bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pronation of the First Metatarsal in Hallux Valgus Deformity
Authors: Cychosz Chris , Johnson Alyssa , Phisitkul Phinit 
Published: September 2018

Category: Bunion Introduction/Purpose: Hallux Valgus is a common condition often resulting in chronic pain and disability. However, the precise etiology of Hallux Valgus deformity remains poorly understood and likely results from a combination of intrinsic and extrinsic factors. There is conflicting evidence regarding as to whether hallux valgus deformity is associated with increased pronation of the first metatarsal. The purpose of this study was to investigate the correlation between hallux valgus and pronation of the first metatarsal in relation to other structural parameters of the foot. Methods: Eighty-five consecutive patients with clinically and radiographically diagnosed hallux valgus, pes planus, or cavovarus that underwent imaging with weightbearing CT between January 2014 and May 2016 were retrospectively enrolled and compared to a control group consisting of patients who with scans completed for indications unrelated to hallux valgus (e.g. ankle arthritis) and were determined to have normal foot structure. Using a weightbearing CT axial view, the alpha angle of the first metatarsal was measured and correlated with other radiographic parameters on plain weightbearing radiographs including Meary’s angle, hallux valgus angle, intermetatarsal angle, and calcaneal pitch. Results: There were 39 males and 46 females (91 feet) with a mean age of 47.16 (SD14.89) years and BMI of 32.99 (SD 7.35) kg/m2 included in this study. Mean pronation of the first metatarsal significantly (p<0.001) different in all group compared to the control: 15.23 (SD 7.96) in the hallux valgus group, 15.22 (SD 8.56) in the pes planus group, negative 0.23 (SD 5.99) in the cavovarus group, and 6.98 (SD 5.09) in the control group. There was moderate correlation between meary’s angle, tripod index, calcaneal pitch, and the alpha angle (negative 0.70, 0.65, negative 0.53, respectively) with a p-value < 0.001. HVA demonstrated little correlation with the measured alpha angle (0.23), p<0.03. Conclusion: Patients with hallux valgus deformity demonstrated a significantly higher pronation of the first metatarsal compared to the control group. However, a greater number of patients in the hallux valgus group had flatfoot deformity and further analysis revealed a greater correlation between foot type and pronation of the first metatarsal. Weightbearing CT is a reasonable way to image complex forefoot deformities prior to bunion surgery and it is important to take into account rotation of the first metatarsal in bunion surgery.
A Comparative Study of Two Different Techniques for Calcaneal Displacement Osteotomy
Authors: Gutteck Natalia 
Published: September 2018

Category: Hindfoot Introduction/Purpose: The lateral oblique incision is widely used for calcaneal displacement osteotomy in correction of hindfoot deformities. Wound healing problems and neurovascular injury are limitations of this procedure. A technique using a Shannon burr for calcaneal displacement osteotomy was introduced to avoid these complications. The advantages of the percutaneos calcaneus osteotomy have been evaluated in a comperative study. Methods: Lateral oblique incision for calcaneus osteotomy was performed in 58 patients. The senior author changed the osteotomy technique 2014. Further 64 calcaneus osteotomies were performed percutaneously. The main indication for the calcaneus osteotomy was correction of hindfoot deformities. Complementary the number of screws used for the fixation have been axamined in the study. Results: The mean age of the patients was 51,6 (14-72) years. The patients were folled up for 12 months. All cases achieved radiographic union. Wound healing problems have been registrated in the open technique group in 16 patients (27,6%). Six of them (10,3%) required a surgical revision. No wound healing problems appeared in the percutaneous group. N. suralis was affected in the open technique group in 12 patients (20,6%) and in 4 patients (6,2%) in the percutaneous osteotomy group (p 0,02). The operating time was significantly shorter in the percutaneus osteotomy group. The correction of the hindfoot axis succeed in all patients. Risk of complication did not differ significantly between single and double screw in the percutaneous osteotomy group. Conclusion: The clinical and radiological examinations showed outstanding results. There is no evident difference between the two techniques in the radiological results. Use of a single screw in percutaneous osteotomy of the calcaneus did not increased the complication rate. The percutaneous calcaneal osteotomy had a lower complication rate in our study and is probably a useful technique in patients with diabetes and affected perfusion. Further randomised studies should consider this results.
