bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring Functional Range of Motion in Patients with Ankle Arthritis
Authors: Goldberg Andy J. , Thornton James D. , Sabah Shiraz A. , Segaren Neil , Cullen Nick , Singh Dishan 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Measurement of range of motion is an important outcome measure following ankle surgery. However, there is wide variation in its measurement: from clinical evaluation, to radiographic metrics, and gait analysis. The purpose of this study was to present and validate a simple, standardized technique for measurement of function total range of motion between the tibia and the floor using a digital goniometer. Methods: Institutional review board approval was obtained. Forty-five ankles from 33 participants were recruited into two groups. Group 1 (Healthy controls), comprised 20 ankles from 10 participants. None had any musculoskeletal or neurological pathology. Group 2 (Ankle osteoarthritis), comprised 25 ankles from 23 patients. Ankle pathology had been treated with ankle arthrodesis (n=5), total ankle replacement (n=6), and non-operative treatment (n=14). Measurement was performed by two testers according to a standardized protocol developed for the Pivotal Total Ankle Replacement Versus Arthrodesis (TARVA) RCT. Intra- and inter-rater reliability was calculated using intra-class correlation coefficients. Results: Group 1 (Healthy controls). The median difference for all measurements within an observer was 1.5 (IQR 0.7-2.5) degrees. The ICC for inter-rater total ankle range of motion was excellent 0.95 (0.91-0.97, 95% confidence interval, p < 0.001). The ICC for intra-rater total ankle range of motion was excellent 0.942 (0.859-0.977, 95% CI, p < 0.001). Group 2 (Ankle osteoarthritis). The median difference for all measurements within an observer was 0.6 (IQR 0.2 -1.3) degrees. The intra-class coefficient (ICC) for inter-rater total ankle range of motion was excellent 0.99 (0.97 -1.0), 95% CI, p < 0.001). The ICC for intra-rater total ankle range of motion was 0.99 (0.96 -1.0), 95% CI p < 0.001). Conclusion: This technique provides a reliable, standardized method for measurement of total functional range of motion between the tibia and the floor. The technique requires no specialist equipment or training, and provides a valid functional assessment for patients with and without ankle osteoarthritis and also following treatment even with an ankle arthrodesis.
Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the Ankle is Safe and Effective - 2-Year-Followup in 130 Patients
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: For treatment of chondral defects, matrix-associated stem cell transplantation (MAST) is a modification of autologous matrix-induced chondrogenesis (AMIC) with a potential higher concentration of stem cells due to harvesting fluid at the bone marrow and in-vitro processing. The aim of the study was to assess the 2-year-followup of MAST in chondral defects of the ankle. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April 1st 2009 to March, 31st, 2013 were analyzed. Patients with bilateral treatment or with MAST at more than one joint surface were excluded from the study. The size and location of the chondral defects, method-associated problems and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at followup were registered and analyzed. MAST was performed as a single open procedure including debridement and microfracturing of the chondral defects. Stem cell-rich blood was harvested during the procedure from the ipsilateral pelvic bone marrow and centrifuged (10 minutes, 1,500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide®, Geistlich, Baden-Baden, Germany) that was cut to the size of the defect before. The matrix with stem cells was fixed into the chondral defect with fibrin glue (Tissucoll, Deerfield, USA). Results: One hundred and fifty chondral defects in 144 patients were included in the study. The age of the patients was 35 years on average (range, 10-68 years), 85 (59%) were male. The VAS FA before surgery was 58.5 on average (range, 16.5-78.8). The defects were located as follows, medial talar shoulder, n=62; lateral talar shoulder, n=66 (medial and lateral talar shoulder, n=6), distal tibia, n=22. The defect size was 1.6 cm2 on average (range, .6 - 6 cm2). Additional autologous bone transplantation (harvested from the proximal tibia) was performed in 19 cases (medial/lateral talar shoulder, n=8/8; distal tibia, n=3). 130 patients (90%) completed 2-year-follow-up. No method related complications or consecutive surgery were registered. The VAS FA improved to an average of 87.5 (range, 62.1-100; t-test (comparison with preoperative scores), p=.01). Conclusion: MAST led to good clinical scores. No complications were registered. Even though a control group is missing, we conclude that MAST is a safe and effective method for the treatment of chondral defects of the ankle. The main advantage of MAST in comparison with ACI and MACI is the single procedure methodology. The advantage in comparison with AMIC is the potential higher concentration of stem cells. It remains unclear if this method is superior to AMIC, and what kind of tissue is created.
