bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Stocking to Improve Venous Return Compared to the Class 1 Compression Stocking
Authors: Paramasivan Arjun C. , Sampathkumar Kandasamy 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Venous thromboembolism (VTE) is a serious risk of major orthopaedic surgery, associated with significant morbidity and mortality. VTE events are annually costing the US healthcare system over $13.5 billion and causing approximately 200,000 deaths each year. In current clinical practice, the risk of VTE events are reduced with various pharmacological and mechanical thromboprophylactic measures. Class 1 compression stockings are frequently used as mechanical prophylaxis due to few associated complications. The purpose of this study was to determine if the addition of a novel device to the conventional compression stockings improved venous return. Methods: This prospective study measured ejected venous volume (EVV) of the superficial femoral vein in both legs of healthy volunteers (n=10). The novel device wraps around the heel and holds the meta-tarsophalangeal joint of the great toe flexed, encouraging active toe dorsiflexion and partial ankle dorsiflexion. EVV was obtained using duplex scanning, and measured 1) when participants were supine at rest 2) with the addition of the compression stocking and 3) with the novel device in addition to the compression stocking. Results: The use of compression stockings compared to the baseline did not demonstrate a difference in EVV (6.13±0.43 ml vs 6.02±0.32 ml, p=1.000). However, the addition of the novel device significantly increased EVV compared to the baseline (6.13±0.43 ml vs 12.16±1.20 ml, p < 0.001) and more importantly compared to the compression stockings alone (6.02±0.32 ml vs 12.16±1.20 ml, p < 0.001). The novel device therefore augmented the EVV, two times greater than the compression stocking used as monotherapy. Conclusion: We have demonstrated that the addition of the novel device significantly improves venous return, compared to the compression stocking used as a monotherapy. DVT outcome studies assessing efficacy of this novel device in the clinical setting are now required. Nevertheless, these preliminary results demonstrate excellent potential in the next generation of VTE prophylaxis.
A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures
Authors: Jones Caleb W. , O’Daly Andres , Smith Kenneth S. , Shah Ashish 
Published: October 2016

Category: Ankle Introduction/Purpose: Ankle fractures encompass 9% of all orthopaedic fractures and when they require surgical fixation can use 1/3 rd tubular plates, locking plates, antiglide plates, lagging screws, intramedullary nails which have been made from various metals most commonly stainless steel or titanium alloys. Carbon fiber implants have been used for a number of years more frequently in the humerus, the femur, and the spine. Our hypothesis is that the carbon fiber plates are just as efficacious in fixing ankle fractures as titanium and stainless steel plates. Methods: This is retrospective study of one surgeon’s ankle fractures which were fixed by ORIF with carbon fiber plates. All patients from Jan 2013-May 2015 who underwent a ankle orif with carbon fiber plate were collected and assessed for time to fracture consolidation, return to function, and complications and these were compared to historical models of fracture fixation with titanium and stainless steel plates. The results were assessed by ANOVA statistical models. Results: We found that the carbon fiber plates are equal in their time to consolidation, wound healing, and return to function, however we found that the carbon fiber plates allow for better fracture site visualization post operatively to determine fracture consolidation Conclusion: The carbon fiber plate is a viable alternative to ankle fracture ORIF especially in patients where close follow up of the fracture site is of benefit.
