bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Study of Mobility and Perceived Exertion for the Wheeled Knee Walker and Axillary Crutches in Healthy Participants
Authors: Kirk Kevin L. , Kocher Benjamin K. , Lopez Donna M. 
Published: October 2016

Category: Other Introduction/Purpose: Functional limitations are common after lower extremity surgery and often require the use of an assistive device for ambulation during rehabilitation and recovery. There is no known data evaluating the wheeled knee walker (WKW) as an assistive device for postoperative protected ambulation. The purpose of this study is to compare mobility and perceived exertion in the WKW and the axillary crutch (AC) in healthy volunteers. Methods: This is a cross sectional study of the WKW and the AC that was performed on 24 healthy volunteers utilizing the Six- Minute Walk Test (6MWT). The participants were randomized into two separate arms, one starting with the AC (N=12) and one starting with the WKW (N=12). A modified version of the American Thoracic Society (ATS) Guidelines for the 6MWT was performed for both assistive devices on all subjects. Pre-activity and post-activity heart rates were recorded for both events. From the 6MWT data the values for the Self Selected Walking Velocity (SSWV) were calculated and the subjects rating of perceived exertion was recorded using the OMNI Rating of Perceived Exertion (OMNI-RPE). Patient's preference for assistive device was identified. Results: The 6MWT, SSWV and the Omni-RPE were evaluated using paired T-tests and was determined to be statistically significant for the WKW when compared to the AC (p < 0.001). The confounding effect of the sequences were measured utilizing a mixed-model 2x2 ANOVA and was determined to have no significant 3 way (time x device x sequence) interaction (p = 0.968). Factorial 2 x 2 repeated measures ANOVA was used to evaluate the pre-activity and post-activity heart rates and demonstrated a statistically significant difference for the WKW when compared to the AC (p < 0.001). 87.5% of subjects preferred the WKW to the AC. Conclusion: The WKW provided increased mobility and had a lower rating of perceived exertion than the AC on level surfaces in healthy participants
Comparison of Weil Osteotomy and Cheilectomy for Second Metatarsophalangeal Joint Osteoarthritis
Authors: Kim Ji-Beom , Lee Woo-Chun , Yi Young , Kim Jae-Young 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Second metatarsophalangeal (MTP) joint osteoarthritis (OA) was newly introduced at 2013. However, treatment of second MTP joint OA was not reported yet. The purpose of this study was to investigate the difference in clinical and radiographic outcomes between a chilectomy and an Weil osteotomy for treatment of second MTP joint OA. Methods: From August 2007 to January 2015, 61 feet of 51 patients who had been operated for second MTP joint OA by were retrospectively reviewed. The cheilectomy involved removal of bone spur on the second MTP joint. And the Weil osteotomy involved shortening of second metatarsal bone and removal of the bone spur (Fig.1). The average age was 60 years (95% CI: 57-62 years), the mean duration of follow up was 15 months (95% CI: 12-17months). The 61 feet were divided into two groups, the cheilectomy-group (36 feet) and the Weil-osteotomy-group(25 feet). The preoperative and the last follow-up radiological values and clinical values were measured. Length of the second metatarsal relative to the fourth (2-4 MT length ratio), second MTP joint OA grade, and Visual Analogue Scale (VAS) of pain were measured to evaluate clinical and radiological outcomes. Further, prevalence of second MTP joint disturbance at the time of last follow-up was measured. Results: There were no significant differences of age (P=0.83), gender (P=0.08), BMI (P=0.09), the preoperative 2-4 MT length ratio (P=0.68) and the second MTP joint OA grade (P=0.21) between the chilectomy-group and the Weil-osteotomy-group. In the cheilectomy-group, the last follow-up 2-4 MT length ratio and second MTP joint OA grade were not statistically different from the preoperative values. In the Weil-osteotomy-group, there was a significant decreasing of the 2-4 MT length ratio and a significant improvement of the second MTP joint OA grade between the preoperative values and the last follow-up values. For both the cheilectomy-group and the Weil-osteotomy-group, there was a significant improvement of the VAS of pain after treatment. However, the cheilectomy-group showed the statistically higher prevalence of second MTP joint disturbance than the Weil- osteotomy-group (Table.1). Conclusion: The Weil-osteotomy group showed superior result than the cheilectomy group clinically and radiologically in this study. Because shortening of second metatarsal bone could reduce a pressure of second MTP joint, joint space widening and joint disturbance decreasing could be achieved after the Weil osteotomy. We therefore recommend the Weil osteotomy as a treatment of second MTP joint OA.
