bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Percentile Weight Bearing on Foot Radiographs
Authors: Shelton Trevor , Singh Sohni , Kreulen Christopher , Giza Eric 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Clinical decisions are often made based on the measurements of foot radiographs. Orthopaedic patients who have had lower extremity trauma or surgery are often given different weight bearing conditions including non-weight bearing, touch-down weight bearing, partial weight bearing (of various percent of body weight), and weight bearing as tolerated. However, it is largely unknown how these various weight bearing conditions alter specific parameters of foot radiographs. As such, the purpose of this study was to determine whether percent weight bearing influences radiographic measurements of the foot on anteroposterior (AP) and lateral radiographs? Methods: A total of 20 healthy subjects had AP and lateral radiographs of the foot under five weight bearing conditions (non-weight bearing, 10% body weight, 25% body weight, 50% body weight, and 100% body weight). Measurements were then made of hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), talonavicular coverage angle (TNCA), talo-calcaneal angle (TCA), forefoot width, LisFranc distance, cuboid height to ground (CHG), and talo-1st metatarsal angle (TMA) of each weight bearing condition. Statistical differences of each measurement for each weight bearing condition were then determined. Measurements were made by a radiologist and orthopaedic surgeon and inter-observer reliability determined for each measurement. For each radiographic measurement, a single factor ANOVA determined whether measurements were different between non-weight bearing, touchdown weight bearing, 25% weight bearing, 50% weight bearing, and 100% weight bearing. When a significant difference was detected, a post-hoc Tukey’s determined which categories of weight bearing were different. Results: The inter-observer reliability determined by the intraclass correlation coefficient was excellent to good in all measurements except for the TCA which was fair. For measurements made on the AP radiographs of the foot, the measurements that changed with percent weight bearing were the TNCA (p = 0.0009) and TCA (p = 0.0446) (Table 1). Weight bearing did not change the HVA (p = 0.2564, IMA (p = 0.1698), forefoot width (p = 0.2431), or LisFranc distance (p = 0.9854). For measurements made on the lateral radiographs of the foot, the measurement that changed with percent weight bearing was the CHG (p = 0.006). Weight bearing did not change the TMA (p = 0.9889). Conclusion: This study demonstrates a flattening of the medial arch with increasing percent body weight applied to a foot. This results in an increase in the TNCA as well as a decrease in the CHG. In addition, increasing percent body weight to the foot increases the hindfoot alignment. However, percent body weight does not alter measurements of the forefoot. Percentage body weight increase may not influence clinical preoperative/non-operative treatment as much as we expect; however, our findings do show that certain parameters increase with increasing weight bearing.
Double wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture
Authors: Shi Zhongmin 
Published: September 2018

Category: Hindfoot Introduction/Purpose: The pathoanatomy characteristics of the rockbottom malunion after calcaneal fracture include severe loss of calcaneal height, which result in the horizontal of the talus in the ankle mortise and anterior ankle impingement. This study was carreid out to evaluate the clinical results of double wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture. Methods: From February 2014 to February 2015, 9 cases of calcaneal rockbottom malunion after calcaneal fracture were treated with wedged osteomy and subtalar arthrodesis. And 8 patients get final followup. Weight bearing X ray were taken before the surgery and at final followup. Talar declination, lateral talocalcaneal angle, lateral talo-first metatarsal angle and Bohler’s angle were used to evaluate the correction of the malunion. The American Orthopaecid Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analog scale (VSA) for pain were collected. SPSS 22.0 software was used for Statistical analysis. Results: The average time for bone union was 17.1 weeks (12weeks~22weeks). The talar declination was improved from 2.5 ° (- 6°~13°) preoperatively to 13.25° (5°~19°) postoperatively (P<0.001); the lateral talocalcaneal angle was improved from -0.25° (-15°~10°) preoperatively to 0.25° (7°~25°) postoperatively (P<0.001); the talo-first metatarsal angle was improved from 21.13° (10°~30°) preoperatively to 9.88° (5°~14°) postoperatively (P<0.001); and the calcaneal Bohler’s angle was improved from -25.6 ° preoperatively to 22.4 °postoperatively(P<0.001). The AOFAS scale was 26.63 (12~53) preoperatively, and 79.75 (72~89) at final followup (P<0.001); the VAS scale for pain was 7.5 (6~9) preoperatively, and 2.6 (2~3) at final followup (P<0.001). Conclusion: Wedge osteomy and sutalar arthrodesis can effectively correct the malunion, restore the calcaneal height and hindfoor alignment. Pain was relieved after correction, and the function of the ankle and hindfoot was restored.
