bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of First Metatarsophalangeal Joint Fusion in Patients with Greater Than Fifteen Percent Intermetatarsal Angle. Is Lag Screw Essential?
Authors: Shah Ashish , Hudson Parke , Araoye Ibukunoluwa , Pinter Zachariah , Motwani Girish , Sahranavard Bahman , Cone Brent , de Cesar Netto Cesar 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal arthrodesis has usually been performed using a dorsal plate to immobilize the MTP joint with or without lag screw fixation. Data in the literature is sparse on outcomes of dorsal plate plus lag screw fixation, especially in patients with IMA greater than 15 percent. Our objective was to compare IMA correction outcomes and union rates between dorsal plate only fusions and dorsal plate plus lag screw fixation in patients with IMA greater than 15 percent. Methods: We retrospectively reviewed the charts of 36 patients (39 feet) who underwent first MTP joint arthrodesis for moderate to severe HV deformity between 2011 and 2015. Average age was 61 (range, 39 to 84) years. There were 24 females and 12 males. A single surgeon performed all operations. Joints were immobilized postoperatively using either dorsal locking plate alone or dorsal locking plate with a lag screw. Union (at least 3 bridging cortices) was determined radiographically at 6 weeks, 3 months, 6 months and yearly. All suspect nonunions were examined with CT. Other radiographic parameters examined included preoperative and postoperative hallux valgus, intermetatarsal, and dorsiflexion angles (HVA, IMA, and DFA respectively). Student’s t test was used to compare group means while Pearson’s Chi square test was used to compare group rates. Results: Overall union rate was 82.1% (32/39). There was no significant difference in union rates between the two groups (dorsal plate only = 81.5% (22/27), dorsal plate plus lag screw group = 83.3% (10/12)) (P > 0.05). Average follow-up was 9 (range 7 to 35) months. Overall, the average IMA correction was 4.7 (preoperative = 17.8, postoperative = 13.1) degrees. Average IMA corrections were 4.7 and 4.54 degrees in the dorsal plate only group and dorsal plate plus lag screw groups respectively. Overall, average HVA correction was 21 (preoperative = 39.5, postoperative = 18.5) degrees. Conclusion: Our findings indicate that there is no difference in the fusion rates between both patient groups with IMA greater than fifteen percent. Because other published studies have a wide range of IMAs preoperatively, our study represents more attainable goals in patients with severe (IMA greater than 15%) deformities. In addition, our findings suggest that in such patients, MTP arthrodesis may not be sufficient as a standalone procedure for correction of IMA. Additional proximal osteotomy may be required for correction of the IMA.
Early Outcomes of Arthroscopic Modified Brostrom Operation for Chronic Ankle Instability
Authors: Shim Dong-Woo , Hwang Yeokgu , Park Yoo Jung , Lee Jin Woo 
Published: September 2017

Category: Ankle, Arthroscopy Introduction/Purpose: The gold standard for the surgical treatment of chronic lateral ankle instability is the modified Brostrom procedure. Surgery aims to re-establish ankle stability and function, without compromising ankle motion. Recently introduced all inside arthroscopic modified Brostrom procedure coincide with the goal on that aspect. The purpose of this study was to investigate the early outcomes of all inside arthroscopic modified Brostrom operation for chronic ankle instability. Methods: From January 2015 to August 2016, 30 patients were included. The visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, Foot and Ankle Outcome Score (FAOS), and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Clinical outcome evaluations were performed preoperatively, at 3 months and 6 months postoperatively, and at a final follow-up using the VAS score, the AOFAS ankle-hindfoot score, FAOS, and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: Thirty patients (19 males and 11 females) were followed up for a mean of 11.0 (range 4 – 23) months. The VAS, AOFAS, 1 FAOS subscale (Quality-of-life) and the Karlsson scores were improved significantly at the each follow-up period of 3 month, 6 month and 1 year postoperatively. Other 4 subscales of FAOS showed no significant outcomes (Table 1). The mean anterior talar translation and talar tilt showed significant improvements from 5.8 mm (SD = 0.4) and 7.9° (SD = 1.0) to 5.3 mm (SD = 0.3) and 5.7° (SD = 0.6) at the final follow-up each (p = 0.034, p=0.034). Conclusion: The arthroscopic modified Brostrom technique could be a viable alternative to the gold-standard open modified Brostrom procedure for anatomic repair of chronic lateral ankle instability. It can yield outstanding functional and clinical outcomes without adverse effects in terms of pain.