Cost Comparison of Operatively Treated Ankle Fractures Managed in an Inpatient versus Outpatient Setting
Authors: Bettin Clayton C. , Lyman Mikayla , Barg Alexej , Saltzman Charles L. , Rothberg David , Nelson Richard 
Published: October 2016

Category: Trauma Introduction/Purpose: Although choices physicians make profoundly impact the cost of healthcare, few surgeons know actual costs. Without valid cost information, surgeons cannot understand how their choices impact the total cost of care. We leveraged a validated value analytics framework to efficiently allocate clinical care costs to individual patient encounters in an effort to understand the sources and variation of cost of care for a putatively straightforward and common orthopaedic problem. Methods: We conducted a retrospective cost analysis on all isolated, operatively treated ankle fractures from a Level 1 trauma hospital and affiliated outpatient surgery center between 2013 and 2015. Patients were categorized based on whether they were treated on an inpatient or outpatient basis, and records were reviewed to determine the presence of confounding variables as well as readmission and emergency department (ED) visits within 90 days after surgery. Actual costs were determined using a validated episode of care costing system and analyzed using multivariate regression analysis. Results: 148 patients (61 inpatients, 87 outpatients) with isolated, operatively treated ankle fractures were included. After controlling for confounding variables, outpatient care was associated with 31.6% (95% CI: 19.8% - 41.8%) lower costs compared to inpatient care. Obese patients had 21.6% (95% CI: 5.8% - 39.8%) higher costs compared to patients who were not obese. There was no difference in reoperation, readmission or return visits to the ED for patients treated on an inpatient or outpatient basis. Conclusion: Inpatient surgical care is clearly more expensive than outpatient care primarily due to higher facility and labor costs without a clear advantage relative to lower readmission or ER visit rates. Where medically appropriate, this analysis suggests ankle fracture surgery should be provided in an outpatient surgical facility to provide the greatest value to the patient and society.
Does the Learning Curve of Minimally Invasive Chevron and Akin Osteotomies Affect Outcome of Hallux Valgus Correction?
Authors: Asaad Asaad , Kakwani Rajeshkumar , Townshend David , Hutt Nicholas J. , Grey W 
Published: October 2016

Category: Bunion Introduction/Purpose: Minimally invasive chevron and akin osteotomy (MICA) has become increasingly popular in the correction of hallux valgus deformity. This study compared the radiological outcomes of the first cases performed by 2 surgeons using this technique with open scarf and akin osteotomy Methods: A retrospective review of hallux valgus corrections performed in Northumbria Healthcare NHS Trust between March and September 2014. Consecutive patients who underwent MICA correction by 2 surgeons trained on a cadaveric course were compared with a group of patients with mild to moderate deformity that underwent open scarf correction. Pre and post radiographic assessment was performed measuring the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and medial sesamoid position (MTS) using Hardy and Clapham classification. Radiographic measurements where statistically compared for difference and complications were recorded. Results: 14 MICA procedures were identified and compared with 14 scarf procedures. Average age of the MICA group was 46 vs. 55 for the scarf group. Pre operative radiographic measurements showed no statistical difference between MICA vs. scarf: Mean HVA 26.9 vs. 28.2 degrees (p 0.698), mean IMA 14.7 vs. 15.3 degrees (p 0.512) and mean MTS grade 5 vs. 5.5 (p 0.251). Change in these parameters between MICA vs. scarf also did not show any statistical difference: Mean HVA change 17.2 vs. 19.2 degrees (p 0.396), mean IMA change 8.5 vs. 8.1 degrees (p 0.680) and mean MTS grade change 2.6 vs.3.2 (p 0.149). In the MICA group, 1 procedure was converted to open and post operatively 1 screw was removed due to length. In the scarf group 1 patient developed a superficial infection that resolved with antibiotics and 1 prominent screw for akin osteotomy required removal. Conclusion: Early experience of MICA resulted in similar outcomes and complications compared with open scarf and akin osteotomy.