Long-Term Outcome Following Interpositional Arthroplasty of the First Metatarsophalangeal Joint
Authors: Aynardi Michael , Dein Eric J. , Zahoor Talal A. , Atwater Lara C. , Schon Lew C. , Miller Stuart D. 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Surgical treatment for osteoarthritis of the first metatarsophalangeal joint (MTPJ) includes cheilectomy or fusion for advanced arthritis. In addition, procedures to preserve or restore motion have demonstrated promising short-term results. Currently, no studies have described long-term results following interpositional arthroplasty. Our institution has performed interpositional arthroplasty with autograft (joint capsule/extensor hallucis brevis) or allograft (dermal matrix) with anecdotal success for over 15 years. The purpose of this study is to report long-term outcomes following interpositional arthroplasty. Methods: All patients undergoing interpositional arthroplasty at our institution from 2000-2015 were identified and a retrospective chart review was performed. Long-term follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Average follow-up was 89.1 months (range, 6 to 179 months). Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure. Results: From 2000-2015, 292 interpositional arthroplasties were performed at our institution. The overall failure rate was 1.7 % (5/292), which included patients requiring revision surgery (2 patients) or subsequent fusion (3 patients). Autograft interpositional arthroplasty had a failure rate of 2.1% (2/94) and allograft interposition was 1.5% (3/198). Failure and reoperation occurred at an average of 11 months from the index procedure (range, 6-17 months). 88.7% of patients rated their overall satisfaction as excellent or good. Average preoperative VAS score was 8.2 ± 1.5 (range, 6 to 10) and 2.1 ± 1.6 (range, 0 to 7) at latest follow-up, and (79.1%) patients reported tolerance to fashionable shoes. There were no major wound complications. The most common complications were metatarsalgia (8.6%) and cock-up deformity (5.7%). Conclusion: Interpositional arthroplasty demonstrated excellent long-term survivorship and high patient satisfaction at long-term follow-up.
Evaluating the Safety of Percutaneous Dorsolateral Talonavicular Joint Fixation in Modified Double Arthrodesis
Authors: Aynardi Michael , Atwater Lara C. , Melvani Roshan T. , Schon Lew C. , Miller Stuart D. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Hindfoot arthrodesis has demonstrated reliable long-term outcomes for treatment of symptomatic hindfoot arthritis, but the incidence of nonunion of the talonavicular joint has been reported as high as 29%. Retrograde percutaneous insertion of a dorsolateral screw in addition to the standard medial distal to proximal screw has been shown to add significant construct stiffness across the talonavicular joint in biomechanical testing. However, placement of this dorsolateral screw may result in increased neurovascular injury. The purpose of this cadaveric study was to investigate the proximity of important anatomic structures to dorsal, percutaneous, screw fixation across the talonavicular joint for hindfoot arthrodesis. Methods: 17 fresh frozen cadaveric limbs without deformity were transected across the supracondylar femur. A single fellowship-trained orthopedic surgeon performed all procedures. Percutaneous dorsolateral fixation across the talonavicular joint was performed with a cannulated screw. A 1.5-cm incision was created over the lateral third of the navicular after localization under fluoroscopy, and a 4.5 mm cannulated screw was inserted using standard AO technique. The guide wire was left within the screw. The incision was extended 2 cm proximal and distal and a separate orthopaedic surgeon used a caliper to measure the distance from the guide wire to the superficial peroneal nerve, extensor hallucis longus, extensor digitorum longus, deep peroneal nerve, and deep peroneal artery. Injuries to neurovascular structures were noted. Finally, solder wire was laid atop the deep neurovascular bundle to allow radiographic imaging of the screw and the bundle. Results: Injury to the deep neurovascular bundle occurred in 6 of 17 specimens (35.3%). There were 5 injuries (29.4%) to the deep peroneal nerve, 3 to the deep peroneal artery, and 2 to branches of the superficial peroneal nerve. The average distances from the guide wire to anatomic structures were superficial peroneal nerve: 1.8 mm (0.5-4.10 mm), extensor hallucis longus: 6.10 mm (0.6-15.0), extensor digitorum longus: 6.8 mm (0.5-14.0 mm), deep peroneal artery: 2.27 mm (0.0-5.1), and deep peroneal nerve: 2.4 mm (0.0-7.10 mm). Conclusion: A high rate of neurovascular injury was observed after percutaneous dorsolateral fixation across the talonavicular joint. These data suggest that this approach should be avoided in favor of an open approach, which allows identification and protection of the superficial peroneal nerve, extensor tendons, and the neurovascular bundle.
