bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Ankle Motion after Triple Bundle Technique Repair vs. Casting for Acute Achilles Tendon Rupture
Authors: Jaakkola Juha I. , Beskin James L. , Griffith Letha H. , Cernansky George 
Published: January 2017

The purpose of our study is to evaluate the triple bundle technique for acute Achilles tendon rupture repair followed by early (at 14 days) postoperative ankle range of motion compared to nonoperative treatment with delayed ankle range of motion. We retrospectively reviewed 73 patients with an acute Achilles tendon rupture treated with either a plantar flexed cast or surgical repair. We found operative treatment reduces immobilization time, allows safe early return to weight-bearing, and diminishes risk of rerupture compared to nonoperative treatment. However, at an average follow-up of greater than 3.5 years, there was no statistical difference in AOFAS hindfoot scores, strength, or patient satisfaction between the two groups. Significant complications were higher in the nonoperative group manifested by three reruptures (7.7%) vs. one deep wound dehiscence in the operative group (3%).
The Functional Outcome of Displaced Intra-articular Calcaneal Fractures: A Comparison between Isolated Cases and Polytrauma Patients
Authors: Aktuglu Kemal , Aydogan Umur 
Published: January 2017

This study was conducted to analyze the functional outcome of displaced intra-articular calcaneal fractures in polytrauma patients and isolated cases, and to make a comparison between them. Twenty-eight patients (12 women and 16 men) with an average age of 37 (range, 13 to 60) who had 35 displaced intra-articular calcaneal fractures were included in this study. Among these, 17 fractures were due to polytrauma and 18 were due to isolated trauma. According to Sanders CT classification, 19 fractures (54.3%) were classified as type II, 10 fractures (28.5%) as type III and six fractures (17.2%) as type IV. The treatment consisted of operative and closed methods. The average follow-up time was 38 months (range, 18 to 83 months). The functional outcome was evaluated using Maryland Foot Score and there were three (17%) excellent, nine (52.9%) good and five (29.5%) fair results in polytrauma patients Seven (38.8%) excellent, 10 (55.6%) good and one (5.6%) fair results were seen in isolated cases. When compared with isolated cases, the functional outcome of displaced intra-articular calcaneal fractures in polytrauma patients was worse. With the findings available, it appears that foot trauma is usually ignored and should be treated without delay as for other system injuries in polytrauma patients.
Anatomic Study of the Gastrocnemius–Soleus Junction and its Relationship to the Sural Nerve
Authors: Tashjian Robert Z. , Appel A. Joshua , Banerjee Rahul , DiGiovanni Christopher W. 
Published: January 2017

Background: Gastrocnemius recession is performed for equinus contracture of the ankle and as an adjunct treatment for various foot pathologies. Successful release relies on many factors, including a thorough knowledge of the anatomy of the gastrocnemius-soleus junction and its relationship to the sural nerve which may be vulnerable to iatrogenic injury. Neither the average width of the tendon at the gastrocnemius-soleus junction, the anatomy of the sural nerve with respect to the gastrocnemius-soleus junction, nor appropriate landmarks for accurate incision placement at this level to avoid undesirable vertical extension, however, have yet to be acceptably defined. Methods: Fourteen fresh-frozen cadavers were dissected and the width of the tendon at the gastrocnemius-soleus junction, the distance of the sural nerve from the lateral border of the tendon at this level, the length of the fibula, and the distance from the distal tip of the fibula to the gastrocnemius-soleus junction were measured. Results: The average width of the gastrocnemius-soleus complex at the junction was 58 mm (range, 44–69 mm), the average distance of the sural nerve from the lateral border of the gastrocnemius-soleus complex at the level of the gastrocnemius-soleus junction was 12 mm (range, 7–17 mm), the average percentage of this distance as compared to the entire width of gastrocnemius-soleus junction was 20% (range, 13%-27%), and the ratio of the distance of the gastrocnemius-soleus junction from the distal tip of the fibula divided by the length of the fibula was 0.5 (range, 0.5–0.6). Conclusion: These results provide some guidelines as to the approximate size of the gastrocnemius–soleus complex at the site of gastrocnemius recession along with the location of the sural nerve at the musculotendinous junction. Also, the results indicate that the fibula can serve as a reproducible anatomic landmark to enable localization of the gastrocnemius–soleus junction at the time of gastrocnemius recession.
Perioperative Complication Rate of Total Ankle Replacement is Reduced by Surgeon Experience
Authors: Haskell Andrew , Mann Roger A. 
Published: January 2017

