bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lateral Ankle Instability Surgical Treatment
Authors: Sahranavard Bahman , de Cesar Netto Cesar , Shah Ashish , Hudson Parke , Araoye Ibukunoluwa , Cone Brent , Pinter Zachariah , Lee Sung , Jones Caleb , Bergstresser Shelby , Johnson Michael 
Published: September 2017

Category: Ankle, Sports Introduction/Purpose: Lateral ankle instability is a common cause of disability in the active population. Although the majority of patients can be treated conservatively, surgical repair of the ligaments, with or without reinforcement, represents an excellent option for refractory cases. Failed primary surgical repair, recurrence of the ankle instability and need for revision surgery can rarely happen and is probably affected by multiple variables. That includes patient’s characteristics such as BMI and comorbidities and surgical aspects such as the use of suture anchors and soft-tissue reinforcement. The purpose of this study was to compare patient’s characteristics and complication rates of primary repair and revision procedures. Methods: We retrospectively reviewed 231 patients (160 Female, 71 Male) who underwent surgical treatment for lateral ankle instability between 2010-2016. Thirty-two were revision cases (14.2%), including 24 females and 8 males, and 199 were primary direct repairs (85.8%). The mean age at the time of the surgery was 39 (19-65)years, and average follow-up was 9 (2-55) months. The procedures were performed by four different surgeons. All cases were reviewed based on age, gender, BMI, procedure type and number of incisions, comorbidities, and complications. Data found was compared between the two groups (primary repair and revision surgery) by T-test. A p-value <0.05 was considered significant. Results: The Brostrom-Gould procedure was used in 69.5% of the primary repairs and 63.6% of the revision cases. The use of suture anchors was also similar in both groups (51%). Repair of the calcaneofibular ligament was performed in 68% of primary repairs and 81.8% of the revisions. We didn’t find significant differences regarding comorbidities between two groups: smoking (23.4% x 27.2%, p-value 0.371); diabetes (6.8% x 6%, p-value 0.951) and body mass index above 30 (28.5% x 24.2%, p-value 0.347). We found significant difference in the complication rate of the procedures, with a higher incidence in the revision group (48.4%) when compared to the primary repair group (24%). That included: sural neuritis (15.1% x 3.4%), superficial peroneal neuritis (12.1% x 4.5%), skin problems (9% x 7.4%). Conclusion: Our study of 231 patients that underwent surgical treatment for lateral ankle instability found significant higher incidence of complications in patients who had revision procedures when compared to primary repair. No differences regarding smoking status, diabetes and BMI were found.
Rotated Insertion Metatarsal Osteotomy with Distal Soft Tissue Procedure for Severe Hallux Valgus Deformity ―Novel Procedure of the 1st metatarsal osteotomy―
Authors: Samoto Norihiro , Tanaka Yasuhito , Katsui Ryuhei , Sugimoto Kazuya 
Published: September 2017

Category: Bunion Introduction/Purpose: Hallux valgus deformity is recently a common disease involved in the foot and ankle and many procedures are recommended globally. However it is controversial about the operative treatment for severe hallux valgus. Many authors have reported the technical difficulties and various complications. We performed rotated insertion metatarsal osteotomy with the distal soft tissue procedure for severe hallux valgus deformity since January 2008. The purpose of this study is to evaluate the medium-term outcome of this procedure. Methods: Two hundred thirty-two feet in 173 patients were enrolled in this study and followed them up for a mean of 44.5 months. The mean age at the operation was 64.5 years. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured. This procedure consists of the rotated insertion metatarsal osteotomy and the distal soft tissue procedure. This diaphysial longitudinal metatarsal oblique osteotomy was performed from proximally- medial site of the first metatarsal directed to distally- lateral site through the dorsal exposure. The tip of osteotomized proximal metatarsal was formed at the dorso-distal site to insert in the central intramedullary aspect of osteotomized distal metatarsal. The second triangular cut of one third of dorso-plantar thick was made about 10 to 15 mm length from the lateral tip of osteomized proximal metatarsal. The internal fixation was performed with locking plate with screws. As a result, osteotomized sites were locked each other such as a puzzle. Results: The mean preoperative HVA and IMA were 43.8 degrees and 20.1 degrees. The mean postoperative HVA and IMA were decreased to 9.0 degrees and 6.1 degrees. AOFAS scores improved from 49.3 to 89.7. All cases were obtained complete union. Postoperative displacement was in 12 feet (5.2%) and followed under-correction (or recurrence). Overcorrection (hallux varus) occurred in 10 feet (4.7%). Wound healing was delayed in 21 feet (9.1%). In general, we found no severe complication and unsatisfactory result. Conclusion: This procedure provided satisfactory result for severe hallux valgus deformity. Especially the rigid fixation at the site of metatarsal osteotomy was much stronger because of the insertion and locking plate. However the further more outcomes in detail are essential for longer term follow-up.
