bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical comparison of ankle arthrodesis with distal tibial oblique osteotomy for the patient with stage 3b ankle arthritis
Authors: Taniguchi Akira , Tanaka Yasuhito , Kurokawa Hiroaki , Takakura Yoshinori 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis (AA) has been applied for end-stage ankle arthritis. On the other hand, low tibial osteotomy has been applied for mild to moderate ankle arthritis, however distal tibial oblique osteotomy (DTOO) has come to be applied for end-stage arthritis and clinical results were reported to be favorable. The purpose of this study was to compare clinical outcomes after AA and DTOO. Methods: From 2011 to 2014, 37 patients with stage 3b ankle arthritis were treated surgically. In these patients, 25 whose talar tilting angle (TTW) was over 10 degrees with minimum follow-up of 1 year were investigated in this study. Seventeen patients were treated by AA and 8 were treated by DTOO. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale before surgery and at the latest follow up. The patient-based evaluation was performed at the latest follow up using Self-administered evaluation questionnaire (SAFE-Q). TTW and range of motion (ROM) of the ankle were also evaluated before surgery and at the latest follow up. In addition, rate of bony union and complications were investigated. Results: The average ages at the surgery were 60(41-77) years old in the AA group and 66(49-75) in the DTOO group. The average follow up periods were 32(15-49) months in the AA group and 29(13-52) in the DTOO group. Scores of the JSSF scale significantly improved at the latest follow up in both groups. In comparison between two groups, “Social functioning” and “General Health and Well-being” scores in SAFE-Q were significantly higher in the AA group than in the DTOO group. In contrast, ROM was higher in the DTOO group than in the AA group. There were no significant differences in TTW, bony union rate and complications. Conclusion: Ankle arthrodesis spoils the joint motion, however it restores stability and activity of the daily living, that leads to the higher levels of social functioning, general health and well-being.
Early Weightbearing After Operatively Treated Trimalleolar Ankle Fractures with Large Posterior Malleolar Fragments
Authors: Tartaglione Jason , Thamyongkit Sorawut , Abbasi Pooyan , Parks Brent , Hasenboehler Erik , Schon Lew 
Published: September 2018

Category: Trauma Introduction/Purpose: No consensus exists regarding postoperative rehabilitation protocols after surgical fixation of unstable trimalleolar ankle fractures with large posterior malleolar fragments. Additionally, no consensus exists regarding type of fixation of large posterior malleolar fragments in these fractures. It is unclear whether clinical results with early weightbearing differ between large posterior malleolar fragments fixed with either screws alone or a plate and screws construct. We evaluated fracture displacement with simulated early weightbearing in a cadaveric model. Methods: Sixteen fresh-frozen lower extremities were assigned to Group 1, trimalleolar ankle fracture with a large posterior malleolar fragment fixed with screws (n=8) or Group 2, trimalleolar ankle fracture with a large posterior malleolar fragment fixed with a plate and screws construct (n=8). Both Groups were tested with an axial compressive load at 3.2 Hz from 100 to 1,000 N and internal/external torque at 1.6 Hz at 0.5 Nm for 250,000 cycles to simulate 5 weeks of full weightbearing. Displacement was measured by differential variable reluctance transducer. Results: The average motion at all fracture sites in both groups was less than 1 mm. Group 1 displacement of the medial, lateral, and posterior malleolar fracture was 0.30 ± 0.27 mm, 0.12 ± 0.11 mm, and 0.87 ± 0.68 mm respectively. Group 2 displacement of the medial, lateral, and posterior malleolar fracture was 0.78 ± 1.52 mm, 0.12 ± 0.16 mm, and 0.87 ± 1.20 mm respectively. There was no significant difference between the average motion at all fractures sites between Group 1 and Group 2 (P > 0.05). There was no statistical correlation between fracture displacement and bone mineral density. Conclusion: This study supports early weightbearing after surgical fixation of unstable trimalleolar ankle fractures regardless of type of fixation of the posterior malleolus. Further investigation of early weightbearing protocols after surgical fixation of unstable trimalleolar ankle fractures are needed to help guide future treatment.
Does nerve injury following minimally invasive calcaneal osteotomy clinically correlate to Talusan’s Zone?