Background: Recent studies suggest the perioperative complication rate of total ankle arthroplasty decreases as a surgeon becomes familiar with the procedure. This study tests the hypothesis that the number of perioperative adverse events will decrease as surgeon experience with total ankle replacement increases. Methods: Ten surgeons completed retrospective chart and radiographic reviews of their first 10 cases as well as 10 subsequent cases of the Scandinavian Total Ankle Replacement (STAR). Not all surgeons completed 10 cases within the allotted time periods, and two patients were excluded for less than 3-month follow-up, resulting in 187 cases for review. The surgeons performed an average of 12.8 (range, 0–61) STARs between these two time periods. Cases were divided into Early Group if they were among the first five STARs a surgeon performed and Late Group if they were after the first five. Results: The average patient age was 60.4 ± 12.8 years. The etiology of arthrosis included 96 (51%) of 187 posttraumatic, 49 (26%) idiopathic, and 33 (18%) rheumatoid. Patients in Early Group had a 3.1 times greater chance of having a perioperative adverse event (95% CI 1.6–6.1, p < .001), and a 3.2 times greater chance of having a perioperative wound problem (95% CI 1.5–6.8, p = .002) than patients in Late Group. Patients in Early Group took 1 week longer to heal their wounds than patients in Late Group (4.5 vs. 3.5 weeks, p = .046). Conclusions: This study shows a decrease in the perioperative adverse event rate commensurate with surgeon experience with STAR. In contrast to other reports, this study was unable to show a decrease in the number of perioperative fractures with increasing surgeon experience. This information is important for planning how best to train surgeons new to total ankle replacement and for patient counseling regarding the potential risks of the procedure.
Fibular Position in Relation to Lateral Ankle Instability
Authors: Berkowitz CPT Mark J. , Kim David H. 
Published: January 2017

Background: The position of the fibula within the ankle mortise may be a factor contributing to recurrent ankle instability. The current study was performed to determine whether significant differences in fibular position exist in a population of patients who underwent lateral ankle stabilization procedures. The hypothesis that a fibula positioned posteriorly within the mortise predisposes the ankle to chronic instability was evaluated. Methods: Sixty-five CT/MRI scans of patients who underwent lateral ankle stabilization procedures from 1998 to 2001 were reviewed. The position of the fibula in relation to the tibia at the ankle mortise was expressed as the axial malleolar index (AMI). A greater AMI corresponds to a more posterior fibula. The AMI was also calculated from 65 CT/MRI scans performed on control patients who had no ankle instability. Results: The average AMI in the study group was 17° ± 6° (SD) compared with an average of 9° ± 4° (SD) in the control group ( p < .01). Therefore, the fibula was nearly twice as posterior in patients undergoing ankle reconstruction. In 42/65 (65%) study patients, the AMI was greater than 15°. Only 5/65 (8%) control patients had AMI values greater than 15°. This corresponds to an eightfold greater likelihood of AMI greater that 15° in the instability group than in the control group. Conclusions: This study supports the hypothesis that a posteriorly positioned fibula predisposes to ankle instability.
Stabilization of Lisfranc Joint Injuries: A Biomechanical Study
Authors: Lee Cassandra A. , Birkedal John P. , Dickerson Emilee A. , Vieta Paul A. , Webb Lawrence X. , Teasdall Robert D. 
Published: January 2017