Five to Sixteen Year Follow-Up of the STAR Total Ankle Replacement
Authors: Sanders Thomas H. , Walling Arthur K. , Loewy Evan M. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Limited intermediate and long-term follow-up data has been published for total ankle arthroplasty in the United States (U.S.). This is a report of clinical follow-up data of a prospective, consecutive cohort of patients that underwent total ankle arthroplasty by a single surgeon at a single institution from 1999 to 2009 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing total ankle arthroplasty at a single U.S. institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination and radiographs; American Academy of Orthopaedic Foot and Ankle Surgeons (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Implant survival was defined as retention of both initial tibial and talar components at final follow up. Patients undergoing the surgical procedure from 1999 to 2009 were selected for inclusion. Results: Between 1999 and 2009, eighty-five STAR total ankle arthroplasties were performed in eighty-one patients; fifty patients were female. The mean age at surgery was 59.8 ± 12.8 years (range, 30-88 years). Thirteen patients died with implants in place and one patient with bilateral arthroplasties was lost to follow up. The mean duration of follow up for living patients that retained both initial components at final follow up was 11.3 ± 3.3 years (range, 5.5-16.75 years). The mean change in AOFAS Ankle-Hindfoot scores from baseline to final follow up was 34.4 ± 16.3 (range, -5-67). There were fifteen (17.6%) implant failures that occurred at a mean 5.2 ± 3.9 years postoperative. Eight glidecores (9.4%) required replacement for fracture at an average 8.6 years postoperative. Conclusion: This cohort of patients with true intermediate to long-term follow-up after total ankle arthroplasty with the STAR prosthesis demonstrates maintained acceptable revision rates, maintained improved patient reported outcomes scores and low major complication rates. Further intermediate and long-term outcome studies with follow up over 15-20 years on total ankle arthroplasty are needed to further understand the survivability of these implants.
Functional Outcomes of Gastrocnemius Recession for Isolated Gastrocnemius and Gastrocnemius-Soleus Contractures
Authors: Gross Christopher E. , Messerschmidt Cory A. , Netto Anuj P. , Barfield William R. , McKibbin William K. 
Published: October 2016

Category: Ankle Introduction/Purpose: Contracture of the gastrocnemius muscle with or without involvement of the soleus muscle has long been proposed as an etiologic factor in the development of chronic pathology of the foot and ankle including among others plantar fasciitis, hallux valgus, metatarsalgia, and symptomatic pes planovalgus deformity. Very few studies have analyzed the effect on strength and function of the gastrocnemius recession and those that have, are limited by sample size and functional outcome tools utilized. This prospective study reports on strength and functional effect of the gastrocnemius recession utilizing a validated outcome measure on the largest sample size yet reported. Methods: We developed two treatment arms to achieve our aims. Twenty-four patients (25 extremities) underwent a gastrocnemius recession for isolated gastrocnemius and gastrocnemius-soleus contracture. In one arm, eight patients (8 extremities) prospectively underwent range of motion, isokinetic and isometric testing pre-operatively and at 3 and 6 months post-operatively. Validated functional outcomes were also assessed using the Foot Function Index (FFI). In the second arm, an additional sixteen patients (17 extremities) prospectively completed the validated functional outcomes using the FFI. Variables were compared across three time intervals with repeated measure ANOVA with Bonferroni post hoc testing and t testing between control and operative sides was with IBM SPSS Statistics-Version 22. Results: The average age in the 24 patients (25 extremities) was 58.4 ± 15.2 years-old. Treatment for symptomatic pes planovalgus was the most common reason for surgery (10, 40%). Significant improvement in functional outcomes were observed across all three time points (p < 0.001) based on a multivariate repeated measures ANOVA for all 3 subscales (pain, disability, activity limitation) of the FFI. The improvement was significantly greater between pre-operative and 6 months post-operative intervals (p < 0.001) although significant improvements were observed between pre-operative and 3 months post-operative intervals (p=0.001). Range of motion significantly improved between pre-operative and 6 months post-operative intervals (p=0.023) and between 3 and 6 months post-operative intervals (p=0.012). No differences were observed in isokinetic and isometric testing. Conclusion: Analysis of results demonstrates improved range of motion and functional outcomes of the gastrocnemius recession between pre-operative and 6 months post-operative intervals for isolated gastrocnemius and gastrocnemius-soleus contracture.