Authors: Teoh Kar , Hariharan Kartik 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Talusan et al (FAI, 2005) described a safe zone for neural structures in medial displacement calcaneal osteotomy following a cadaveric and radiographic investigation. The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line which is from the plantar fascia origin through the center of the posterosuperior aspect of the calcaneal tuberosity. Minimally invasive calcaneal osteotomies been gaining in popularity as it minimises soft tissue disruption and surgical morbidity. However, neural structures are at risk on both the medial and lateral side of the foot during this procedure. We aim to correlate our clinical results with Talusan’s Radiographic Zone (TRZ) following minimally invasive calcaneal osteotomies. Methods: Sixty-three calcaneal osteotomies were performed in our unit from 2010 and 2016. The type of osteotomies was as follows: Medialising, n = 34; Lateralising n =15; Zadek (Dorsal closing wedge), n =13; and Dwyer (lateral closing wedge), n = 1. Clinical data were recorded with any nerve injury noted. The calcaneal osteotomies were graded into whether they fell into TRZ. We also evaluated Talusan’s alternative method which he described and is based on alternative line 60% of the distance from the angle of Gissane to the tip of most posterior aspect of the calcaneal tuberosity where the safe zone is a window 5.6 mm anterior to this. Results: Five (8%) patients (Medialising, n = 2; Lateralising n =2; Zadek, n =1) reported sural nerve paraesthesia following surgery in our series. However, this was transient and they recovered fully. In total, seven patients (Medialising, n = 4; Lateralising n =1; Zadek, n =1; Dwyer, n=1) fell outside TRZ in our series, of which 2 reported transient sural nerve paraesthesia. Based on our results, TRZ clinically correlated with nerve injury (Chi square test, p=0.032). The other three patients who reported sural nerve paraesthesia but fell inside TRZ measured on average 10.4 mm from the landmark line (10.2, 10.4, 10.7 mm). However when we used the alternative method, they all fell outside the safe zone of this alternative line. Conclusion: Our results suggest that TRZ clinically correlated with nerve injury. However, the alternative line (where the safe zone is a window 5.6 mm anterior to this line) might be more accurate than the landmark line (where the safe zone is 11.2 ± 2.7 mm anterior to this line). More clinical studies with larger numbers might be required to confirm this.
Minimally Invasive Dorsal Cheilectomy of the first metatarsal
Authors: Teoh Kar , Hariharan Kartik 
Published: September 2018

Category: Other Introduction/Purpose: Traditionally, a dorsal cheilectomy of the first metatarsophalangeal (MTP) joint is performed with an open approach through a dorsomedial or midmedial incision. It is now possible to perform minimally invasive dorsal cheilectomy (MIDC) of the first metatarsal with a wedge burr. The stab incision for MIDC needs to be dorsomedial to allow an ergonomic sweeping movement of the burr. This potentially puts the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. There have been no clinical or cadaveric studies to date quantifying the risk to the DMCN and the surrounding structures when a Wedge burr was used for MIDC. We aim to determine this by using fresh-frozen cadaveric specimens in a “high-risk” situation in which most of the surgeons were novices to the technique. Methods: A total of 13 fresh-frozen cadaveric specimens (7 right, 6 left) amputated below the knee were obtained for this study. 13 foot and ankle surgeons (2 left handed, 11 right handed) who had no or minimal experience in MI surgery participated in this study. After a demonstration by an experienced MI surgeon and a practice on sawbones by participants, each surgeon performed a MIDC over the first metatarsal. Fluoroscopic guidance was available throughout the procedure. After the procedure, the specimens were dissected and the DMCN and the extensor hallucis longus (EHL) were inspected for damage. The same dissection steps were used for each specimen. The relationship of the DMCN to landmarks were measured. All measurements were made to the nearest millimetre. Results: Dissection of the specimens revealed that the DMCN to the hallux was cut completely in two specimens (15%). All the EHL tendon were intact, although in one specimen, the tendon showed some fraying on the underside of the tendon, estimated to be 15%. The average distance of the stab incision from the first MTP joint was 17.7 (range: 10 – 23) mm. In terms of the relationship of the DMCN to the stab incision in specimens where the DMCN was not cut, the DMCN was superior in five specimens and inferior in six specimens. The distance of the DMCN to the incision was 3.8 (range: 0 -7) mm. Conclusion: The DMCN to the hallux has been well studied by several authors and has a variable course. This nerve is at high risk of being damaged with open surgery and is a commonly reported complication of surgery to the hallux with rates reportedly as high as 45%. This nerve was damaged in 15% of our specimens following MIDC in a “high-risk” situation. Patients need to be specifically made aware of this risk when being consented for surgery. A carefully made working capsular pocket for the burr and marking this nerve before placing the incision if palpable could mitigate this risk.
