bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is there a Relationship between Bone Morphology and Injured Ligament on Imaging Studies and Laxity on Ankle Stress Radiographs?
Authors: Lee Seung Yeol , Kwon Soon-Sun , Park Moon Seok , Sung Ki Hyuk , Koo Seungbum , Kim Sung Jin , Sangyeop Shin , Choi Hyun , Chun Sangho , Lee Kyoung min 
Published: September 2017

Category: Ankle, Sports Introduction/Purpose: We hypothesized that the bony configuration of the ankle could also be associated with ankle stress radiographs, in addition to ligament injury of the ankle. Therefore, this study aimed to investigate the relationship between bone morphology and injured ligament on imaging studies and laxity on ankle stress radiographs in patients with lateral ankle instability. Methods: In total, 115 patients who had undergone ankle MRI, ankle radiography, and stress radiography were included. Distal tibial articular surface angle, bimalleolar tilt, medial and lateral malleolar relative length, medial malleolar slip angle, anterior inclination of the tibia, and fibular position were measured on ankle radiographs. Tibiotalar tilt angle and anterior translation of the talus were measured on ankle stress radiographs. Degree of ligament injury was evaluated on ankle MRIs. Multiple regression analysis was performed using the following independent variables: age, sex, and factors significantly associated with ankle stress view on univariate linear regression analysis. Results: Age (p = 0.041), sex (p = 0.014), degree of anterior talofibular ligament injury (p < 0.001), and bimalleolar tilt (p = 0.016) were correlated with tibiotalar tilt angle (Table). Younger patients demonstrated a larger tibiotalar tilt angle than older patients, and the angle decreased by 0.07° per year of age. Tibiotalar tilt angle in female patients was 2.2° larger than that in male patients. Fibular position and degree of posterior talofibular ligament injury were factors significantly related to anterior translation of the talus. Conclusion: Differences in patient characteristics might predispose ankle stress radiograph results. Comparison of both ankles on stress radiographs is superior to applying fixed numerical values to the injured side, in order to reduce the influence of patient factors.
Safe Zone for the Plantar Portal
Authors: Maeda Shingo , Hirano Takaaki , Yui Akiyama , Mitsui Hiroyuki , Niki Hisateru 
Published: September 2017