Gait Analysis of Patients Suffering From Hallux Valgus
Authors: Ito Naoya , Nishimura Akinobu , Nakazora Shigeto , Kato Ko , Sudo Akihiro 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus that is defined as HVA (hallux valgus angle) >20 is one of the most common forefoot problems and can lead to alterations of the plantar pressure pattern. In addition, it can cause clinically gait alterations. Hence, we investigated the plantar pressure pattern and the gait-related factors using the gait analyzer. The purpose of this study was to examine the relationship between gait alterations or motor function and hallux valgus deformity. Methods: In 2009, we examined 309 inhabitants (male, 105; female, 204; age, >65 years) of Miyagawa village in Mie, Japan and compared the plantar pressure pattern between the subjects who has hallux valgus (HVA, >20; n=88) and those who does not have hallux valgus (HVA, < 20; n = 221). Furthermore, we compared gait-related factors among mild group (20< HVA < 30; n=88), moderate group (30< HVA < 40; n=24), and severe group (HVA, >40; n=9). If the right and left hallux valgus varied in severity, we selected severe side. The plantar pressure pattern and the gait-related factors such as stride, step width, foot angle (Figure 1), and gait speed were measured using the gait analyzer (Walk way MW 1000; Anima, Tokyo, Japan). Statistical analyses were performed using t-test, Chi-Square test, or logistic analysis adjusted age, gender and height. P < 0.05 was considered significant. Results: The average weight and height of hallux valgus group were significantly lower, and age of hallux valgus group were significantly higher than those of normal group. About the plantar pressure pattern, ratio of the subjects in hallux valgus group who can use the hallux ball in toe off were significantly less than those of normal group. However, the gait-related factors were not significantly different between 2 groups. On the other hand, when we compared by severity, step width tended to increase with progression of hallux valgus. Moreover, stride, gait speed, and foot angle of severe group were the lowest among 4 groups (normal, mild, moderate, and severe). Especially stride of severe group was significantly lower than those of other 3 groups. Conclusion: Mild hallux valgus can cause alterations of the plantar pressure pattern, but didn’t cause motor functional decline. However, when hallux valgus become severe, hallux valgus can cause not only gait alterations but also motor functional decline.