Background: Lisfranc joint injuries are often misdiagnosed, leading to significant morbidity. Methods for anatomic reduction of the tarsometatarsal joint include closed reduction with casting or surgical stabilization with either Kirschner wires and/or cortical screw fixation. Controversy exists as to which fixation technique offers optimal stability. In the present study, the biome-chanical stability of three fixation methods was tested: (1) four Kirschner wires, (2) three cortical screws plus two Kirschner wires, and (3) five cortical screws. Methods: Ten matched pairs of fresh-frozen cadaveric feet were dissected to their ligamentous and capsular elements. The tarsometatarsal ligaments were completely transected to replicate a Lisfranc dislocation; the “injury” was reduced and stabilized using one of the three methods. Biomechanical studies were performed by applying a 100-N cyclic load physiologically distributed to the plantar aspect of the metatarsal heads. Displacement and force measurements were taken from the first and fifth metatarsal heads. Average stiffness of each construct was calculated from the force displacement curves. Results and Conclusions: Method 2 provided significantly more stability than Kirschner wire fixation. Method 3 created more stiffness than method 2 at the medial portion of the foot; no statistical difference between the two methods was evident at the lateral foot. Clinical Relevance: Cortical screw fixation provides a more rigid and stable method of fixation for Lisfranc injuries as compared to Kirschner wire fixation. This fixation method allows maintenance of anatomic reduction and possibly earlier mobilization with a decreased risk of posttraumatic arthrosis.
PEMF as Treatment for Delayed Healing of Foot and Ankle Arthrodesis
Authors: Saltzman Charles , Lightfoot Andrew , Amendola Annunziato 
Published: January 2017

Background: Arthrodesis is the most common surgical treatment for foot and ankle arthritis. In adults, these procedures are associated with a 5% to 10% rate of nonunion. Pulsed electromagnetic field (PEMF) stimulation was approved by the Federal Drug Administration (FDA) for treatment of delayed unions after long-bone fractures and joint arthrodesis. The purpose of this study was to examine the results of PEMF treatment for delayed healing after foot and ankle arthrodesis. Methods: Three hundred and thirty-four foot and ankle arthrodeses were done. Nineteen resulted in delayed unions that were treated with a protocol of immobilization, limited weightbearing, and PEMF stimulation for a median of 7 (range 5 to 27) months. All patients were followed clinically and radiographically. Results: The use of PEMF, immobilization, and limited weightbearing to treat delayed union after foot and ankle arthrodesis was successful in 5 of 19 (26%) patients. Of the other 14 patients with nonunions, nine had revision surgery with autogenous grafting, continued immobilization, and PEMF stimulation. Seven of these eventually healed at a median of 5.5 (range 2 to 26) months and two did not heal. One patient had a below-knee amputation, and four refused further treatment. Conclusions: The protocol of PEMF, immobilization, and limited weightbearing had a relatively low success rate in this group of patients. We no longer use this protocol alone to treat delayed union after foot and ankle arthrodesis.
Subtalar Joint Arthrodesis Using a Single Lag Screw
Authors: Haskell Andrew , Pfeiff Cynthia , Mann Roger 
Published: January 2017

Background: This study tested the hypotheses that fusing the subtalar joint with a single lag screw from the posteroinferior calcaneus to the anterior talar neck is an effective technique and that factors affecting the time to fusion can be identified. Methods: Between October, 1995, and July, 2002, the senior author (RAM) performed 101 isolated subtalar arthrodeses using a technique of single lag-screw fixation from posteroinferior to anterosuperior across the posterior facet of the subtalar joint combined with the application of an autograft taken from the floor of the sinus tarsi and anterior process. The average patient age was 52 (range 17 to 82) years. There were 52 women (53 arthrodeses) and 48 men (48 arthrodeses). Eight of 101 (8%) arthrodeses were revisions. The indications included posttraumatic arthritis (45), posterior tibial tendon dysfunction (18), failed prior ankle joint fusion (14), idiopathic disorders (12), hindfoot coalition (7), rheumatoid arthritis (3), and Charcot-Marie-Tooth disease (2). Fifteen of 101 patients (15%) smoked an average of 0.9 ± 0.5 pack of cigarettes per day. Results: Two of 101 joints did not fuse, resulting in an overall fusion rate of 98%. The average time to fusion was 12.3 ± 3.4 weeks. The presence of a prior ankle fusion significantly prolonged the time to fusion of the subtalar joint (11.9 ± 2.3 vs. 14.9 ± 7.0, p = .003). Other factors, including smoking, revision surgery, patient age, and patient sex, did not affect time to fusion. The fixation screw was removed in 13 of 101 (13%) joints at an average of 8.8 ± 0.5 months. Conclusions: Using a single 7.0-mm lag screw across the posterior facet of the subtalar joint results in fusion of the subtalar joint in 98% of patients. A prior ankle arthrodesis delays the time to fusion of the subtalar joint by 3 weeks. This is a simple and reliable technique for achieving fusion of the subtalar joint.
Acceptability of Ankle Tourniquet Use in Midfoot and Forefoot Surgery: Audit of 1000 Cases
Authors: Rudkin Adam K. , Rudkin Glenda E. , Dracopoulos George C. 
Published: January 2017