Analysis of Clinical Outcomes and Prognostic Factors in Bosworth Fractures
Authors: Cho Byung-ki , Choi Seung-Myung , Kang Chan , Jeong Jae-Jung , Kim Jun-Beom 
Published: October 2016

Category: Trauma Introduction/Purpose: Unlike routine ankle fractures, Bosworth fracture-dislocation lead to devastating complication such as compartment syndrome, neurovascular injury, and subsequent ankle OA more frequently. However, due to the low incidence of this injury, no study have reported clinical outcomes of Bosworth fracture in comparison to which of routine ankle fractures or these prognostic factors. Therefore this study was performed to assess and compare the outcomes of Bosworth fracture- dislocation to that of routine ankle fractures and understand the prognostic factors in order to prevent the irreversible and severe status. Methods: Twelve patients were followed for more than 1 years after surgical management for Bosworth fracture-dislocation. The mean age was 39.2 years, and the mean follow-up period was 38.4 months. All patients were treated with ORIF including syndesmosis fixation. The clinical evaluation consisted of the AOFAS ankle-hindfoot score, Olerud & Molander scale. Reduction of tibiofibular syndesmosis and restoration of the ankle mortise were evaluated with plain radiographs and 3-D CT. The clinical and radiological outcomes were compared to those of routine ankle fractures (50 patients). To detect prognostic factors affecting the clinical results, age, fixation methods, interval to operation, existence of post. malleolar fractue, shape of fibular fracture, number of syndesmotic screw, frequency of closed reduction trial were studied. Results: Clinical results of Bosworth fracture-dislocation showed improvement including AOFAS score (87.6 on average) and Olerud and Molaner scale (89.7 on average), and corresponded to those results of routine ankle fracture (p = 0.234). All the patients achieved union in 12.6 weeks on average. However, postoperative CT revealed syndesmotic diastasis in 5 of 12 cases As complication, there were two cases of compartment syndrome, 2 cases of posttraumatic OA, 2 cases of ankle stiffness. Interval to operation and frequency of closed reduction trial were foud to be predictive factors of poor outcomes (p = 0.003, 0.011 respectively). Conclusion: The results of our study showed that although the clinical results were comparable statistically, Bosworth fracture are more frequently associated with the development of complications than routine ankle fractures. More specifically, prolonged interval between occurrence of fracture and surgical fixation and repeated attempts of closed reduction are at risk for poor outcomes. A prospective study with sufficient power would be needed to further identify risk factors associated with complications.
Anterior Plating with Retention of Nail for Salvage Ankle Arthrodesis After Failed Tibiotalocalcaneal Fusion
Authors: Matson Andrew P. , Hamid Kamran S. , Dekker Travis J. , DeOrio James K. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal arthrodesis (TTCA) by retrograde intramedullary nailing (RIMN) is commonly used to treat degenerative disease affecting both the tibiotalar and subtalar joints. In the event of TTCA failure, techniques for salvage arthrodesis are not well-described. The aim of this study is to demonstrate the feasibility of anterior plating with retention of nail as a salvage option for patients who experienced failed TTCA by RIMN. Methods: Six patients with failed TTCA following RIMN underwent revision ankle arthrodesis with anterior plating and retention of nail between July 2013 and July 2015. Patient demographics, presentation details, and clinical records were reviewed for clinical and patient-reported outcome measures. Postoperative outcomes consisted of visual analog scale (VAS) pain rating, Coughlin satisfaction scale, Foot & Ankle Activity Measure (FAAM) score, and complications. Results: Anterior plating was performed at a mean of 15.8 months (range, 6.3-25.7) after primary TTCA by RIMN. All patients achieved bony fusion at an average of 9.3 weeks (range, 5.4-16.1) postoperatively. Postoperative outcomes at 1 year follow-up demonstrated an average VAS score improvement from 7.8 to 5.3 (p = 0.019) and an average postoperative FAAM score of 50.9 (range, 37.5-75.0). One major complication occurred in a patient who had a posterior tibial nerve neuroma from the initial TTCA procedure. Despite achieving union following anterior plating, the patient had several subsequent procedures to manage the neuroma but eventually required amputation. There was one minor complication consisting of postoperative swelling requiring a compressive stocking. Conclusion: Anterior plating with retention of nail is a viable option for salvage arthrodesis in patients with failed TTCA after RIMN. Given the complex presentation of most patients with this problem, detailed preoperative counseling regarding the potential risks of surgery should be performed.