Evaluating Recovery Following Total Ankle Arthroplasty Using a Smartphone Mobile Application
Authors: Sanders Austin , Kunas Grace , Fields Kara , Demetracopoulos Constantine , Deland Jonathan , Ellis Scott , Lyman Stephen 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: The use of smartphone applications to assist with medical care is increasing. An important aspect of total ankle arthroplasty is to allow patients to remain active and mobile following their surgery while decreasing discomfort. To our knowledge, no other studies have quantitatively and qualitatively assessed post-operative mobility following total ankle arthroplasty. The goals of the present study were to assess the reliability of a mobile health application to measure step counts, to correlate mobility with pain and functional assessments, and to determine average walking ability following total ankle arthroplasty. Methods: A smartphone app, Moves, used a pedometer to record the number of steps taken daily. The device was chosen because it is a free application and is compatible with both iPhone and Android. Patients were identified through the OR schedule and called one month prior to surgery. After obtaining consent, patients completed an online consent form, an online pre- operative survey and downloaded the Moves application to their smartphone. Mobility data was gathered for the month prior to surgery and from post-operative months 3-9. Beginning at 3 months post-operatively, patients completed a weekly online survey until 6 months post-operatively, which was then completed biweekly until study completion at 9 months post-operatively. The correlation of step count with pain and quality of life scores as reported through the Foot and Ankle Outcome Score (FAOS) and pain as reported by the Numeric Rating Scale (NRS) were assessed via Spearman’s rank correlation coefficients. Results: 46 patients (23 female and 23 males) were enrolled with a mean age of 63.6 years (range 33.0 to 78.9). Maximum daily step count increased from a median (1st quartile, 3 rd quartile) 4348 (2737, 7253) steps pre-operatively to 4411 (3237, 9614) steps post-operatively, with patients continuing to increase their step count at 9 months post-operatively. Step count showed weak correlation with FAOS pain scores (rs=0.21 [95% CI: 0.08, 0.33]), FAOS QOL scores (rs=0.11 [95% CI: -0.02, 0.24]), and NRS pain scores (rs=-0.27 [95% CI: -0.38, -0.14]). Conclusion: Using mobile technology following total ankle arthroplasty may be useful for patients to quantitatively assess their recovery; however, this application fails to correlate increased ambulation with qualitative assessments such as pain and quality of life. While improved pain and quality of life scores only showed weak correlations with increased ambulation, it is important to note that pain improved despite increasing ambulation in the post-operative period. In addition, it may be that differences in functional outcomes do not appear until beyond 9 months as step count has not yet plateaued at that point.
Risk Factors for Failure of Cheilectomy for Hallux Rigidus
Authors: Sanders Austin , Nguyen Joseph , Deland Jonathan , Ellis Scott 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in 2.5% of the population over 50 years of age and is commonly treated with cheilectomy or arthrodesis. While long-term outcomes following cheilectomy for hallux rigidus are promising, questions remain concerning indicators for failure of a cheilectomy. The goal of this study was to use clinical, radiographic, and subjective assessments to determine potential risk factors for failure of cheilectomy and indicators for success of cheilectomy. Methods: A retrospective review of 66 patients with hallux rigidus treated with cheilectomy by two orthopaedic foot and ankle surgeons between 2007 and 2016. A list of patients was generated using the CPT code 28289. Patients were excluded if they had prior forefoot surgery, a cheilectomy with fusion involving the first metatarsal, or if they did not have postoperative FAOS scores. Data was collected regarding demographics, clinical classification, medical history/comorbidities, radiographic measurements, surgical information, complications, and pre and postoperative FAOS. The cheilectomy was considered a failure if the patient was converted to a metatarsophalangeal fusion following the cheilectomy or if their postoperative FAOS score failed to improve compared to their preoperative FAOS score. Independent samples t-test and chi-square tests were used to analyze the continuous variables and categorical variables, respectively. A two-way repeated measures ANOVA was used to analyze the pre and postoperative radiographic outcomes between and within the two groups. Results: 21 out of 66 patients had decreased postoperative FAOS scores and were considered the failure group. There was no difference between the two groups for age at surgery, BMI, gender, ASA, diagnoses, or medical history. Clinically, the failure group had more subsequent surgeries compared to the success group (p=0.039), resulting in longer postoperative follow-up time (10 months vs. 32.4 months, p=0.005). Radiographically, the failure group had a lower mean AP talar-1st Metatarsal Angle pre- operatively (8.10 mm) compared to the success group (12.77 mm, p=0.028). Postoperatively, the failure group had an increased Calcaneal Pitch (p=0.048), despite no significant difference between groups preoperatively (p=0.087). The failure group also demonstrated a reduced ratio of first metatarsal to second metatarsal length postoperatively (p=0.007), which was not seen in the success group. Conclusion: Our study found radiographic measurements to be different in patients with a failed cheilectomy as compared to patients with a successful cheilectomy. Preoperatively, a decreased AP Talar-1st Metatarsal Angle may be a risk factor for failure of cheilectomy. Postoperatively, a decreased length of the first metatarsal and an increase in Calcaneal Pitch may result in worse outcomes following cheilectomy.