New screening method for hallux valgus with using smartphone
Authors: Hayatoshi Shibuya , Nakasa Tomoyuki , Sawa Mikiya , Tsuyuguchi Yusuke , Kanemitsu Munekazu , Ota Yuki , Adachi Nobuo 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: We developed a new screening method for hallux valgus during weight bearing using the photo-capturing function in cell phones. Methods: We compared apparent hallux valgus angles measured from photographs of people in a standing position during weight bearing, which were captured on a smartphone (smartphone Hallux Valgus Angle: SP-HVA) (Smartphone Method), with hallux valgus angles determined using conventional radiography in a standing posture during weight-bearing (X-ray HVA: XR-HVA). We evaluated 37 feet of 25 patients (5 men and 25 women) who visited our hospital. The mean age at the time of the visit was 73.9 years. In the Smartphone Method, subjects stood upright and the examiner used a smartphone to take photos of both feet from above while holding the phone at the level of the anterior knee. Results: The mean value was 36.2° for SP-HVA and 36.7° for XR-HVA; the two methods showed a statistically significant correlation (correlation coefficient of 0.86). Conclusion: Our smartphone-assisted screening method for hallux valgus was possible to make a diagnosis equivalent to conventional radiography method without radiation exposure.
Ankle Arthrodesis Through an Anterior Approach
Authors: Jarrell Kathleen , Denisiuk Marek , McDonald Elizabeth , Raikin Steven 
Published: September 2018

Category: Ankle Introduction/Purpose: Ankle arthrodesis can be approached anteriorly, laterally, medially, or posteriorly, and debate remains as to which approach is most advantageous. Although an anterior approach using the interval between the extensor hallucis longus and tibialis anterior is commonly performed, there is a paucity of studies showing the clinical outcomes after this procedure. This study aims to evaluate the functional outcomes and patient satisfaction at mid-term follow-up after ankle arthrodesis via an anterior approach. Methods: All isolated primary ankle arthrodeses performed with the anterior approach by a single fellowship-trained foot and ankle surgeon between May of 2011 and December of 2015 were retrospectively included. Chart review was performed and patient reported outcomes were collected including FAAM ADL, FAAM Sports, VAS, and SF-12 scores pre-operatively and at a minimum of two-years post-operatively. At final follow-up, a survey was distributed via phone or email inquiring about level of satisfaction and whether they would undergo the procedure again. A total of 108 patients were included, of which only 45 (41.67%) had pre-operative functional scores, 24 (22.2%) completed both pre- and post-operative functional scores, and 20 patients (18.5%) had satisfaction results. The average length of follow-up was 4.4 years (range: 1.7 – 7.9, SD 1.6). Results: FAAM ADL scores improved from a mean of 48.1 to 67.6, FAAM Sports increased from 18.1 to 34.9, VAS Pain decreased from 73.2 to 44.9, SF-12 MCS changed from 44.2 to 46.7, and SF-12 PCS increased from 31.0 to 42.2. Using a linear mixed effects model and controlling for length of follow-up, all functional and pain score improvements were significant except SF- 12 MCS (Table 1). Overall, 65% of patients were satisfied with their results and 85% of patients would consider the same surgery if needed. Patients who were more satisfied with their surgery were more likely to say that they would consider the same surgery given similar circumstances (p = 0.001). Conclusion: Post-operative functional scores were significantly improved and pain scores were significantly decreased compared to pre-operative scores in a cohort of patients who underwent ankle arthrodesis using an anterior approach. Satisfaction with the surgery was lower than expected given the improvement in functional scores. Further study is indicated to determine methods to improve satisfaction. Our study suggests that an anterior approach to ankle arthrodesis is an effective technique to improve function and pain in patients with ankle arthritis, however satisfaction after surgery is no guarantee. The study is limited by the small subset of patients with pre- and post-operative functional scores.