Assessing the Utilization of Total Ankle Replacement in the US
Authors: Koenig Lane , Demiralp Berna , Nguyen Jennifer , Zhang Qian , Reddy Sudheer C. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: While total ankle arthroplasty has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis, implant costs and complications have the potential to increase the overall financial burden of performing TAR. The purpose of this investigation is to analyze the overall cost and utilization of total ankle arthroplasty. Methods: Our analytical sample consisted of Inpatient Prospective Payment System hospitals from 2011 and 2012 Medicare claims data and the 2011-2012 Medicare Inpatient Limited Data Sets. Outcome variables of interest were the likelihood of a hospital performing TAR and the volume of TAR cases, conditional on a hospital having performed at least 1 TAR in a year. Data from the 2010 Cost Report and from Medicare inpatient claims were utilized to compute average margins for TAR cases and overall hospital margins. TAR cost was calculated based upon the all payer cost-to-charge ratio for each hospital provided by the Healthcare Cost and Utilization Project. The FY2015 Impact File was used to gather data on hospital-level characteristics, such as bed size, census region, teaching status, and urban/rural location. Hospital ownership data were obtained from the CMS Hospital Compare Database. Nationwide Inpatient Sample (NIS) data was used to generate descriptive statistics on all TAR patients. Results: Medicare participants accounted for 47.5% of the overall population of patients. Orthopaedic specialty hospitals are four times more likely to perform TAR than a non-orthopedic specialty hospital. Average implant cost was $13,034, which accounted for approximately 70% of the total all-payer cost. With respect to teaching versus non-teaching hospitals, the average cost per case is $18,331 and $19,303 respectively. Compared to nonprofitable hospitals, profitable hospitals performing TAR in 2011 had lower total costs ($14,425 vs. $19,884) and higher payments ($19,631 vs. $13,640), leading to a difference in profit of approximately $11,000 from TAR surgeries between profitable and nonprofitable hospitals. Approximately, one-third of hospitals were profitable with respect to TAR. No difference was noted with respect to length of stay or number of cases performed between profitable and nonprofitable hospitals. Conclusion: There is an overall significant financial burden associated with performing total ankle replacement with many health systems failing to demonstrate profitability despite its increased utilization. Profitable hospitals are more likely to have lower cost per day and prosthesis costs and higher payments compared to nonprofitable hospitals. While additional factors such as improved patient outcomes are driving utilization of TAR, financial barriers exist that can affect utilization of TAR across health systems.
Assessment Inter- and Intraobserver Agreement in Two Radiological Indexes in True Lateral X-Rays View for Syndesmotic Reduction in Ankle Fractures
Authors: Briceno Jorge A. , Filippi Jorge , Abarca Mario C. , Mery Pablo , Villa Andres , Garcia Ignacio , Bernal Jaime 
Published: October 2016

Category: Trauma Introduction/Purpose: Malreduction of distal tibio-fibular syndesmosis in ankle fractures has been reported from 20% to 52% in surgically treated patients. Current intraoperative methods, fluoroscopy and intraoperative CT, have not improved consistently this results. Recently, new indexes to determine the normal anatomy of the syndesmosis have been published using a true lateral view of the ankle to evaluate the relation of the fibula with the tibia in the sagittal plane. These studies have been made in non- injured ankles. If these measurements could be performed intra operatively, they may improve the evaluation of syndesmotic reduction. To our knowledge this indexes have been not tested in injured ankles. The purpose of this study is to assess intra- observer and inter-observer agreement in two radiological indexes by evaluating true lateral x-ray view in surgically treated patients for ankle fractures with syndesmotic injury. Methods: Retrospective study of case series. Forty-three consecutive patients who underwent open reduction and internal fixation for ankle fractures with syndesmotic screw were evaluated. The inclusion criteria were syndesmotic injury fixed with one or two screws, and having a true lateral postoperative ankle x-ray view. Two measurements were performed: Anteroposterior Tibiofibular Ratio (APTF) and Anterior Tibiofibular Ratio (ATFR). Three independent evaluators performed the measurements. The intra-class correlation was used to determine inter- and intra-observer agreement, through statistical package SPSS 20. Results: The intra-observer and inter-observer agreement in the APTF was good to very good, with intra-class correlation values between 0.77 and 0.81; The reproducibility of the ATFR was also good to very good, but with lower intra-class correlation values between 0.62 and 0.79. Conclusion: Intra- and inter-observer concordance in APTF and ATFR in operated ankle fractures with syndesmotic injury was similar to that reported in healthy ankles. This study validates, in terms of intra and inter-observer agreement, the use of these indexes in surgically treated ankle fractures with syndesmotic repair. The next step is to compare these measurements made intra-operatively with a CT scan.