Endoscopic Resection for Talocalcaneal Coalition Using Posteromedial Approach
Authors: Nakazora Shigeto , Nishimura Akinobu , Ito Naoya , Kato Ko , Sudo Akihiro 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Initial treatment of symptomatic talocalcaneal coalition (TCC) is reduced activity or cast immobilization. If these conservative treatments does not relieve symptoms, surgical treatment is recommended. The operation for TCC is usually treated by an open procedure. We report the results of the three cases by endoscopic resection using posteromedial approach. Methods: Three consecutive patients (3 feet, 2 men and 1 female) who underwent surgery for TCCs were reviewed. Patient’s age at the time of surgery were 12, 13, 19 years respectively. All patients suffered from a foot pain after ankle sprain. Two patients didn’t play sports because of this pain. This operation is performed in the supine position. Two portals are each created at the proximal and distal to the vertex of the medial malleolus. Portal positions are marked by use of sonography to avoid the injury of tendons and neurovascular. By use of a shaver a radiofrequency device, as much soft tissue must be removed as possible to allow easy coalition resection, the surgeon performs sufficient resection of the coalition using an abrader until the normal articular surface can be confirmed. Movements of ankle and toes are encouraged from immediately post-operatively. Weight bearing is permitted 1 week after surgery. Results: All patients had a relief of pain. The mean preoperative and final follow-up AOFAS ankle-hind foot scale scores were from 65.3 to 92.3. Two patients returned to playing sports by three months. The mean operation time was 123 minutes (range: 97–148 minutes). However, compared with the initial cases, recent cases tended to have shorter surgical times. No complications occurred. Conclusion: A posteromedial approach for TCC is a useful technique because the advantage of allowing (1) a direct approach to both the middle- and posterior-facet coalitions without obstruction, (2) the creation of sufficient working space, (3) the obtuse insertion angle between the endoscope and instrument. On the basis of these advantage, endoscopic resection of a TCC using the posteromedial approach is considered a useful technique. To decrease the risk of neurovascular damage and tendon injury, portal positions are marked in advance by use of sonography, so that, a safe endoscopic resection of the coalition is performed.
Flexible Adult Acquired Flatfoot Deformity
Authors: Netto Cesar Cesar , Demehri Shadpour , Dein Eric J. , Thawait Gaurav K. , Zhang Hanci , Fonseca Lucas F. , Zahoor Talal A. , Lee Moses , Guo Yi , Ficke James R. , Schon Lew C. 