Immediate Weight Bearing after Bi-planar Plantar Fixation of Lapidus
Authors: Smith W. Bret , Santrock Robert , Dayton Paul , Hatch Daniel 
Published: September 2017

Category: Bunion Introduction/Purpose: There are many options when choosing to repair HAV (hallux abducto-valgus) deformity of the foot. The Lapidus procedure and its modifications are often selected to correct these deformities due to multiplanar correction at the CORA (center of rotational angulation). As with any surgical procedure, there are advantages and disadvantages when selecting the correct technique. One drawback often identified with the Lapidus procedure is the need for extended immobilization and the inability to weight bear for an extended period of time. The objectives of this study were to demonstrate a new, novel construct that can allow for immediate weight bearing after Lapidus arthrodesis with predictable outcomes. Methods: This IRB approved study was comprised of 4 centers that performed a specific modification of the Lapidus procedure with an identical fixation construct. The construct consisted of 2 mini-plates that were applied across the first tarsometatarsal (TMT) joint. The plates were applied while the joint was held in compression. The plates were oriented dorsal and plantar-medial allowing for a greater than 90° spread between plates for appropriate distribution of the forces and a true multi-planar construct. This concept takes into account biplanar stability as described by Kolner[1] and micromotion to stimulate secondary bone healing as described by Perren[2]. All patients were placed into a protective, cushioned dressing with a rigid bottom shoe or boot depending on surgeon preference. The patients were allowed weight-bear as tolerated with walker or crutches for safety as soon as the regional anesthesia dissipated to allow for complete sensation in the operative limb. Results: Twelve months of consecutive cases with immediate weight bearing and minimum follow-up of 6 months were included in the study. All cases that met inclusion criteria were included in the analysis; inclusion criteria were primary corrections of a HAV deformity with correction done via the described technique performed within the approved date range. Procedures not utilizing the described technique, revision procedures and procedures that extended the arthrodesis outside of the first TMT joint were excluded. Conclusion: Preoperative and postoperative measurements of 50 patients were obtained in this study. Radiographic evaluation of the fusion site was used to determine if the arthrodesis demonstrated healing at a minimum of 6 months. Other studies have shown early weight bearing (<3 weeks) is possible after the Lapidus procedure [3], this study demonstrated that immediate weight bearing after a modified Lapidus procedure is possible with a decreased reported nonunion rate (4.0%). This modified procedure did not result in a recurrence of the deformity. We expect continuation of the study to demonstrate that there are no long-term issues.
The Function Axis of Rotation of the Ankle Joint during Simulated Gait
Authors: Sturnick Daniel , Demetracopoulos Constantine , Saito Guilherme Honda 
Published: September 2017

Category: Ankle, Ankle Arthritis, Hindfoot Introduction/Purpose: Implant component positioning is considered as an important factor in function and longevity in total ankle arthroplasty (TAA). However, accurate and repeatable positioning remains a limitation with current techniques and instrumentation. In addition, further investigation is needed to objectively define the optimum component positioning. Cadaveric gait simulation is a valuable tool for investigating foot and ankle joint mechanics during functional tasks such as the stance phase of gait. The objective of this study was to investigate the functional axis of rotation of the native ankle joint during simulated gait. Methods: The stance phase of healthy gait was simulated with six mid-tibia cadaveric specimens using a previously validated device and methodology. A robotic platform reproduced tibial-ground kinematics by moving a force plate relative to the stationary specimen while physiologic loads were applied to the extrinsic tendons to actuate the foot. (Figure 1A). Ankle kinematics were measured from reflective markers attached to the tibia and talus via surgical pins. The helical axes of rotation of the talus with respect to the tibia was calculated during three portions of stance: initial plantarflexion during earlier-stance after heal strike, dorsiflexion during mid-stance, and final plantarflexion during late-stance. The position and orientation of these kinematic-defined axes of rotation were compared to the transmalleolar axis and reduced to its anteroposterior position and transverse plane angle (Figure 1B). Results: Analyses revealed that ankle joint functional axis of rotation varied from the anatomic reference throughout stance. The kinematic center of rotation was located 16.4 ± 5.8 mm, 16.5 ± 6.6 mm, and 15.6 ± 6.5 mm anterior to the transmalleolar axis during early-, mid- and late-portions of stance, respectively. Conclusion: This study revealed that the position of the flexion-extension axis varies greatly between specimens during simulated gait. While previous reports have suggested that the transmalleolar axis is an acceptable approximation for the ankle joint center, these findings suggest that further research in warranted to better describe the complex tibiotalar kinematics. This work may provide future insight to guide implant design and advance techniques, to better place articular constraints of a total ankle in the native center of rotation of the joint.