Biomechanical Comparison of the Holding Strength of a PEEK Locking Dorsal Plate Versus Lag Screw Fixation for Triple Arthrodesis
Authors: Sabatini Jefferson , Smith Kenneth S. , Eberhardt Alan , Kirchner John S. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Hindfoot arthrodesis is often the treatment of choice for hindfoot pain due to arthritis or advanced deformity. Good results are dependent on secure fixation while avoiding hardware related side effects. A small radiolucent locking dorsal circular plate placed into the talonavicular and calcaneocuboid joints may provide a low-profile solution for secure fixation of these joints. The goal of this study is to compare the fixation strength of a locking dorsal circular plate to that of the current gold standard technique of screw fixation. Methods: Eight matched fresh-frozen cadaveric foot-ankle pairs were obtained for comparison of the two fixation methods. One side of each matched pair was plated with a locking dorsal circular plate and the contralateral foot was fixed with partially threaded 4.5 mm cannulated screws. All subtalar joints were fixed with two 7.3 mm cannulated screws. Translational forces through a mechanical testing system (MTS) were applied to the constructs cyclically for 40 cycles followed by loading to failure. Displacement was recorded using two high-speed infrared cameras, following sets of orthogonal marker systems attached to each bone. Results: Cyclical loading trials found there to be no significant difference in resistance to motion between the two methods. However, specimens instrumented with plates had an approximately 400% higher load to failure (513.3 N vs 127.7 N) than specimens instrumented with screws. Conclusion: Locking dorsal circular plates are a viable option that provide equivalent and possibly better fixation strength than screw fixation for the talonavicular and calcaneocuboid components of a triple arthrodesis of the hindfoot. These plates are radiolucent allowing easy assessment of the fusion site. In addition, these plates have the theoretical benefit of being low profile to decrease tendon irritation and wound healing problems.
Bone-Block Arthrodesis Procedure in Failures of First Metatarsophalangeal Joint Replacement
Authors: Maccario Camilla , Grassi Miriam , Usuelli Federico G. , Manzi Luigi 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: The treatment of the failure of the first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding treatments options. The main issue is the available bone stock.The aim of the study was to report on clinical and radiographic results for MTP1 arthrodesis with autologous bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure. Methods: We enrolled 12 patients who underwent MTP1 prosthesis failures and retrospectively collected data. All the patient underwent removal of the prosthetic implant and simultaneous MTp1 arthrodesis with autologous bone graft, harvested from the ipsilateral calcaneus (minimum follow-up of 24 months). The minimum time period elapsed between the surgical procedure of prosthetic implant and the revision surgery has been 18 months. Patients were evaluated preoperatively with a weight-bearing radiograph of the foot and CT-scan and at 24 months after surgery with Foot Ankle Disability Index (FADI). Results: The reasons for implant-failures were: 8 mobilization and 4 malalignment. The average defect filled with bone-block was 12.2 mm. The fusion was performed with a plate and locking-screws. We had 3 cases of asymptomatic nonunion at the falangeal side of the fusion, none on the other side. Mean average rate of consolidation in other patients was 10 weeks. All patients returned to common activities’ of daily living. Average FADI was foun1d to be 84.6 at final follow-up. Conclusion: The management of this pathology is still controversial. Bone-block MTP1 arthrodesis The main limitation of the study is the small sample. seems to be a viable option.
