reconstruction using flexor hallucis longus transfer
Authors: Manzi Luigi , Maccario Camilla , Palanca Ariel , Di Silvestri Claudia , Usuelli Federico Giuseppe 
Published: September 2018

Category: Sports Introduction/Purpose: Neglected or chronic Achilles tendon ruptures can be significantly disabling to patients if the muscle-tendon unit is stretched beyond its normal passive limit. Chronic rupture of the Achilles tendon (delayed diagnosis of more than 4 weeks) can result in retraction of the tendon and inadequate healing. Direct repair may not be possible and clinical results may not be satisfactory especially if the distal stump is grossly tendinopathic and when the defect exceeds 5-6 cm. Methods: We evaluated 9 patients (mean age 63) who underwent flexor hallucis longus transfer for treatment of chronic Achilles tendinopathy between May 2014 and January 2017 at a 12 months follow-up. Our results were measured with the SF-12 survey, AOFAS Ankle-Hindfoot Scale and VAS. Activity levels were determined using the Halasi ankle activity scale and the UCLA score obtained preoperatively and 12 months after surgery. Wound complications and tip-toe stance were also assessed. Results: All patients had a significant improvement of AOFAS, VAS and SF-12 scores. The Halasi activity scale and UCLA score were 5.8 and 8.2 respectively 12 months after surgery. Patient reported outcome measures consistently demonstrated improvement in clinical putcomes at 12 months follow-up. The patients went back to full daily function, could single leg heel raise and were gradually returning to sport. No major complications were recorded. Conclusion: Reconstruction of chronic tears of the Achilles tendon with flexor hallucis longus transfer can achieve satisfactory improvements in clinical outcomes at 1 year follow-up.
Hindfoot alignment in total ankle replacement at 2 year follow-uo
Authors: Manzi Luigi , Indino Cristian , Gross Christopher , D’Ambrosi Riccardo , Usuelli Federico Giuseppe 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis frequently involves multiplanar malalignment both tibio-talar and subtalar joint. Restoration of the correct position of the tibial and the talar component and of the hindfoot is mandatory for the long-term survival of total ankle replacement. Since patients with ankle osteoarthritis often present concomitant hindfoot deformity, radiographic references are needed to describe deformities. However, the possible compensatory mechanisms of these linked joints are not well known.The aim of this study is to show if there is any difference regarding hindfoot position at 6 months, 1 year and 2 years follow-up. Methods: The study included 68 ankles who underwent Total Ankle Replacment through a later transfibuklar approach between May 2013 and December 2015. The main indications for TAR were: post-traumatic (55 patients, 80.9%) and reumathoid arthritis (5 patients, 7.4%). In these patients the hindfoot view angle was measured 6, 12 and 24 months postoperatively. Furthermore, clinical outcomes were recorded. Patients who underwent hindfoot/midfoot fusions were excluded. Results: The mean hindfoot alignment angle (HAV) was 0.4±0.0 pre-operatively and 0.1±6.2, 0.7±6.2, 1.2±7.0 at 6, 12 and 24 months postoperatively. There was no statistically significant difference in the HAV between follow-up. A statistically significant improvement in clinical scores (AOFAS, VAS and SF.12) was found at each follow-up. The main complications were: 6 hardware removal for intollerance (8,8%), 3 delayed wound healing (4,4%), 1 medial impingement (1,5%). Conclusion: Regarding the hindfoot alignment angle, TAA through a lateral approach showed a good reliability. Furthermore, hindfoot alignment remains stable over time.
Ankle Fracture Stability-based Classification
Authors: Michelson James , Delaney John 
Published: September 2018