Factors Related to the Occurrence of Osteochondral Lesions of the Talus by 3-dimensional Bone Morphology of the Ankle
Authors: Teramoto Atsushi , Shoji Hiroaki , Kura Hideji , Sakakibara Yuzuru , Kamiya Tomoaki , Watanabe Kota , Yamashita Toshihiko 
Published: September 2018

Category: Ankle Introduction/Purpose: Repeated microtrauma is thought to play a major role in the occurrence of osteochondral lesions of the talus (OLTs), but much remains unknown. Two-dimensional assessments of the relationship between ankle bone morphology and OLTs are occasionally seen. The purpose of this study was to evaluate the bone morphology of the ankle in OLT 3-dimensionally using three-dimensional computed tomography (3DCT), and to investigate the factors related to the occurrence of OLTs. Methods: The subjects were 19 patients (19 ankles) who underwent surgery for medial OLTs (OLT group). They included 13 men and 6 women. A healthy group without ankle disease served as a control group with the same number of 19 ankles. Three-dimensional ankle joint models were made based on DICOM data obtained with CT images. In the 3D model, the medial malleolus articular surface and the tibial plafond surface, the medial surface of the trochlea of the talus, and the lateral surface of the trochlea of the talus were defined. The tibial axis-medial malleolus (TMM) angle, the medial malleolus surface area (MMA), the medial malleolus volume (MMV), and the anterior opening angle of the talus were measured 3-dimensionally and compared in the OLT and control groups. Results: The mean TMM angle was significantly larger in the OLT group (34.2 ± 4.4°) than in the control group (29.2 ± 4.8°; p = 0.002). The mean MMA was significantly smaller in the OLT group (219.8 ± 42.4 mm2) than in the control group (280.5 ± 38.2 mm2; p < 0.001). The mean MMV was significantly smaller in the OLT group (2119.9 ± 562.5 mm3) than in the control group (2646.4 ± 631.4 mm3; p = 0.01). The mean anterior opening angle of the talus was significantly larger in the OLT group (15.4 ± 3.9°) than in the control group (10.2 ± 3.6°; p < 0.001). Conclusion: It was shown with 3DCT measurements that, in medial OLT patients, the medial malleolus opens distally, the MMA and MMV are small, and the talus anterior opening angle was significantly larger than in controls. This study suggests the possibility that the 3D bone morphology of both the mortise and tenon of the ankle joint are closely related to the occurrence of OLTs.
Modified Scarf osteotomy for hallux valgus deformity in rheumatoid arthritis
Authors: Tsuboi Hideki , Hirao Makoto , Noguchi Takaaki , Hashimoto Jun 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: For severe hallux valgus (HV) deformity in rheumatoid arthritis (RA) cases, arthrodesis of the 1st metatarsophalangeal (MTP) joint has been recommended. However, with the progress of medical treatment of RA, joint preservation surgery has recently been performed. This study aimed to investigate the clinical and radiographic outcomes of modified Scarf osteotomy with medial capsule interposition for RA cases, including severe 1st MTP joint destruction, and to evaluate risk factors for recurrence. Methods: A retrospective observational study of 76 cases (60 patients) [mean follow-up period: 35.3 months (24-56 months)] that underwent the modified Scarf osteotomy was performed. Japanese Society for Surgery of the Foot (JSSF) RA foot ankle scale scores, hallux scale scores, and a self-administered foot evaluation questionnaire (SAFE-Q) were evaluated, along with preoperative and postoperative radiographic parameters. Results: The mean JSSF RA foot and ankle and hallux score improved significantly (RA: preoperative: 52.2, final follow-up: 76.9, hallux: preoperative: 38.2, final follow-up: 74.5). Recurrence (hallux valgus angle (HVA) >20°) occurred in 12 feet (15.8%). Preoperative DAS28-CRP (Disease activity score evaluated on 28 joints-C-reactive protein), intermetatarsal angle between the first and second metatarsal bone (M1M2A), and M1M5A, as well as HVA, M1M2A, M1M5A, and Hardy grade at 3 months after surgery, were significantly greater in the recurrence group. There was a significant negative correlation between preoperative DAS28-CRP and JSSF RA foot and ankle scores at final follow-up (ß = -0.39: p=0.02), while there was a significantly positive correlation between preoperative DAS28-CRP and HVA at the final follow-up (ß = 0.44: p=0.001). Conclusion: The modified Scarf osteotomy with medial capsule interposition for HV deformity improved clinical and radiographic outcomes in RA cases with severe 1st MTP joint destruction. Increased preoperative M1M2A and M1M5A, incomplete reduction of the sesamoid bone, HVA, M1M2A, and M1M5A at 3 months after surgery should be kept in mind for recurrence. The preoperative DAS28-CRP score was associated with clinical and radiographic outcomes after surgery.