All-inside Arthroscopic Modified Broström Operation for Lateral Ankle Instability with Os Subfibulare
Authors: Kim Woo Jong , Lee Young Koo 
Published: September 2018

Category: Sports Introduction/Purpose: Os Subfibulare(OSF) is an accessory ossicle that lies at the tip of the lateral malleolus of the ankle. Patients with chronic lateral ankle instability (CLAI) have a high incidence of OSF, and there relationship implies that there is a correlation between OSF and CLAI. The all-inside arthroscopic Modified Broström Operation (MBO) has been developed for the treatment of chronic lateral ankle instability (CLAI) and the outcome was reported as good or excellent. But there were no report about comparison of the outcome between OSF and non-OSF patients with chronic lateral ankle instability treated by all-inside arthroscopic MBO. The purpose of this study was to evaluate the clinical and radiologic outcomes of the arthroscopic MBO procedure for CLAI with or without OSF. Methods: From January 2013 to september 2016, arthroscopic MBO was performed on 133 patients with CLAI. Of these, 126 ankles were evaluated for this study. Patients were divided into two groups: the OSF group (26 patients), without OSF group (100 patients). Evaluation tools included the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score and pain Visual Analogue Scale (VAS) at preoperatively, 6 and 12 months postoperatively for clinical outcomes. And we also evaluated the talar tilt angle in the varus stress radiograph at preoperatively, 6 and 12 months postoperatively for radiologic outcomes. Results: There were no difference in age, sex, preoperative AOFAS hindfoot ankle scores and VAS scores and talar tilt angle between the two groups preoperatively(P >.05). And there also were no difference at the final follow-up (P >.05).The final follow-up AOFAS hindfoot ankle score and Vas in both group showed improvement compared with preoperaive values. Conclusion: There were no difference in both clinical and radiologic outcomes between OSF group and non-OSF group at a minimum 12 months follow-up. We achieved similar successful outcomes in both groups using All-inside arthroscopic MBO. Arthroscopic MBO should be considered as a reasonable alternative method in patients who have chronic lateral ankle instability regardless of the presence of OSF.
Effect of CAM boot immobilization on weightbearing stability in syndesmotic injuries
Authors: Lamer Stéphanie , Dube Vincent , Hebert-Davies Jonah , Stephane Leduc , Menard Jeremie , Nault Marie-Lyne 
Published: September 2018

Category: Trauma Introduction/Purpose: Ankle injuries are one of the most frequent traumas of the lower limb. They typically involve the lower lateral ligaments of the ankle, but the syndesmosis is also affected in up to 18% of cases. The degree of instability of syndesmotic joint depends on which ligaments are affected. Adequate management of syndesmotic injuries is crucial to avoid long term complications. The primary goal of our study was to evaluate the effect of simulated weightbearing on syndesmotic instability resulting from isolated AiTFL injury and from combined AiTFL/IOL injuries. The secondary goal was to evaluate the effect of a controlled ankle motion walking boot on syndesmosis stability following injury. We hypothesized that the CAM boot would prevent significant instability even in two ligaments injuries. Methods: Ten cadaveric specimens were dissected to expose the syndesmosis to create progressive iatrogenic syndesmosis ruptures. Uninjured syndesmoses were compared to isolated AiTFL and combined AiTFL/IOL ruptures. The specimens were fitted in a custom-made device to allow stabilization of the leg and apply a reproducible axial load (AL) of 750 N, equivalent to the weight of a 168-pound person. For each specimen and injury pattern, CT-scan images were obtained with and without AL, and with a CAM boot under AL. Distal tibio-fibular relationship was evaluated in three planes using a previously validated measurement system developed on CT. Wilcoxon tests for paired samples and non-parametric data were done to compare the different conditions. Results: For our first objective, when comparing ankles with isolated AiTFL to combined AiTFL/IOL rupture with and without AL, the only significant difference was an increase in internal rotation between the incisura and a line drawn in the axis of the fibula. Even with minimal statistical differences, it appears that axial loading does not impact syndesmotic stability apart from a slight increase in internal rotation with a single or two-ligament injury. As for our second end point, with the CAM orthopedic boot, no significant widening of the syndesmosis happened when either one or both ligaments were sectioned, in an axial loading state. We therefore confirmed our hypothesis that even with two syndesmotic ligament injuries, axial loading in a CAM boot does not affect distal tibio-fibular anatomy. Conclusion: This study reveals that weight bearing without rotational force does not affect the stability of the syndesmosis. Incomplete syndesmotic injuries can likely be treated with nonoperative treatment in a CAM boot and weight bearing as tolerated. Further clinical studies are needed to confirm these findings.