The LiLiPUT for Ligamentous Lisfranc Injury
Authors: Smith George , Dunne Michael 
Published: September 2018

Category: Trauma Introduction/Purpose: The Lisfranc ligament complex is integral to the stability of the 2nd tarsometarsal joint (TMTJ). Injury causes the 2nd metatarsal to displace dorsally and laterally. Injuries are often missed acutely because of subtle findings that are not always apparent on both weight bearing and non-weight bearing radiographs. The concept of the LiLiPUT (Ligamentous Lisfranc Push Up Test) originated from observations during operative cases that dorsal displacement appeared to be the major direction of instability. A sensitive and reproducible out-patient ‘stress test’ for occult Lisfranc injury is, as yet, elusive. The aims of the study were to assess the ability of the LiLiPUT (a raised block beneath the 2nd metatarsal) to reveal an occult ligamentous Lisfranc injury. Methods: Ten fresh frozen cadaveric lower limbs were used. Postero-anterior and lateral foot radiographs were obtained prior to simulation of a ligamentous Lisfranc injury via a dorsal approach incising the dorsal and plantar ligaments of the 2nd TMTJ. Radiographs were obtained with: Blocks of increasing size placed underneath the 2nd metatarsal. The foot in 3 different positions of increasing dorsiflexion over the blocks. 10Kg load applied skeletally to the leg over the same blocks and positions. A pressure sensor was at the interface between the 2nd TMTJ and block obtaining pressure maps with maximal load readings for each test. Results: The introduction of a 2 x 1 cm block beneath the 2nd metatarsal, with downward force coming from the weight of the amputated limb, revealed an occult injury on the lateral radiographs in 8 of the 10 specimens. A positive test was taken as any discernible dorsal displacement. An increase in block size did not change the force transmitted through the 2nd TMTJ (p=0.32 to 0.42) and had no significant effect on diagnostic yield. Increasing dorsiflexion and increasing load also had no effect on the diagnostic yield. The two specimens without displacement had cavus type foot deformities. Conclusion: A small raised block beneath the 2nd metatarsal in a non weight-bearing patient with the foot in a neutral position may be an adequate means of identifying occult ligamentous Lisfranc injuries on lateral radiographs. Further evaluation in the clinical setting is required as this test may not demonstrate instability in the cavus foot variant.
The Effect of Obesity on Achilles Tendon Repair
Authors: Smyth Niall , Hillam Jeffery , Kaplan Jonathan , Aiyer Amiethab 
Published: September 2018

Category: Sports Introduction/Purpose: Obesity is increasingly common and has been highlighted as a comorbidity that may negatively impact outcomes following orthopaedic surgery. Operative versus nonoperative treatment of Achilles tendon ruptures continues to be controversial, as operative treatment may slightly reduce the likelihood of rerupture but carries the inherent surgical risks. To further delineate the patients who are at risk of postoperative complications it is of value to determine whether obese patients are particularly vulnerable. The purpose of this study was to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods: Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The patients were divided into two cohorts (obese and nonobese), and peri and postoperative factors were evaluated for association with obesity. Results: A total of 2128 patients were identified, of which 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 minutes versus 56.1 minutes. The only postoperative complication that was associated with obesity was wound healing complication, based on univariate analysis. Multivariate analysis demonstrated obesity was not associated with an increased risk of wound healing complication, infection, deep venous thrombosis, or other systemic complication. Conclusion: A large segment of the patient population undergoing Achilles tendon repair is obese. In the current study, although obesity increased the likelihood of developing a wound complication following Achilles tendon repair based on univariate analysis, it was not significantly associated with any other complication.
Clinical Significance of Lateral Ankle Radiograph after the Reduction of a Syndesmosis Injury
Authors: Suh Jae Wan , Kim Sunghyun , Park Hyun-woo 
Published: September 2018

Category: Trauma Introduction/Purpose: To introduce reliable and newly developed radiographic measures based on a lateral ankle radiograph to assess a syndesmotic reduction after screw fixation and to compare with the radiographic measures based on the anteroposterior (AP) and mortise radiographs. Methods: The postoperative ankle radiographs of 34 ankle fracture cases after screw fixation for concurrent syndesmosis injury were reviewed. Two radiographic parameters were measured on each AP and mortise radiograph; tibiofibular clear space (TFCS) and tibiofibular overlap (TFO). Five radiographic parameters were measured on the true lateral radiographs; the anteroposterior tibiofibular (APTF) ratio, anterior tibiofibular ratio (ATFR), posterior tibiofibular ratio (PTFR), distances of intersection of the anterior fibular border and the tibial plafond to anterior cortex of the tibia (AA’), and the intersection of posterior fibular border and tibial plafond to the tip of the posterior malleolus (BB’). In addition, the distance (XP) between the fibular posterior margin (X) crossing tibial plafond or the posterior malleolus and posterior articular margin (P) of the tibial plafond was measured on the lateral view. Results: Using TFCS and TFO in the AP and mortise radiographs, malreductions of syndesmosis were estimated in 17 of 34 cases (50.0%). Using the introduced and developed radiographic measures in the lateral radiographs, syndesmotic malreductions were estimated in 16 out of 34 cases (47.1%). Seventeen cases (50.0%) showed no evidence of postoperative diastasis using the radiographic criteria on the AP and mortise view, 10 cases (58.8%) of whom showed evidence of a malreduction on the lateral radiograph. The newly developed measurements, XP, were measured 0 in 11 out of 34 cases (32.4%). Conclusion: The reduction of syndemosis after screw fixation can be accurately assessed intraoperatively with a combination of several reliable radiographic measurements of lateral radiograph and traditional radiographic measurements of AP and mortise radiograph. Using various radiographic parameters selectively, malreduction could be prevented even when some parameters are difficult to measure because of implants or when posterior malleolar fracture is accompanied.