Background: While use of a thigh tourniquet with general anesthesia is widely accepted, use of an ankle tourniquet in the awake patient is more controversial. In particular, it is not clear how long patients tolerate this device or what the consequences are of intraoperative tourniquet pain. Method: A prospective audit was done of 1000 patients undergoing midfoot and forefoot surgery using an ankle block. We examined the intraoperative problems associated with the use of an ankle tourniquet, particularly the role and consequences of intraoperative tourniquet pain. Risk factors for tourniquet pain were statistically examined, and patient acceptance was gauged through followup questions. Results: With correct application and the option of sedation, 3.1% of patients complained of tourniquet pain. In 0.4% of patients tourniquet pain necessitated a conversion to general anesthesia. A significant association was found between tourniquet pain and both age and tourniquet time. We found that for patients younger than 70 years of age, the tourniquet can be applied comfortably for up to 30 minutes in over 97%. For each 11 minutes beyond this, another 1% of patients reported tourniquet pain. However, patients 70 years or older had an average 3.5 times increase in tourniquet pain. In this age group the tourniquet can be applied comfortably for up to 30 min in 91%. For each 3.2 minutes beyond this, another 1% reported tourniquet pain. When questioned, 97.2% of our patients reported that they would have surgery again with an ankle tourniquet. Conclusions: Our audit shows that with correct application and the option of sedation the ankle tourniquet is well tolerated by most patients. However, clinicians need to be mindful that patients 70 years of age or older are at greater risk of tourniquet pain and that in all patients the risk of tourniquet pain gradually increases when application times exceed 30 min.
Reconstruction of the Chronically Failed Deltoid Ligament: A New Technique
Authors: Deland Jonathan T. , de Asla Richard J. , Segal Ayal 
Published: January 2017

Background: Chronic deltoid ligament insufficiency that results in valgus tilt of the talus within the ankle mortise (stage IV adult acquired flatfoot) represents a difficult and so far unsolved problem in foot and ankle surgery. If left uncorrected, the deltoid failure with malalignment predisposes to early ankle arthritis and the need for ankle arthrodesis or possibly ankle arthroplasty. Methods: Five consecutive patients with deltoid ligament insufficiency resulting in a valgus tilt were treated with a deltoid reconstruction. Reconstruction of the deltoid ligament was done by passing a peroneus longus tendon graft through a bone tunnel in the talus from lateral to medial and then through a second tunnel from the tip of the medial malleolus to the lateral tibia. Results: At a minimum 2-year followup, all patients had correction of the talar tilt. One patient had 9 degrees of valgus tilt remaining compared to 15 degrees preoperatively, and the procedure was considered a failure. The remaining four patients had correction of the valgus tilt to 4 degrees or less. Conclusion: Although not uniformly successful, deltoid ligament reconstruction using a tendon graft through appropriate bone tunnels can reconstruct the deltoid ligament and correct the valgus talar tilt. Successful results were achieved when combined with correction of flatfoot deformity, which is considered a necessary part of the procedure.
Pigmented Villonodular Synovitis about the Ankle: A Review of the Literature and Presentation in 10 Athletic Patients
Authors: Saxena Amol , Perez Hugo 
Published: January 2017

Background: Pigmented villonodular synovitis (PVNS) is relatively uncommon. The disorder results in increased proliferation of synovium causing villous or nodular changes of synovial-lined joints, bursae and tendon sheaths. This study examines the occurrence of PVNS about the ankle and its association with trauma. Methods: Ten patients over a 10-year period were identified as having PVNS of the ankle. The average age was 40.2 (range 27 to 62) years. There were four women and six men. Average followup was 4.5 (range 1 to 11) years from the initial surgery. Four patients had bone involvement. All patients who were athletically active before symptoms arose complained of persistent pain and swelling in the lateral ankle. Their initial clinical symptoms were indistinguishable from commonly associated pathologies with persistent lateral ankle pain (i.e. tenosynovitis, osteochondral defects, os trigonum injury, and tendon tears). All patients had magnetic resonance imaging (MRI) revealing PVNS, which is represented by low-signal appearing masses on T1-and T2-weighted images. All patients' histopathology results revealed multinucleated giant cells and foam cells laden with hemosiderin deposits. All patients had synovectomy and tenosynovectomy. Results: Eight patients were able to return to some sports (range 4 to 12 months); two had continued pain, disability, and inability to return to sports because of recurrence. Conclusions: PVNS should be considered in athletically active patients with persistent lateral ankle pain and swelling, particularly if bone erosions are visible on plain radiographs.
Comparison of the Electromechanical Effects of Vesnarinone and Amrinone in Isolated Dog Purkinje Strands and Ventricular Trabeculae
Authors: Lathrop David A. , Náinási Péter P. , Varró András , Schwartz Arnold 
Published: January 2017