Category: Trauma Introduction/Purpose: Rotational ankle fractures are common in orthopaedic surgery, however existing classification systems are mostly descriptive in nature and do not explicitly guide surgical decision-making. A Stability-Based classification was developed recently to provide a more prognostic classification. The purpose of this study was to compare the reproducibility of existing ankle fracture classifications, and determine the ability of the Stability-Based classification to predict clinical treatment. Methods: One hundred ninety-three consecutive ankle fractures treated at our institution were retrospectively analyzed. Rotational type injury patterns in patients >18 years old were included. None of the subjects were clinically treated or evaluated by the study authors. The fractures were treated by attending physicians who were unaware of the Stability-Based classification system. Pathologic fractures were excluded. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and Stability-Based classifications systems. Reproducibility (inter-observer variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve (AUC) for the ROC curves (using surgery as the positive outcome) for each classification. Results: The Stability-Based classification was showed the excellent reproducibility (kappa .938, 95% CI .921-.952), along with the Weber/AO classification (kappa .97, 95% CI .961-.976), while the Lauge-Hansen had the lowest reproducibility (kappa .74, 95%CI .664-.795). The AUC for the three classifications were .883 (95%CI .852-.914), .626 (95%CI .576-.675), and .698 (95%CI .641-.755), respectively (Figure 1). The AUC was significantly better for the Stability-Based classification compared to the other 2 classifications (p<.001). Conclusion: The AO/Weber classification had excellent reproducibility, but did not predict the need for surgical stabilization accurately. In contrast, the Stability-Based classification system was both highly reproducible (kappa .938) with excellent prognostic ability to identify patients who got surgery (AUC .883). Furthermore, there were no patients who were classified as stable who failed non-operative treatment. The Stability-Based classification was found to have superior prognostic capacity compared to both the Lauge-Hansen and AO/Weber classification systems. This extends earlier studies by showing the reproducibility of the Stability-Based classification system and directly demonstrating its prognostic superiority to other classification systems.
MRI Analysis for Clarification of Mechanism of Ankle Osteoarthritis
Authors: Mitsui Hiroyuki , Hirano Takaaki , Niki Hisateru 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: We have previously studied the relationship between Takakura–Tanaka classification stages and bone-marrow edema (BME) in order to elucidate the pathology of ankle osteoarthritis (ankle OA) on magnetic resonance imaging (MRI). Moreover, we have investigated that BME onset on the talocrural joint can be predicted according to radiographic findings. In the present study, we focused on the changes around the subtalar joint to examine the relationship between talar lateral process impingement (TLPI) and foot and ankle joint alignment, and whether TLPI can be predicted on the basis of X-ray findings. Methods: We assessed 30 feet of 30 patients who had a diagnosis of ankle OA in our hospital and underwent MRI. Alignment was assessed radiographically by measuring the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), the lateral talo-first metatarsal angle (LTMT), the lateral talocalcaneal angle (LTC), and the tibial axis–talar ratio (T-T ratio). MRI was obtained with the talocrural, subtalar and Chopart joints into 22 subdivided areas to examine the frequency of BME for each patient. TLPI was considered positive (+) when BME was found in the talar lateral process. The patients were divided into two groups according to TLPI positivity or negativity. Their BME frequency was examined, and significant differences in radiographically measured values were analysed with a t-test. Results: In the TLPI (+) group, BME development occurred at significantly higher frequencies in all areas except those surrounding the lateral process (p = 0.002). In addition, TLS was significantly lower (p = 0.02), and LTMT was significantly higher (p = 0.04). When the cut-off value on the ROC curve was set at TLS of =74° and LTMT of =19°, TLPI onset could be predicted with a sensitivity of 75% and a specificity of 71%. Conclusion: Our results revealed that in the TLPI (+) group, progression of the anteriorly opened talocrural joint and talar dorsiflexion may be causing the talar lateral process to hit the calcaneus. Furthermore, in the TLPI (+) group, BME in other areas also occurred at higher frequencies, and symptoms around the ankle joints may be occurring at multiple locations. The fact that TLPI could be predicted from radiography findings suggests that this may be a potential predictive tool of the severity of clinical symptoms.
Mechanically Superior Molybdenum Rhenium (MoRe®) Alloy provides an advanced option for Foot and Ankle Implants
Authors: Parekh Selene , Adams Samuel , Nunley James , Easley Mark , Pedowitz David , Hyer Christopher , Brigido Stephen 
Published: September 2018

Category: Other Introduction/Purpose: One of the most common complications in orthopaedic surgery of the foot and ankle is nonunion or delayed union and bone or implant fractures. Although foot and ankle surgery has improved dramatically over the past decades primarily due to the development of better techniques, little progress has been made in the development of new materials for implants. Titanium, the most commonly used alloy for foot and ankle implants, has limited strength and is notch-sensitive so repetitive stress leads to fatigue failure of implants and limits design options. Better materials with optimized biomechanical properties could result in the development of superior foot and ankle implants and surgical techniques. The mechanical properties of Molybdenum-Rhenium (MoRe®), a promising new alloy for foot and ankle implants were tested. Methods: Standard test methods (ASTM 1717) were performed to evaluate the mechanical properties of Molybdenum Rhenium (MoRe®) alloy compared to Titanium (Ti-6Al-4 V, ASTM F136-13 annealed bar, Ti-ELI). Results: MoRe® is composed purely (99.99%) of molybdenum and rhenium and does not contain Nickel. Molybdenum is found in food and is a cofactor to the enzymes xanthine oxidase and sulfite oxidase, which are essential to bone and connective tissue metabolism. Rhenium is an inert metal with no biological affect. Mechanical testing showed MoRe to be superior to Titanium: Yield Strength: MoRe® 280ksi, Titanium 115ksi, Ultimate Tensile Strength: MoRe® 300ksi, Titanium 125 ksi. Elongation and Reduction in Area: MoRe® 13%, 50%, respectively; Titanium 10%, 25%. Recoil: MoRe® <2%, Titanium 6%. Hardness Range: MoRe® 280-800HV, Titanium 350-400HV. Max Run-Out Load Bent Rod: MoRe® 4.0 mm rod 350 N, Titanium 5.5 mm rod 150 N. Decrease in Max Run-Out Load Bent, Unbent, Re-bent Rod: MoRe® -9%, Titanium -17%. Conclusion: The MoRe® alloy, with its advantageous mechanical properties, offers great promise for the design of a new generation of smaller, stronger and more fatigue resistant foot and ankle implants, resulting in less soft tissue disruption, quicker recovery and better outcomes for patients.