The valid diagnostic parameters in static bilateral CT scan to predict unstable syndesmotic injury with ankle fracture
Authors: Lee Si Wook 
Published: September 2018

Category: Trauma Introduction/Purpose: The purpose of this study is to evaluate valid and reasonable parameters to predict syndesmotic injury in ankle fracture. Methods: Seventy patients who underwent preoperative bilateral CT scans were enrolled retrospectively. On preoperative x-ray, tibiofibular overlap (TFO) and tibiofibular clear space (TFCS) were measured. On preoperative CT scan, anterior fibular distance (AFD), posterior fibular distance (PFD), anterior translation distance (AT), fibular diastasis (FD), anterior-posterior translation (APT), fibular length (FL), surface area of syndesmosis (SAS), surface area of syndesmosis of 1.5 cm above the ankle joint line (SAS1.5) were measured. Those measured values were divided with those of uninjured side, in order to minimize the differences among the individuals. Results: Statistically significant differences has been shown between The measurements of ratio (Injured/Uninjured) of TFO, PFD, APT, Diastasis, and SAS of groups which required transfixation have shown statistically significant difference, compared to those of groups which did not require transfixation. Other measurements were not showing significant difference. Furthermore, using ROC curve analysis, a ratio of measurement which is the most reasonable to predict transfixation was SAS (95% confidence interval = 0.598 – 0.869, cut of value = 1.555) Conclusion: Measuring TFO, PFD, APT, Diastasis, and SAS from CT scans and comparing with uninjured side preoperatively can provide surgeon an reasonable evidence to perform transfixation intraoperatively
Functional treatment for fractures to the base of the 5th metatarsal - Influence of fracture location and fracture characteristics
Authors: Polzer Hans , Braunstein Mareen , Baumbach Sebastian 
Published: September 2018

Category: Trauma Introduction/Purpose: Fractures to the base of the fifth metatarsal are common, but their treatment remains controversial. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures. Of special interest were the influence of (1) the fracture location (L&B type I vs. II) and (2) the fracture characteristics (displacement, intra- articular involvement, communition) on the subjective outcome. Methods: Retrospective registry study with a prospective follow-up. Patients with an acute, isolated, epi-metaphyseal fracture to the fifth metatarsal bone (L&B type I and II) treated by full weightbearing with a minimum follow-up of 6 months were included. Fracture location (L&B type I and II) and characteristics (displacement <2 mm or >2 mm, intra-articular involvement, and number of fragments) were assessed. Outcome parameters were return to work, return to sports, VAS-FA, and SF-12. The influence of the fracture location and -characteristics on these parameters was tested. Results: 39 patients (40±15 years, 56% female) were enrolled with a mean follow-up of 22±10 months. L&B type I fractures occurred in 59%, type II in 41%. Thirty-one percent of all fractures were dislocated, 74% intra-articular, and 41% multi-fragmentary. Patients returned to work after 17±12 days, to sports after 53±22 days. The VAS-FA score at the final follow-up was 96±4, SF-12 PCS score 57±5 and MCS score 51±8. No complications were reported, no patient required surgery. None of the assessed outcome parameters differed significantly between (1) the different fracture locations (L&B type I vs. II) or (2) the different fracture characteristics (displacement, intra-articular involvement, and number of fragments). Conclusion: Both, L&B I and II fractures featured excellent results with immediate full weightbearing. Consequently, L&B type I and II fractures should be summarized as epi-metaphyseal fractures. Fracture displacement, articular involvement, and number of fragments did not influence the outcome. Therefore, functional treatment should be recommended for all epi-metaphyseal fractures.