Comparison of treatment outcomes of Arthrodesis and Two Generations of Ankle Replacement Implants
Authors: Sangeorzan Bruce , Ledoux William , Benich Marisa Rose , Orendurff Michael , Hansen Sigvard , Davitt James , Anderson John , Bohay Donald , Coetzee J. Chris , Brage Michael , Houghton Michael 
Published: September 2017

Category: Ankle, Ankle Arthritis, Arthroscopy, Trauma Introduction/Purpose: We tested clinical equipoise in ankle arthrodesis and ankle arthroplasty during a time of transition from older to newer generation implants using a prospective cohort. Methods: We performed a prospective cohort study comparing outcomes in 273 consecutive patients treated for ankle arthritis by arthrodesis or ankle arthroplasty between 2005 and 2011. Adult Patients with end-stage ankle arthritis, who were ambulatory and willing and able to respond to surveys were included. Patients were excluded from the study if they had another significant lower limb problem that might affect ambulation. At baseline and at 6, 12, 24, and 36 months follow up visit, participants completed a pain and satisfaction survey, a Musculoskeletal Function Assessment (MFA), and a Short Form-36 (SF-36) survey. Surgery was performed by surgeons trained in both foot and ankle reconstruction and hip and knee arthroplasty. The participants were primarily enrolled from a tertiary teaching hospital but also at three sites in different states that included both teaching hospitals and private practice settings. Results: Linear mixed effects regression adjusted for baseline differences (age, BMI, and surgery type.) There were no significant baseline differences in MFA or SF-36 by surgery type. There was significant mean improvement after surgery regardless of procedure (p<0.001). The greatest improvement occurred at 6 month follow-up; Mean ± SE, (%) improvement was 12.6±0.7, (32%) for MFA, 22.0±1.4, (58%) for Physical Function (PF); 32.4±1.6, (96%) for Bodily Pain (BP), 4.0±0.2, (60%) for pain score. Average improvement was significantly better with arthroplasty in MFA (3.6 ± 1.6, p=0.023) and in PF (7.5 ± 2.9, p=0.0098). The difference between arthrodesis and arthroplasty was greater for patients receiving the newer Salto Talaris implant; average improvement for MFA (3.9±1.4, p=0.031), PF (8.8±3.3, p=0.0074), BP (7.3±3.6, p=0.045), and pain score (0.8±0.4, p=0.038). Conclusion: Conclusions Both ankle replacement and ankle arthrodesis are highly effective treatments for ESAA. When treated by surgeons with expertise in both foot reconstruction and hip and knee arthroplasty, patients reported improved comfort and function with both treatments. Average improvement was significantly better in those with arthroplasty in MFA and in SF-36 PF scale (7.5 ± 2.9, p=0.0098). That difference was greater when earlier generation implants were removed from the analysis. Younger patients had greater functional improvements than older patients. Patients with low BMI had better improvement that those with high BMI.
Medial Soft-tissue Release for a Lateralising Calcaneal Osteotomy
Authors: Shah Kalpesh , Dash Kumar Kaushik 
Published: September 2017

Category: Hindfoot Introduction/Purpose: Lateralising calcaneal osteotomy (LCO) for pes cavus is generally regarded to be harder to shift than a medialising calcaneal osteotomy for pes planus. Whilst this may be due to tight tissues as in pes cavus, no attempt has been made to define a particular structure that could limit the lateral shift in a LCO. Some surgeons recommend releasing the flexor retinaculum routinely with a LCO to avoid a tarsal tunnel syndrome, suggesting that perhaps it is the flexor retinaculum that is the main restrictor to the lateral shift in a LCO. The purpose of our study was to define the structures that restrain the lateral shift in a calcaneal osteotomy in a cadaveric study. Methods: Calcaneal osteotomies were carried out by a single orthopaedic surgeon on 10 embalmed, below-knee cadavers. LCOs were performed using standard lateral approach and the lateral calcaneal shift was measured before and after the release of flexor retinaculum in 4 cadavers. Further exploratory dissection around the osteotomy site, however, revealed that abductor hallucis muscle must be the main restraint to the lateral shift of the calcaneus. Subsequently, LCO was performed on another 6 cadavers and the abductor hallucis muscle fascia as well as the plantar fascia was released. The lateral shift was measured before and after the fascia releases, and compared with those of the flexor retinaculum release. Results: The average shift with a LCO by itself in the first 4 cadavers was similar to the last 6 (4.5 mm and 5.5 mm respectively). Releasing the flexor retinaculum created a further 3 mm lateral shift on average; however, release of abductor hallucis muscle fascia and the plantar fascia increased lateral shift by an additional 7 mm on average; which is an extra 4 mm shift on average compared with those of flexor retinaculum release. Conclusion: The results of this study suggest that the abductor hallucis muscle along with the plantar fascia is one of the main structures limiting the lateral shift in LCO, and release of fascia over this muscle as well as the plantar fascia should be an essential part of the lateralizing calcaneal osteotomy.