Foot Width Changes Following Hallux Valgus Surgery
Authors: Tenenbaum Shay , Bariteau Jason , Herman Amir , Coifman Oded 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus is one of the most common deformities of the adult foot, and can adversely affect quality of life, with common complaints including pain, footwear restrictions and cosmesis. Every clinician is familiar with the patients’ concerns regarding the postoperative foot appearance and footwear anticipations. Surprisingly, although patients are concerned with postoperative foot width, there are only scarce reports on this issue. This study was undertaken to evaluate the impact of hallux valgus surgical treatment on foot width. Methods: Study included 71 consecutive cases with moderate to severe hallux valgus treated with Scarf osteotomy, distal soft tissue release and Akin osteotomy as needed. Patients were included only if pre- and postoperative weightbearing X-rays at minimum 6 months followup were available. The average age was 55.7 years (range, 20 to 76), with average follow-up of 20.7 months (range, 6 to 96). Patients’ medical records were reviewed for clinical data, surgical technique and radiographic measurements. The radiographic measurements included hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and foot width. Foot width was assessed by measuring both the bony width (BW: maximal distance between the medial cortex of 1st metatarsal head and lateral cortex of the 5th metatarsal head) and the soft tissue width (STW: maximal distance between most medial soft tissue outline and the most lateral soft tissue outline at the level of metatarsal heads). Results: Preoperative HV deformity (mean HVA 35.8, IMA 14.1 and DMAA 15.2) was successfully corrected (postoperative mean HVA 13.7, IMA 6.9 and DMAA 7.7). Overall bony foot width was reduced by 5% and soft tissue foot width by 2% postoperatively. Further analysis showed there were 13 feet (18.3%) with increased (>5%) bone width, 26 feet (36.6%) with no change (±5%) and 32 feet (45.1%) for which width decreased in more than 5% postoperatively. Patients with the widest foot before surgery, had a decrease in foot width following surgery whereas, patients with the narrowest foot width, had an increase in foot width. Magnitude of preoperative deformity (as assessed by HVA, IMA and DMMA measurements) or amount of correction had low correlation (<0.2) with postoperative foot width. Conclusion: While the ability of surgery to correct HV deformity is well established and reported in the literature, its effect on foot width is less understood or predictable. Overall, the postoperative reduction of foot with was modest. Furthermore, while postoperative foot width (both bony and soft tissue) decreases or does not change in 4 out of 5 patients, there are cases in which foot width actually increases.
The Effect of Pitch Variation and Diameter Variation on Screw Pullout in 3D Printed Screws
Authors: Veenstra Joshua , Gustafson Peter , Bearden Cody , Jastifer James 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: There are many screw and thread designs available to the foot and ankle surgeon for bone fixation. Comparing screws between companies is difficult because properties including core diameter, thread diameter, and pitch confound direct comparisons. There is a paucity of literature on comparative mechanical properties of various screw designs including variable pitch screws and tapered screws. The purpose of this study was to determine the effect of varying thread pitch and/or tapering a screws core diameter. Our hypothesis was that variable pitch screws and tapered screws would have decreased strength compared to screws with constant diameter and constant pitch. Methods: 3D metal printing technology was used to manufacture screws that varied in only the test variables. Four different screws designs were created including variable and constant pitch screws in both straight and tapered diameter versions. These screws were pulled out of synthetic bone at a constant rate while force was measured. Pull out strength and stiffness was calculated for each screw. A generalized linear model and ANOVA were completed to assess the effect on pull out strength and stiffness of the pitch and taper variables. Results: The pull out strength of the constant pitch screws (304.9N+-25.3 N, p<0.001) was significantly greater than the variable pitch screws (259.7N+-23.4 N). The pull out strength was also significantly greater for screws with a tapered diameter (305.4N+- 24.1 N) than a constant diameter (259.1N+-23.5 N, p<0.001). Tapered diameter variable pitch screws had the largest stiffness overall (mean stiffness 556.6 N/mm), which was greater than all other screw designs (p=0.001). The difference in stiffness between all screws with either constant pitch or constant diameter was not statistically significant (p=0.060). Conclusion: The pull out strength is significantly greater for screws with a constant pitch than for a variable pitch and greater for a tapered diameter than a constant diameter. The clinical significance of this study is that it provides data on the effects that thread design and tapering have on the pullout strength of screws providing some evidence that variable pitch screws may have lower pull out strength than constant pitch screws. Utilizing 3D printed screws allowed for the control of all other variables, which may otherwise confound the comparison of different commercially available screws.