Morphological change of OLT after excision of osteochondral fragment with microfracture on MRI
Authors: Tsuyuguchi Yusuke , Nakasa Tomoyuki , Sawa Mikiya , Yoshikawa Masahiro , Ota Yuki , Kanemitsu Munekazu , Adachi Nobuo 
Published: September 2018

Category: Ankle Introduction/Purpose: Osteochondral lesion of talus (OLT) is treated by several procedures such as bone marrow stimulation technique, cartilage fragment fixation, or autologous osteochondoral bone implantation. The choice of surgical methods depends on the size of lesion and cartilage condition. For unstable small lesion, excision of osteochondral fragment is usually performed. Good clinical results after this procedure is reported, but it is unclear that the morphological repair of subchondral bone and cartilage like tissue at the lesion. The purpose of this study is to evaluate the restoration of subchondral bone and cartilage like tissue after arthroscopic microfracture with excision of osteochondral fragment, and to investigate the clinical outcomes of this operation for the athletes. Methods: From 2005 to 2015, 11 patients (6 men and 5 women) were performed arthroscopic microfracture with excision of osteochondral fragment for OLT. Average age was 28.6 years old (17 - 59 years old). The site of OLT was 10 medial and 1 lateral. The cases of athletes were 7 of 11 cases. The size of preoperative OLT by MRI, measure the depth of the resected site on 3-month postoperative MRI. And we evaluated the appearance of the repair site on 1 year postoperative MRI, clinical outcome using American Orthopaedic Foot and Ankle Society Clinical Rating System (AOFAS), return rate to sports, and period of return to the sports. Results: Preoperative size of lesion on MRI was 9.8 mm in sagittal view, and 6.0 mm in coronal view. Depth of the resected site in 3 months postoperative MRI was 3.1 mm. On one year postoperative MRI, the resected site was filled with cartilage like tissue, and the shape of restored site was good that mimicked the original shape (Figure 1). As for clinical outcome, AOFAS score was 65.4 points preoperatively, and it improved to 93.4 points 1 year postoperatively. In clinical outcomes of the athletes, all cases could return to sports. Average period to return sports was 5.6 months. Only in 1 case, mild pain during sports activity was remained. Preoperative AOFAS score of athletes was 71.4 points and it improved to 98.5 points postoperatively. Conclusion: According to this study, even if a symptom is mild, an early operation will be more likely to result in the early return to sports and good outcomes. In addition, these good outcomes and good congruency on 1 year postoperative MRI suggest that the restored cartilage like tissue is enough for the high activities. The cartilage is repaired with maintaining original shape of talus cartilage. And this method was effective for athletes and was able to get them return to sports with good outcome.