Use of Telemedicine for Initial Consultations in Elective Orthopaedics—Results from a Large Volume Centre
Authors: Shah Kalpesh 
Published: September 2017

Category: Healthcare Delivery Introduction/Purpose: Telehealth and telemedicine are at the heart of healthcare Vision for several countries including Canada, U.S.A, Scotland, etc; and and the aim is to use technologies to transform the way health and is delivered. Deployed thoughtfully and carefully, telehealth and telecare can help generate efficiencies through more flexible use of our workforce capacity and by reducing travel and minimising access delays. In line with this we wanted to use telemedicine for doing preoperative consultations for elective foot/ankle and lower limb arthroplasty procedures in patients referred from remote parts of the country to our hospital. The purpose of our study was to prove that telemedicine clinics (or Tele clinics) are just as safe, effective and satisfactory as face to face interactions between doctors and their patients. Methods: Two studies were conducted at this hospital between 2015-16. The first was a prospective pilot study of 50 new patients who were all seen using two different consultation rooms; with the patient along with a physiotherapist in one room, and the surgeon in another. Patients were seen via the Telemedicine unit without being aware that the surgeon was in the same building, and were then asked to rate their experience. The unanimous positive feedback received from this pilot study encouraged us to start using Tele clinics for initial consultations on a regular basis. The second study is a retrospective analysis of the safety and quality of the Tele clinics during a twelve months period. Results: 4 surgeons saw 320 patients in the Tele clinics over the study period of 12 months for foot/ankle as well as lower limb arthroplasty conditions. The number of patients who required surgery and the number of additional investigations carried out were similar to the ones from regular clinics. Feedback from patients remained very high for the Tele-clinics. Conclusion: Tele-clinics are largely used for reviewing patients after surgery. Our study shows that Tele-clinics can also be used for initial consultation for routine orthopaedic conditions, and are as safe and effective as face to face consultations. This provides an opportunity to treat patients in new ways and help manage rising costs and demand.
Detection of Tram Track Lesion in the Ankle Joint; A Comparative Study of Magnetic Resonance Imaging with Ankle Arthroscopy
Authors: Shim Dong-Woo , Hwang Yeokgu , Park Yoo Jung , Lee Jin Woo , Han Seung Hwan 
Published: September 2017

Category: Ankle, Arthroscopy Introduction/Purpose: Tram track lesion in the ankle joint has been occasionally found during the ankle arthroscopy and there has been few studies relating the pathophysiology, diagnostic method and treatment of the lesion. This study aimed to show the effectiveness of magnetic resonance imaging (MRI) for detection of tram track lesion in the ankle joint comparing with ankle arthroscopy. Methods: We retrospectively assessed 175 ankles in 170 patients with anterior bony impingement syndrome in the ankle who underwent arthroscopic surgery between January 2013 and July 2015. Anterior ankle bony spurs were scored in preoperative weight-bearing radiographs using the impingement classification. MRIs were reviewed for the detection of tram track lesions according to our definition (focal high signal intensity along the talar dome cartilage surface on coronal view), which were then compared with arthroscopic findings. The grade of cartilage defect was stratified according to international cartilage repair society (ICRS) grading system by arthroscopic finding. Results: Fourteen (8.0%) ankles were identified with tram track lesion on MRI and 16 (9.1%) ankles were identified with tram track lesion at ankle arthroscopy. Overall sensitivity of MRI for detection of tram track lesion was 87.5% and specificity was 100%. On plane weight-bearing radiographs, 4 patients had grade 1, 2 patients had grade 2 and 10 patients had grade 3 impingement spurs. Under the ICRS grading system, 4 cases were grade 2, 4 cases were grade 3, and 8 cases were grade 4 at arthroscopy. Comparing with MRI, 2 cases of grade 2, 4 cases of grade 3 and 8 cases of grade 4 were detected (Table). Impingement spur grade showed no significant correlation with arthroscopic ICRS grade of tram track lesion (p = 0.609). Conclusion: Tram track lesions in the ankle joint can be confidently detected on MRI with high sensitivity and specificity. Early detection and following treatment of the lesion can maximize the clinical outcome that eliminates the possibility for further damage to the cartilage and consequent osteoarthritic change.