Background: Conventional microelectrode techniques were used to compare the concentration-dependent effects of vesnarinone (0.1-100 μM) and amrinone (1 μM-1 mm) on action potential duration (APD) and developed force in both isolated dog ventricular trabeculae and Purkinje strands. Methods and Results: Both drugs increased contractility of trabecular muscle preparations, while, in Purkinje strands, vesnarinone failed to increase developed force during continuous pacing at 2 Hz. Vesnarinone lengthened APD in both preparations; although this effect was more marked in Purkinje strands. Ventricular muscle APD was not affected by amrinone (1 μM to 1 mM), while, in Purkinje strands, amrinone produced a biphasic effect on APD. Low concentrations (1-100 μM) of amrinone shortened Purkinje fiber APD, while only the highest concentration (1 mM) used lengthened APD. In addition, in Purkinje strand preparations the effects of vesnarinone (10 μM) on APD and developed force were proportional to pacing cycle length at frequencies slower than 2 Hz; however, at frequencies faster than 2 Hz vesnarinone decreased developed force while APD was lengthened. In ventricular trabecular muscle preparations, the effects of vesnarinone were not affected by frequency. Conclusions: These results indicate clear differences between the effects of vesnarinone and amrinone in isolated cardiac preparations. These differences in experimental effects in isolated cardiac preparations may help provide an explanation for the disappointing clinical response of patients in heart failure to amrinone, while vesnarinone has appeared to be beneficial.
Nurses Impaired by Emotional and Psychological Dysfunction
Authors: Smith George Byron , Hukill Elizabeth 
Published: January 2017

Background: There may be at least 220,000 to 286,000 registered nurses in the United States who have some form of mental illness. There have been no published studies of nurses impaired by emotional or psychological dysfunction. Objective: This study provides a description of characteristics of nurses impaired by emotional and psychological dysfunction. Design: Fifty-seven nurses in a Southeastern state's peer assistance program responded to a questionnaire adapted from Sullivan's (1987a) descriptive study of recovering chemically impaired nurses. Results: Fifty-eight percent of the sample report major depression as their primary psychiatric diagnosis with 21% of the sample believing their emotional or psychological impairment was caused by a personality weakness. Conclusions: The findings indicate the needfor improved education and support of nurses impaired from emotional and psychological dysfunction.
A Survey of Psychiatric Nurses Regarding Working with Clients who have a History of Sexual Abuse
Authors: Gallop Ruth , McCay Elizabeth , Austin Wendy , Bayer Margaret , Peternelj-Taylor Cindy 
Published: January 2017

BACKGROUND: There is strong evidence that a history of sexual abuse can have serious psychologic sequelae. OBJECTIVE: The purpose of the study was to assess the comfort, attitudes, identif ed competencies, and educational needs ofpsychiatric nurses who work with these clients. STUDY DESIGN: Surveys were mailed to a random sample of 3542 nursing personnel in four Canadian provinces. Measures were used to assess comfort, sexual attitudes, competencies, and educational needs. RESULTS: A response rate of 48% (1 701 responses) was achieved. Comfort and competency regarding working with clients varied according to educational preparation, gender of the nurse, and a personal history of abuse (p <.001). All participants identified a critical need for more knowledge in all areas related to providing care for these clients. CONCLUSION: The surveys showed that significant numbers of nurses are working with clients who report a history of sexual abuse. However, most participants do not believe they have adequate knowledge or therapeutic skills to work with these clients. Information from this study should provide directionfor content of sexual abuse education programs.