Clinical Analysis of the Conservative Treatment for Treating Diabetic Foot Osteomyelitis
Authors: Chun Dong Il , Cho Jaeho , Park Chul hyun , Choi Hongjoon 
Published: October 2016

Category: Diabetes Introduction/Purpose: The question of surgical versus non-surgical treatment for diabetic foot osteomyelitis remains subject to debate. The aims of this study were to analyze the outcome of conservative treatment (antibiotics treatment and conservative surgery) for diabetic foot osteomyelitis and identify the predictive factors of remission in conservative treatment of diabetic foot osteomyelitis. Methods: 77 patients with diabetic foot osteomyelitis who were initially treated by conservative treatment from January 2004 to July 2013 were identified, and their medical records were reviewed. We defined diabetic foot osteomyelitis by imaging studies or histological evidence. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 12 months after the end of treatment. The demographic, clinical and therapeutic factors were analyzed. Results: The mean age of the patients was 62.6 years(SD=12.20), and 47(61.0%) of these patients were male. The median diabetes duration was 15.6 years(SD=11.20) and mean HbA1c was 8.7%(SD=2.40). Forty-eight (62.3%) patients healed with conservative treatment (antibiotics treatment and conservative surgery). Twenty-five(32.5%) patients underwentamputation. Inthe multivariate analysis, concomitant peripheral artery diseaseand inadequate antibiotics therapywere associated with failure of conservative treatment. Conclusion: Antibiotics alone, or with conservative surgery, were successful in treating diabetic foot osteomyelitis in 62.3% of the patients. Concomitant peripheral artery diseaseand inadequate antimicrobial therapy were risk factors for remission in diabetic foot osteomyelitis treated conservatively.
Clinical and Radiographic Evaluation of Total Ankle Arthroplasty with Custom Image Measurement Software
Authors: Kosugi Shinichi , Takakura Yoshinori , Tanaka Yasuhito , Matsumoto Yuki , Koeda Masanao 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Ceramic 2-component total ankle prosthesis, TNK-Ankle, has been used clinically as standard prosthesis in severe ankle osteoarthritis or rheumatoid arthritis for long years in Japan. Two-component prosthesis would require more precise replacing because of more constraint than mobile type. We would report the outcomes of total ankle arthroplasty (TAA) with TNK-Ankle investigated radiographically using custom image measurement software and compared with clinical scores. Methods: Twenty four cases of total ankle arthroplasty with TNK-Ankle for osteoarthritis in stage 3b and 4 operated by an expert surgeon from 2009 to 2013 have investigated on X-rays of preoperative unaffected and postoperative affected ankles. Clinical outcomes by JSSF score based on AOFAS score and SAFE-Q, patient-based questionnaire, were compared with radiographic measurements. Image analysis performed with custom OpenCV software programmed for this study. This could match translucent X-ray images, an unaffected lateral ankle image and an implanted lateral ankle image with TNK-Ankle, and measure differences in geometry of ankle joint for tibia and talus between two images. Results: Postoperative clinical outcomes were improved from preoperative on JSSF (from 57 to 90) and generally affirmative on each item of SAFE-Q at forty-six months follow-up. But three ankles had some subsidence and loosening of prostheses, two ankles needed revision surgeries. Their ankles were classified for revision and loosening group, and the other ankles were classified for non-loosening group. X-ray image measurements with the custom software had elucidated two dimensional geometry of postoperative implanted ankle compared to preoperative unaffected ankle joint and its differences between two groups. In Revision and loosening group, the top of tibial plafond of tibial component of TNK-Ankle was placed 7 mm anterior to the top of unaffected tibial plafond and more than 4 mm anterior in non-loosening group. Inclination of component in loosening and revision group was a little more than in non-loosening group. Conclusion: In this study it was indicated that a few case may have loosening and revision after TAA even if it was performed on correct indication and by an expert surgeon, and clinical results may be concerned in geometry of implanted ankle. Precise replacing of total ankle prostheses by means of navigation and image-guided surgery may produce better results means. Data accumulation by more radiographic measurements with digital tools must become useful for future navigation system. Custom- made software development suitable to research demand like this study would be more efficient.