Preliminary results of the “four-dimensional six degrees-of-freedom” gait simulation system improvement
Authors: Wang Xu , Ma Xin 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: Using computer-controlled electro-hydraulic servo technology, we studied the improved “four-dimensional six degrees-of-freedom” gait simulation system based on motor and hydraulic hybrid drive control and achieved the human body’s normal gait cycle with fresh cadavers Methods: Through the superimposed combination of a composite servo motor drive mechanism, a highly precise “four-dimensional six degrees-of-freedom” at the tibia could be achieved using fresh cadavers below the knee. At the same time, ten sets of independently controlled electro-hydraulic servo hydraulic cylinders were used to achieve the mechanical loading of the tendon and tibia to reproduce the dynamic and kinematic parameters of the normal gait cycle with the cadaver model Results: The time for the system to complete a gait cycle was controlled at approximately three seconds. The coordinate motion curve of the tibia in the six degrees-of-freedom space was consistent with the M curve of the normal gait cycle, and the measurement results of plantar stress were similar to the measurement curves of the normal gait cycle. Conclusion: The improved “four-dimensional six degrees-of-freedom” gait simulation system successfully reproduced a gait cycle that was the closest to the normal gait cycle among all existing research.
Fusion Versus Flexible Reconstruction for Patients with Flexible Flatfoot
Authors: Whitelaw Kathryn , Shah Shivesh , Hagemeijer Noortje , Guss Daniel , Johnson Anne , DiGiovanni Christopher 
Published: September 2018

Category: Other Introduction/Purpose: When passively correctible, adult acquired flatfoot deformities (AAFD) are often treated with joint-sparing procedures. Questions remain, however, as to the efficacy of such flexible procedures when clinical deformities become more severe. In patients with increasingly severe deformities, a primary fusion may lead to more predictable outcomes, but also risks nonunion. The primary aim of this study was to compare the reoperation rates and complication rates following flexible reconstructions versus fusion procedures in the treatment of flexible AAFD. Methods: All patients, who were diagnosed and treated surgically for a flexible AAFD between January 1, 2001 and January 1, 2016, were identified. Exclusion criteria included incomplete medical records, rigid flatfoot deformities, and prior flatfoot surgery. Procedures defined as flexible reconstructions included medial calcaneal osteotomy (MCO), lateral calcaneal lengthening (LCL), double osteotomy, posterior tibial tendon (PTT) debridement, or PTT augmentation; procedures defined as fusions included subtalar (ST) arthrodesis, talonavicular (TN) arthrodesis, calcaneocuboid (CCJ) arthrodesis (alone or in combination with a LCL), double arthrodesis, or triple arthrodesis. Patient demographics, type of surgical procedure, postoperative complications, and reoperation rates were collected. Bivariate analysis was performed to compare patients who had a flexible reconstruction procedure versus a fusion procedure. Results: Two-hundred-thirty-nine patients (255 feet, mean follow up 62±50 months, range 15-104) were included. Two-hundred-eight (87%) patients underwent a flexible reconstruction, average age 55 (±12.0), while 31 (13%) patients underwent a fusion, average age 58 (±14.4) (p = 0.161). Age, BMI, diabetes and neuropathy rates were similar for both groups. Fifty-four patients (24%) underwent a flexible reconstruction and returned to the OR versus 11 (34%) in the fusion group (p = 0.217). Nonunion occurred more in the fusion group, with 5 (16%) versus 10 (4%) nonunions in the flexible reconstruction (p = 0.027). Symptomatic nonunion rates were similar. Rates of surgical revision for nonunion among patients returning to the OR were similar between flexible (7/54, 3%) and fusion (3/11, 9%) groups (p = 0.117). Conclusion: No significant difference in reoperation rates was found between flexible AAFD patients who were treated with flexible reconstructions versus fusions. As expected, the nonunion rate was significantly higher in the fusion group. Notably, rates of revision surgery for nonunion were similar between groups. Our findings suggest that nonunion should be less of a concern when considering a flexible versus fusion procedure for patients with a severe AAFD, and that other factors such as the degree of deformity should guide decision making.