Published: October 2016

Category: Other Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a biomechanical derangement involving the three- dimensional (3D) midfoot and hindfoot osseous complex, which can be challenging to optimally characterize using conventional two-dimensional (2D) plain radiographs. Weightbearing (WB) Cone-Beam CT (CBCT) can better demonstrate the deformity of the 3D structures during WB. Therefore, we compared validated AAFD measurements between non-weightbearing (NWB) and WB CBCT images. Methods: In this prospective, IRB approved study, 20 patients were included, 12 males and 8 females, mean age of 54.21 (20-88) years, with clinical diagnosis of flexible AAFD. Subjects were scanned with standing (WB) and seated (NWB) CBCTs. WB and NWB CBCT images were assessed with traditional flatfoot measurements obtained at sagittal, coronal, and axial planes using predefined anatomical landmarks, by two independent observers. Interobserver reliability was calculated using Pearson correlation. Results: The measurements in patients with AAFD differed significantly between WB and NWB CBCT images. Specifically, WB images showed, when compared to NWB, decreased forefoot arch angle (mean difference: 9.91°, p < 0.0001), increased talus-first metatarsal angle (10.59°, p < 0.0001), increased navicular-medial cuneiform angle (13.89°, p < 0.0001), decreased navicular-floor (coronal 14.05mm/sagittal 14.91mm, p < 0.0001) and navicular-skin distances (coronal 5.87mm/sagittal 8.25mm, p < 0.0001), decreased medial cuneiform-floor (coronal 10.79mm/sagittal 11.07mm, p < 0.0001) and medial cuneiform-skin distances (coronal 4.45mm/sagittal 5.78mm, p < 0.0001), and decreased cuboid-floor (5.78mm, p < 0.0001) and cuboid-skin distances in the sagittal plane (4.60mm, p < 0.0001). Interobserver reliability was good to excellent (0.610-0.991). Conclusion: Traditional adult acquired flatfoot deformity radiographic measurements are obtainable using high resolution 3D WB CBCT imaging, and can help characterize the biomechanical derangements during weightbearing in subjects with flexible AAFD.
Tissue Biopsy in Infected Foot and Ankle Surgery
Authors: Abdalla Samir , Makki Daoud , Elgamal tarel , Harvey David , Jackson Gillian , Platt Simon R. 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: When performing surgical debridement to treat chronically infected orthopaedic cases our unit routinely samples 5 intraoperative specimens for microbiology. Best practice and achieving accurate sampling would suggest that a new scalpel and forceps for each sampling site would yield the most valid results.The alternate option would be to use the same instruments. The aim of this prospective study was to compare the two techniques in treating infected foot and ankle cases. Methods: Ten consecutive patients undergoing debridement for foot and ankle infection were prospectively included. Both techniques were performed on same patient to minimise any bias related to the type of host and severity of infection. This was achieved by collecting 5 tissue samples from 5 different sites initially using fresh instruments for each . We then used the first scalpel and forceps to sample the 2nd, 3rd, 4th, and 5th sites again. Samples were labelled from 1 to 9 where the 6th to 9th samples were from the same sites as the 2nd to 5th samples but taken by different technique. This allowed differentiating a genuine growth at a particular site from a contaminant carried on from another site. Results: In 7 patients the scalpel transferred microorganisms from one site to another as some of the 5 sites showed no organisms when biopsied by fresh instruments but showed growth when sampled by the re-used first scalpel. In the remaining 3 patients, the growth form the sites sampled by re-used first scalpel was consistent with the growth from those sites when ampled by fresh instruments . Conclusion: Our preliminary results showed that fresh scalpel and forceps are required for each sampling site to avoid transferring contamination from one site to another. This helps guide the extent of future debridement and also the type of antibiotics to be used.
Resection Arthroplasty for Limb Salvage in Severe Unreconstructable Charcot Joints
Authors: Gotha Heather , Brodsky James W. , Taniguchi Akira , Shen Wei 
Published: October 2016

Category: Diabetes Introduction/Purpose: When non-operative treatment of very severe Charcot neuroarthropathy (CN) of the ankle and hindfoot fails, surgical options for limb salvage are limited. Some patients have insufficient bone stock or medical and psychosocial factors that make arthrodesis untenable. Resection arthroplasty can create a braceable, plantigrade ankle and foot, preserving the limb and maintaining ambulatory independence. This study evaluated the results of resection arthroplasty and bracing as an alternative technique of limb salvage in the subset of patients who would otherwise require amputation for unreconstructable Charcot deformity. Methods: The medical records and radiographs of 16 patients who underwent resection arthroplasty for unreconstructable Charcot deformity from 2000-2014 were retrospectively reviewed. All