Benefit of weight-bearing CT - what have we learned from more than 8,000 scans at a foot and ankle center
Authors: Richter Martinus , Lintz Francois , Barg Alexej , Burssens Arne 
Published: September 2018

Category: Other Introduction/Purpose: Weight-bearing CT (WBCT) has been proven to allow for more precise and valid measurement of bone position than conventional weight-bearing radiographs (R) and conventional CT without weight-bearing (CT). Time spent for image acquisition has been shown to be lower for WBCT than for R and CT2. Radiation dose for WBCT has been shown to be lower for WBCT than for CT. A WBCT device (PedCAT, Curvebeam, Warrington, PA, USA) had been brought on line July 1, 2013 in the first author´s foot and ankle department. The purpose of this study was to assess the benefit of using WBCT instead of R and/or CT in a foot and ankle center regarding time spent for image acquisition, radiation dose, disturbances, and cost effectiveness. Methods: All patients who obtained WBCT July 1, 2013 until December 31, 2017 were included in the study. Age, sex and primary pathology were analyzed. The time spent for image acquisition (T) was calculated based on an analysis of a previous study as follows: R (bilateral feet dorsoplantar and lateral, metatarsal head skyline view), 902 seconds; CT (bilateral feet and ankle), 415 seconds; WBCT (bilateral), 207 seconds. Radiation dose (RD) per patient was calculated based on previous phantom measurements as follows: R, 1.4 uSV; CT, 25 uSv; WBCT 4.2 uSv. For analysis of cost effectiveness device cost, reimbursement and working time cost of radiology technicians were taken into consideration within the local circumstances. All parameters were compared between the time period using WBCT (yearly average) with the parameters from 2012, i.e. before availability of WBCT. Results: 8,129 WBCT scans were obtained in 3,874 patients (3,874 (48%) preoperatively, 4,255 (52%) follow-up; mean age, 52.2; 39% male). Primary pathologies were forefoot deformities (n=728 (19%) and ankle osteoarthritis/cartilage defect (n=412 (11%)). 1,804 WBCT scans were obtained on average yearly, and 10 CTs (WBCT group). In 2012, 1,750 R and 250 CTs were obtained (R(+CT) group). Yearly RD was 4.3 uSv for WBCT group and 5.0 uSv for R(+CT) group (difference 0.6 uSv decrease with WBCT 13%, p<0.01). Yearly T was 105 hours in total (3.5 minutes per patient) for WBCT group and 961 hours in total (16.0 minutes per patient) for R(+CT) group (difference, 752.0 hours, decrease with WBCT, 78%, p<0.01). Yearly profit was 34,300 Euro for WBCT group, -846 Euro for R(+CT) group. Conclusion: 8,129 WBCT scans in 3,874 patients as substitution of R(+CT) over a 4.5 year period at a foot and ankle center resulted in 13% decreased RD (minus 0.7 uSV on average per patient). Yearly T decreased 752 hours (78%) in total (12.5 minutes per patient). Yearly financial profit increased 35,000 Euro in total (19 Euro per patient). RD decreased despite higher radiation dose for WBCT than for R alone, based on substitution of a high number of CTs by WBCT. Other centers with low usage of CT might not decrease RD by substituting R alone by WBCT.