Minimal Invasive Reconstruction of Neglected Achilles Tendon Rupture
Authors: Sung Ki Sun , Yim Hyun Seok 
Published: September 2017

Category: Sports Introduction/Purpose: Recently minimal invasive reconstruction using semitendinosus tendon autograft was shown to be safe and successful for neglected Achilles tendon ruptures. We hypothesized that allograft could also result in similar result like in the reconstruction of anterior cruciate ligament of the knee joint. Methods: Between December 2013 and September 2015, 19 consecutive neglected Achilles tendon rupture cases underwent minimally invasive reconstruction using semitendinosus allograft tendon regardless of rupture time and gap. Out of them, 5 patients had flexor hallucis longus tendon transfer additionally. Thirteen were male, and the average age at the time of surgery was 63(30~82). MRI was checked to confirm the diagnosis in all cases. The Achilles tendon total rupture score(ATRS) was measured for clinical outcome at both pre and post surgery. Thompson squeezing test, knee flexion test, and single-heel-rise test were recorded. Isokinetic strength of plantar flexion by peak torque with plantar flexion at speeds of 30 and 120°/sec was measured to check triceps muscle power after surgery. Results: The mean follow-up period was 13.6(6~26) months. The ATRS was improved from 34(7~72) to 70(48~97) after the surgery(p<0.0001). At the latest visit, all patients showed negative Thompson squeezing test, and in knee flexion test 16 patients showed normal ankle plantar flexion. Thirteen patients could raise their affected heel at the time. In the affected leg at speeds of 30 and 120°/sec, the isokinetic strength was 14.9(6.0~31.9) and 10.0 Nm (2.8~ 19.0) Nm preoperatively, and 37.3(12.1~90) and 19.6(7.8~47) Nm at the latest follow-up. (P=0.012, 0.017) There was no wound problem, rerupture or other complications related to the surgery. Conclusion: Minimally invasive reconstruction using semitendinosus allograft tendon seems to safe and effective for the treatment of neglected Achilles tendon without sacrificing other healthy tissues. We think that this technique can provide a significant improvement of symptoms and function with fewer complications.
Wound Complications in Calcaneus Fractures Treated with the Sinus Tarsi Approach
Authors: Swords Michael , Brady Candice , Popovich John 
Published: September 2017

Category: Trauma Introduction/Purpose: The purpose of this study is to evaluate risk factors and complications associated with surgical treatment of calcaneus fractures using a sinus tarsi approach in a consecutive series of 164 displaced intra articular calcaneus fractures treated with a sinus tarsi approach. Methods: 150 patients with a total of 164 displaced intra articular calcaneus fractures were treated by a single surgeon using a sinus tarsi approach. Age, nicotine use, diabetes, steroid use, time from injury to surgery were all recorded. Time of suture removal, post operative antibiotics, local wound care and need for secondary surgery for wound problems were recorded. Results: average age was 49.5 years old. follow up averaged 309 days. 60 (39.2%) used nicotine, 14 (8.54%) were diabetics with 3 insulin dependent, 6 used oral steroids or DMARDs, eight fractures (4.88%) were open fractures. Average time from injury to surgery was 10.63 days. Sutures were removed at an average of 16.25 days. 7 patients developed incisional complications. 6 were treated successfully with antibiotics and local wound care. 1 patient require secondary surgery for wound complications. There was no difference in patients treated less then 14 days or more then 14 days from injury. there was no difference in complications in smokers vs. non smokers or diabetics vs. non diabetics. Conclusion: The sinus tarsi approach is a safe surgical approach with an acceptable complication rate for fixation of displaced intra articular calcaneus fractures.