had diabetic peripheral neuropathy. The average follow-up was 46.75 months (range 9-111 months). Data included demographics, medical history, ambulatory status, and soft tissue lesions. Radiographs were categorized according to the Brodsky Charcot classification. Pre-operatively, 2 patients were community ambulators without assistive device. Four patients were wheelchair bound. Ten patients (62.5%) had limited ambulatory independence, as either home ambulators or reliant on assistive devices, such as crutches and walkers. At the time of surgery, 87% had presence of persistent and recalcitrant ulceration as a result of their deformity. Fifteen patients (93%) had Brodsky Type 2 (Hindfoot) or Type 3 (ankle) Charcot joints. Primary outcomes assessed were limb survivorship and ambulatory status at last follow-up. Secondary outcomes included wound complications, infection, and need for subsequent surgical procedures following index procedure. Results: Kaplan-Meier survivorship probability estimate for limb salvage at 5 years following resection arthroplasty was 93% (95% CI 66%-99%). A total of 4 resection arthroplasties ultimately failed, requiring BKA. Three out of 4 amputations occurred after 5 years of successful function. Of the 12 patients who retained their limb at final follow-up, all had braceable deformity without evidence of skin breakdown or infection at the time of final follow-up. Eleven of the 12 were independent community ambulators with bivalved AFO (BAFO). With regard to overall changes in ambulatory status following resection arthroplasty, all patients who were independent community ambulators pre-operatively maintained their ambulatory independence post-operatively with use of BAFO. For patients who were either non-ambulatory or dependent ambulators pre-operatively, 10/14 (71%) achieved ambulatory independence. Conclusion: Resection arthroplasty with long-term post-operative bracing is an effective alternative technique for limb salvage and preservation of ambulatory independence in the subset of CN patients who would otherwise likely require amputation for unreconstructable deformity.
Timing of Antibiotic Prophylaxis for Preventing Surgical Site Infections in Foot and Ankle Surgery
Authors: Tantigate Direk , Jang Eugene , Seetharaman Mani , Noback Peter C. , Heijne Anna M. , Greisberg Justin , Vosseller J Turner 
Published: October 2016

Category: Other Introduction/Purpose: Surgical site infection (SSI) is one of the most troublesome outcomes after any surgery, for both patient and surgeon. In addition to significant morbidity for patients, SSIs have been hallmarked as an important metric in value-based purchasing by CMS. Surgical literature has suggested that 15-60 minutes prior to incision is the ideal timing of intravenous antibiotics. The purpose of this study is to find the optimal timing of antibiotic administration before foot and ankle surgery, as well as to elucidate the risk factors for SSIs. Methods: An a priori power analysis was performed in order to detect a 4% absolute increase in infection rate with delayed timing of antibiotic prophylaxis, based on a presumed baseline SSI rate of 4% in foot and ankle surgeries based on literature on healthy patients undergoing foot and ankle surgery (n=1204 to achieve a power of .80). A retrospective chart review of 1933 foot and ankle procedures in 1632 patients over 56 months was performed. Demographic data, type and amount of antibiotics, timing of antibiotic administration, incision time, and closure time were recorded. The incidence of subsequent wound infection and subsequent incision and drainage procedure (I&D) within 30 days and 90 days were documented. Comparison of outcomes and demographic variables between the group of patients who received preoperative antibiotics less than 15 minutes before incision, and those who received them between 15 to 60 minutes prior to incision was performed. Results: A total of 1569 procedures met inclusion criteria. There were a total 17 cases (1.1%) of subsequent wound infection, of which 11 required a subsequent I&D within 90 days. There were 59 additional cases (3.8%) of wound complications which did not meet SSI criteria. When antibiotics were administered between 15 and 60 minutes prior to incision, there was a 2.7-fold, statistically significant higher rate of SSIs as compared to the group of patients receiving antibiotics < 15 minutes before incision (p < 0.05). When comparing the patients who had subsequent SSIs to those who did not, the only significant independent predictors were longer surgeries and non-ambulatory surgeries (both p < 0.05). When a stepwise multivariate logistic regression was performed to see which variables would predict an SSI, it was found that 91.8% of the risk of an SSI could be predicted by ASA score and length of surgery alone. Conclusion: In foot and ankle surgeries, the timing of intravenous antibiotic prophylaxis does not appear to play as large of a role as in other surgical subspecialties. Our studies revealed that host factors length/complexity of surgery may play a much larger role in determining the rate of infections than the timing of antibiotic prophylaxis.