Gender Differences in End-Stage Ankle Arthritis
Authors: Dodd Andrew , Pinsker Ellie , Khan Ryan M. , Daniels Timothy R. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle arthritis (ESAA) is a debilitating disease that does not affect all individuals equally. Gender differences have been identified in patients with end-stage hip and knee arthritis and have stimulated research to explain these findings. The present study was undertaken to examine if gender has a significant effect on pre-operative disability and post- operative outcomes in patients with ESAA. Methods: Patients undergoing ankle arthrodesis (AA) or total ankle replacement (TAR) with minimum 2-year follow-up were identified in the Canadian Orthopedic Foot and Ankle Society prospective ankle reconstruction database. Demographic data, revision data, patient satisfaction questionnaires, and outcome data using the Ankle Osteoarthritis Scale (AOS) and Short-form 36 (SF-36) health survey were collected. Results: TAR: 384 patients were included, with 198 females and 186 males. Preoperatively females had higher rates of pain and disability, demonstrated by lower SF-36 physical component scores (PCS) (31.0 vs 34.5, p < 0.001), and higher AOS pain (54.7 vs 51.1, p=0.05) and AOS disability scores (66.5 vs 59.6, p < 0.001). Postoperatively, both groups had significant improvement in PCS, AOS pain, and AOS disability scores. Females continued to demonstrate lower PCS scores (38.3 vs 41.9, p < 0.001) and higher AOS disability scores (31.0 vs 25.8, p=0.02) than males. Preoperative PCS, gender, age, and arthritis etiology all had a significant impact on postoperative PCS scores, with preoperative PCS scores having the largest impact. Gender had no significant impact on AOS pain and disability scores postoperatively. AA: Results Pending Conclusion: In patients with ESAA, females tend to have higher pre-operative levels of pain and disability compared to males, which persists post-operatively. This is consistent with the hip and knee arthroplasty literature. This finding may be due to females undergoing surgery at more advanced disease states, arthritis etiology, referral bias, or treatment bias. Both males and females have significant and similar degrees of improvement in pain and disability scores after TAR, and reoperation rates and patient satisfaction rates are similar despite the apparent disparity in outcomes.
Gravity Reduction View
Authors: Gonzalez Tyler A. , Ehrlichman Lauren K. , Macaulay Alec , Ghorbanhoseini Mohammad , Kwon John 
Published: October 2016

Category: Trauma Introduction/Purpose: The determination of stability and ultimate need for operative stabilization of Weber B fibula fractures largely depends on the presence of a competent deltoid ligament. While various radiographic parameters and the application of manual or gravity stress have been proposed to elucidate instability, the prognostic capability of these modalities remains unclear. Given that a recent study found no difference between operative and nonoperative treatment for stress-positive Weber B ankle fractures, the value of stress views is questionable; what may be ultimately more important is the determination of anatomic positioning of the mortise. We propose a novel view, the Gravity Reduction View (GRV), which helps elucidate non-anatomic positioning and reducibility of the mortise. We also propose a treatment algorithm based on the use of the GRV. Methods: To obtain the GRV, the patient is positioned in lateral decubitus with the injured fibula directed upward and elevated with a leg holder. The x-ray cassette is placed posterior to the heel, with the beam angled at 15˚ of internal rotation to obtain a mortise view. Our treatment algorithm is based upon the measurement of the medial clear space (MCS) on the GRV versus the static mortise view. If the MCS on GRV remains wide or decreases, surgery is recommended as the GRV confirms a non- anatomic mortise. If the MCS remains within normal limits on the static and GRV views, a trial of nonoperative treatment with immobilization and repeat radiographs in 1-2 weeks is undertaken. If the MCS is normal on repeat weightbearing x-rays, the patient is treated conservatively; if increased, surgery is recommended. To further assess mortise stability, the MCS is compared to the superior clear space (SCS). Results: 23 patients with Weber B distal fibula fractures were managed according to this treatment algorithm. The mean age was 49.1 years old (range: 18-74). Of these patients, 15 underwent operative treatment and 10 patients were initially treated nonoperatively, although 2 patients demonstrated late displacement and were treated surgically. Using this algorithm, all patients had a final MCS that was less than the SCS (final mean MCS for patients treated operatively or nonoperatively 2.85 mm vs. mean SCS of 3.34), indicating effectiveness of the treatment algorithm. Conclusion: The Gravity Reduction View is a novel radiographic view in which deltoid competency, reducibility and initial anatomic positioning of the mortise are assessed by comparing a static mortise view with the appearance of the mortise on the reduction view (GRV). We have developed a treatment algorithm based on the GRV and have found it to be predictive of mortise alignment and useful in guiding treatment.