Assessing Lateral Ankle Instability Following Modified Brostrom Procedure
Authors: Vasileff Chris , Nowatzke Ryan , Ostosh Andrew , Anderson John , Bohay Donald , Maskill John , Padley Michelle 
Published: September 2017

Category: Ankle Introduction/Purpose: The modified Brostrom procedure obtained excellent to good results in 80% of patients treated for lateral ankle instability, making it one of the most common procedures for the treatment of this injury. In patients with a gastrocnemius contracture, however, the modified Brostrom repair leaves the narrower posterior talar dome held within the mortise. This decreased bony contact reduces stability and may be perceived by patients as continued instability post-operatively. The purpose of this study is to demonstrate that performing a gastrocnemius recession in conjunction with a modified Brostrom will increase the degree of stability of the ankle. This is the first study of its kind to our knowledge and hopes to further our knowledge of the functional improvements in the treatment of lateral ankle instability. Methods: This was a retrospective chart review with patients from the Orthopedic Associates of Michigan. 414 total patients in total with 82 who received gastrocnemius recession in conjunction with modified Bröstrom were evaluated for the purposes of this study. All patients were at least 14 years of age. Patients must have undergone a modified Brostrom procedure at a Spectrum Health or Metro Health facility from 1/1/2002 – 12/31/12 by performed Drs. Anderson, Bohay, or Maskill. Results: The mean age of all of the patients was 34.98 years (range 14-79). Pre-operatively, average AOFAS pain score for patients receiving modified Brostrom in isolation was 20.33, patients receiving concomitant gastrocnemius recession was 17.07. Post-operatively, average AOFAS pain score for patients receiving modified Brostrom in isolation was 32.29, patients receiving concomitant gastrocnemius recession was 32.44. Pre-operatively, proportion of patients meeting AOFAS stability criteria for those receiving modified Brostrom in isolation was 9.8%, those receiving concomitant gastrocnemius recession was 13.4%. Post- operatively, proportion of patients meeting AOFAS stability criteria for those receiving modified Brostrom in isolation was 76.8%, those receiving concomitant gastrocnemius recession was 86.6%. Conclusion: Patients receiving a concomitant gastrocnemius recession in addition to their modified Brostrom had increased pain pre-operatively but equivalent pain levels post-operatively compared to those who received a modified Brostrom in isolation. Additionally, there was a clinically significant increase in the percentage of patients with post-operative stability in those who received the gastrocnemius recession.
Correction of Rigid Equinovarus Deformity in Adults by Tibiotalocalcaneal Arthrodesis with Retrograde Intramedullary Nail
Authors: Yang Yunfeng , Zhou Haichao , Zhang Yun 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: To evaluate the results of tibiotalocalcaneal arthrodesis with retrograde intrameduallary nail for rigid equinovarus deformity in adults. Methods: We performed a retrospective review of rigid equinovarus deformity in adults treated with tibiotalocalcaneal arthrodesis using retrograde intramedullary nail between January 2011 and July 2014.The main outcome evaluations included American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, visual analogue scale (VAS) score and fusion time. All complications were recorded. Results: A total of 14 cases were enrolled. The average AOFAS ankle and hindfoot score improved from 34.4(range from 11 to 48; SD±10.4) preoperatively to 41.6(range from 26 to 55; SD±8.3) at 3 months postoperatively(P=0.041). The score increased significantly at 6 months postoperatively, which was even a little higher at 12 months. The change of the VAS score was similar to that of the AOFAS ankle and hindfoot score. The average VAS score decreased from 6.5 preoperatively to 1.4 at 12 months postoperatively. In total, five patients (35.7%) had complications; three cases developed delayed union, one case developed superficial infection and one experienced the tibial split operatively. Bone fusion was achieved in all patients at a mean of 13 weeks. Conclusion: Tibitalocalcaneal arthrodesis with retrograde intramedullary nail is an effective procedure to correct rigid equinovarus deformity in adults, with a high rate of bone fusion and satisfying outcomes.