Foot and Ankle Patients Prefer a Hands-Free Single Crutch Compared to Standard Axillary Crutches
Authors: Unangst Alicia , Martin Kevin , Mustovich Anthony , Chisholm Jaime 
Published: September 2018

Category: Ankle Introduction/Purpose: Following lower extremity surgery patients are often required to utilize assistive devices in order to perform activities of daily living. As technology and assistive devices continue to improve, providers are faced with selecting a device that is safe while providing high patient satisfaction and a quick return to actives. The purpose of the current study was to compare physical exertion and subject preference between a hands-free single crutch and standard axillary crutches in foot and ankle patients. Methods: A prospective, randomized crossover study was performed using 35 orthopedic foot and ankle patients from within one treatment facility. Each participant had demographic data and heart rate recorded. The patients were then randomized to an assistive device. All participants completed a 6-minute walk test (6MWT); immediately following each 6MWT heart rate, self-selected walking velocity (SSWV), perceived exertion using OMNI Rating of Perceived Exertion (OMNI-RPE) and perceived dyspnea using Modified Borg Dyspnea Scale was obtained. The patients then completed another 6MWT using the other assistive device and was asked the same questions. After completing both 6MWTs participants were asked which assistive device they would prefer to use. Results: A total of 35 patients were included with a median age of 32-year-old. The hands-free crutch was preferred by 86% of participants. Regression analysis was used to test if factors such as gender, height, weight, BMI predicted patient preference of iWalk vs. Crutch. None of these factors were found to be significant. Student t-tests and ANOVAs were performed separately for dyspnea, fatigue ratings, distance (meters) and heart rate between iWalk and crutch all were found to be significant (p<0.05, p=1.13e-11, p=2.29e-13, p=5.21e-05, respectively). The axillary crutch group had higher SSWV (0.8 vs 0.77m/s) but was not found to be significant. Neither group had any falls, however, 58% of axillary participants complained of axillary/hand pain while the hands-free group had 14% complain of proximal strap discomfort. Conclusion: Patients preferred the hands-free crutch while reporting lower perceived dyspnea and fatigue. The hands-free group demonstrated lower physiologic demand, which correlated with patient perception.
Outcome of Helal osteotomy for chronic plantar foot ulcers
Authors: Waldecker Ute 
Published: September 2018

Category: Diabetes Introduction/Purpose: Chronic ulceration of the forefoot is a major problem in neuropathic and diabetic feet. Foot ulceration represents a risk factor for the development of osteomyelitis and increases the risk of amputation.The purpose of this study was to evaluate the effectiveness of Helal osteotomies concerning the development of plantar foot ulcers. Methods: Eighteen patients with a mean age of 69 years (min 55 yr, max 85 yrs) suffering from chronic, refractory ulcerations of the forefoot underwent Helal osteotomies. Demographic parameters, radiologic parameters, ulcer classification, complications, ulcer recurrence and ulcer healing were documented.The ulcerations were assessed according to the Wagner Armstrong classification. Results: The mean follow up was 30 months (min 6, max 68 months). Preoperatively, there were 3 grade 1A, 1 grade 1B,5 grade 2A, 8 grade 2B and 1 grade 3B ulcers. The most common site of ulceration was the MTP 3 joint, followed by the MTP 2 joint. All ulcers recovered with a mean healing time of 5.5 weeks (min: 1 week, max. 12 weeks). One ulcer recurred due to a secondary ossification of the osteotomy. After a reosteotomy, a permanent healing of the ulcer was achieved. There were 4 complications (1 hematoma, 2 wound infections, 1 ossification), of which only the ossification required revision surgery. Conclusion: The Helal osteotomy is a safe and effective method in treating neuropathic forefoot ulcerations. The procedure allows for rapid mobilization of the patient.
Delayed access to bunion correction surgery
Authors: Wing Kevin , Sutherland Jason , Younger Alastair , Veljkovic Andrea , crump Trafford , Liu Guiping 
Published: September 2018

Category: Bunion Introduction/Purpose: Little is known about the effect of delayed access to bunion correction (Hallux Valgus) surgery on patient-reported outcomes. The objective of this study is to measure the association between delayed access to bunion correction surgery and post-operative patient-reported outcomes. Methods: This study prospectively recruited patients to complete pre-operative patient-reported outcomes measuring pain, depression and foot and ankle health. Patients complete the same patient-reported outcomes six months post-operatively. Linear regression models measured outcomes, adjusting for baseline health, age category, sex, comorbidities and socio-economic status. Results: This study included 74 participants, a response rate of 53% among eligible patients. Among participants, 58.9% underwent a Lapidus procedure, the remainder underwent a corrective osteotomy. There was no relationship between post-operative depression and pain scores with duration of wait time, adjusting for patient characteristics. Longer waits for bunion correction surgery, adjusting for other factors, were associated with smaller gains in health in four of the five domains of measurement of foot and ankle health. Conclusion: At the six-month post-operative time point, prolonged wait times were detrimental to foot and ankle outcomes in four of the five domains of the foot and ankle specific PRO. Policies for expediting access for symptomatic hallux valgus are warranted to mitigate poorer long-term outcomes.