A Prospective Study Evaluating Intra-Articular Hyaluronic Acid (1 ml) for Ankle Osteoarthritis
Authors: Younger Alastair , Wing Kevin , Veljkovic Andrea , Penner Murray 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: Early ankle arthritis can result in disabling symptoms and loss of function. However the degree of arthritis may not be severe enough or the symptoms severe enough to merit a fusion or replacement. For other patients they may wish to delay surgery to avoid financial issues with recovery time. Many of these patients have also been treated with NSAIDs, physiotherapy and bracing with variable effect. Stabilized long chain Hyaluronic acid (NASHA) has been used successfully in the knee, and has given a longer duration of effect compared to steroid injection. The purpose of this study was to determine the effect of hyaluronic acid in the ankle for sustainable symptom relief. Methods: A power analysis determined that a minimum of 29 patients would be required to appropriately power the study. A total of 37 adult patients with KL grade II and III ankle arthritis were enrolled in the study at a single institution. Patients recruited via a newspaper advertisement and from the surgical clinics and and screened for standard inclusion and exclusion criteria. The VAS pain preoperatively had to be greater than 30 / 100 mm. Outcomes were recorded at baseline, weeks 6, 12 and 26. The injection was performed after the baseline assessment using 1 ml of Hyaluronic acid NASHA (Q-Med AB, Uppsala, Sweden; DUROLANE 10 mg / mL) with or without local anesthetic to the skin. Outcomes included a VAS from the AOS scale for pain and disability, review of adverse events, physical exam, and use of rescue medication. Results: 35 of 37 patients completed the study. At baseline the VAS pain was 7.2 (SD +/-1.8). At 6 weeks the pain score was 5.4 (+/-2.5) improving by 1.8 points with a 26% improvement. At 12 weeks the pain score was 5.3 (+/-2.7) for a 29% improvement. At week 26 the pain score was 5 (+/- 2.7) for a 32% improvement. 4 adverse events were recorded – one patient reported increased pain after injection. One reported pain and swelling, one reported inflammation, and one pain after injection. Conclusion: This prospective cohort study shows promise for the use of Hyaluronic acid for the treatment of ankle arthritis with relief of symptoms up to 26 weeks after injection. The injection was safe for all 37 patients, although one patient reported pain and dropped out of the study. We would support the use of Hyaluronic acid for the treatment for moderate ankle arthritis. An RCT would be merited based on this study to compare results with placebo or cortisone injection.
Correction of flatfoot deformity by subtalar arthrodesis through single medial approach
Authors: Yu Guang-Rong , Zhang Mingzhu 
Published: September 2017

Category: Hindfoot Introduction/Purpose: To study the clinical results using isolate medial approach to correct flatfoot deformity in subtalar joint arthrodesis. Methods: 14 patients with flatfoot deformity were treated using isolated subtalar joint arthrodesis from March 2011 to March 2014. There were 3 males and 11 females with an average age of 60.81 years (ranged from 51 to 75 years). They are all cases of posterior tibial tendon dysfunctions, 9 of Myerson type Ⅲ, 3 of Ⅱ(b) and 2 of Ⅱ(c). Results: The mean duration of surgery was 100.54 minutes (range, 91-124 minutes). 12 patients were followed up for 20.25 months in average (range from 12 to 48 months). All of the cases have healed well, and the mean time of bone union was 9.53 weeks (ranged from 8 to 17 weeks). No infection was found in any cases. A complication was observed 1 patient which is painful ﬁxation. None of the patients experienced a nonunion or an adverse event related to the medial neurovascular structures. The mean Kitaoka score increased from 43.67 to 80.81 Conclusion: Based on our experience with the procedure, the isolate subtalar joint arthrodesis is a useful alternative to triple arthrodesis for the correction of mild and some moderate flatfoot deformity.