Category: Arthroscopy Introduction/Purpose: Open surgery of the sole of the foot requires an extensive amount of soft tissue to be dissected. In recent years, various types of endoscopic surgery for the sole of the foot have been reported, making it possible to dynamically evaluate and treat plantar lesions with a small skin incision and minimal dissection. However, there have also been reports of complications involving plantar nerve injury. A good knowledge of the plantar nerve anatomy is crucial for safe endoscopic surgery of the sole. We aimed to anatomically dissect the soles of cadaveric feet to investigate the safe zones for plantar portals. Methods: We studied 36 feet of 24 cadavers. The soft tissue of the sole was dissected, and the relationships between the plantar nerve and flexor digitorum longus tendon, flexor hallucis longus tendon and peroneus longus tendon were studied. The plantar nerve course was digitally imaged and uploaded into Image J software to determine the nerve position. The back of the calcaneus, the medial side of the base of M (Metatarsal) 1, the medial side of the head of M1, the lateral side of the head of M5, and the proximal tip of M5 were plotted and defined as A, B, C, D, and E respectively on Image J. The nerve courses were plotted on AB, BE, and CD, and the percentage at which they were positioned on the line segment was calculated. Next, the bifurcation positions of each nerve were plotted and measured to the defined line segments. Results: No major differences were noted in the course of the medial plantar nerve and lateral plantar nerve. The medial plantar nerve and lateral plantar nerve ran between B and E, at 32.4% ± 4% and 61.2%± 5.1% respectively from B. No plantar arteries were found to run between the medial plantar nerve and lateral plantar nerve on BE. Taking mean and standard deviation values into account, no neurovascular structure existed from 36.4% to 56.1% along a line between the medial aspect of the base of M1 to the proximal tip of M5. The flexor digitorum longus tendon and peroneus longus tendon passed through the deep layer of this region. Conclusion: We believe this region to be a safe zone for creating plantar endoscopic portal. The plantar central portal can be created at the center of the sole. An approach from the plantar central portal to the flexor digitorum longus tendon, flexor hallucis longus tendon, and peroneus longus tendon with the plantar lateral portal, posteromedial portal, and toe portal allows for a greater range of vision and treatment options and may further advance endoscopic surgery of the sole.
Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures
Authors: Matson Andrew , Barchick Stephen , Adams Samuel 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Open approaches are often used for the operative treatment of medial malleolar (MM) fractures. Compared to percutaneous approaches, open approaches may entail an increased risk of operative morbidity, postoperative pain, wound complications, and reoperation for hardware removal. However, inherent to minimally invasive or percutaneous techniques is incomplete fracture visualizationwhich may hinder acceptable reduction. In this study, we aimed to compare patients treated with closed reduction and percutaneous fixation (CRPF) to those patients treated with traditional open reduction and internal fixation (ORIF). We hypothesized that the two groups would be similar with regard to patient factors, injury variables, and outcomes. Methods: The study group consisted of 184 consecutive patients who met inclusion criteria and were treated with operative fixation of a MM fracture from 2011-2015 at a single institution. Forty underwent CRPF and 144 underwent ORIF. Patient demographics, injury characteristics, treatment methods, and outcome variables were recorded through review of patient charts, radiographs, and operative reports. Results: Patient variables were similar between groups except for years of age, which was greater on average in the CRPF group (55 vs. 48, p = 0.03). The CRPF treatment group had a higher rate of initial open injury (22% vs. 7%, p<0.01), a lower rate of MM fracture comminution (12% vs. 29%, p = 0.03), and a higher rate of provisional external fixation (35% vs. 14%, p<0.01). There was no statistically significant difference observed between the CRPF and ORIF groups with regard to outcomes including: nonunion (2% vs. 3%), malunion (10% vs. 5%), time to union (10 weeks, each), removal of hardware (8% vs. 14%), or wound complications (0% vs. 4%). Conclusion: Both CRPF and ORIF resulted in acceptable radiographic outcomes and low complication rates for the treatment of MM fractures. Compared to the ORIF group, patients in the CRPF group on average were older and more often had comminution, open fractures, and provisional external fixation.
MRI evaluation with severity of ankle osteoarthritis
Authors: Mitsui Hiroyuki , Hirano Takaaki , Yui Akiyama , Maeda Shingo , Niki Hisateru 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: Takakura-Tanaka classification is effective as an X-ray evaluation method for determining the severity of and treatment strategy for ankle osteoarthritis (OA). Concerning OA, MRI is gaining attention as a tool for examining the condition of the articular cartilage over X-ray findings. However, there are few reports on the relationship between MRI and X- ray findings in ankle joints. We assessed MRI findings of ankle OA at each stage of Takakura-Tanaka classification to investigate the effects of bone and articular cartilage. Methods: We studied the localization of Bone Marrow Edema (BME) partitioned articular surface by MRI in 22 regions at the talocrural, talocalcaneal, talonavicular, and calcaneocuboid joints of 46 feet of 45 patients who had a diagnosis of ankle OA in our hospital. Furthermore, we compared the radiological findings with the localization of BME. Results: By MRI, the area where BME was seen is located in the anterior medial part of the talocrural joint. Pointedly, 60% of BME was confirmed on the tibial side of the talocrural joint. In addition, as the Takakura-Tanaka classification advanced, the identification of BME tended to increase on the anterior of the talus and the medial malleolus articular surface. Conclusion: We found on MRI that the localization of BME was identified by Takakura-Tanaka classification in osteoarthritis of the foot. On the other hand, there are some cases of OA without BME that were identified by X-ray in this study. In the future, there is a possibility that the severity of OA can be classified into more inclusive classifications by MRI. We intend to combine the severity of ankle OA with MRI findings and Takakura-Tanaka classification together.
Complication rates and short-term outcomes similar after hammertoe correction in older patients
Authors: Mueller Claire , Boden Stephanie , Labib Sameh , Bariteau Jason 
Published: September 2017

Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are common lesser toe deformities and multiple methods exist for surgical treatment. The population continues to age and to date, no studies have looked specifically at outcomes in the geriatric cohort, who are often at greater risk of complications or functional compromise due to increased co-morbidities. This study examines differences in short-term outcomes of pain, improvement of SF-36 scores, and complication rates in younger compared to older patients who underwent surgical correction of hammertoe deformities. Methods: 47 patients undergoing surgical correction of hammertoe deformities were prospectively followed. All surgical procedures were performed by a single surgeon and the specific surgical technique was tailored to each patient’s deformity. All patients were treated with early mobilization and progressive weight-bearing as tolerated. Subjective assessment of function was obtained using pre-operative and post-operative Visual Analogue Scale (VAS) and Short Form Health Survey (SF-36) scores with a minimum of six-month follow-up. 38 patients met inclusion criteria for length of follow-up (5 males, 33 females). Patients were divided into two groups based on age at the time of surgery (those younger than sixty years old, and those older than sixty years old). The improvements in mean (+/- SEM) VAS and SF-36 scores for patients younger than sixty years were compared to outcomes of patients older than sixty years of age, and results were assessed for statistical significance using a student’s t-test. Results: The mean age was 46.4 +/- 4.1 years in the younger patients and 68.0 +/- 1.2 years in the older cohort. The mean improvement in VAS score from pre-op to six months post-op was 2.8 +/- 0.8 and 2.8 +/- 0.6 (p = 0.95) in the younger and older cohorts, respectively (Table 1). The mean improvement in SF-36 Physical Component Score from pre-op to six months post-op was 8.6 +/- 6.7 and 6.7 +/- 4.4 (p= 0.81) in the younger and older cohorts, respectively. The mean improvement in SF-36 Mental Component Score was 1.5 +/- 3.7 and 1.4 +/- 4.2 (p=0.99) in the younger and older cohorts, respectively. One complication occurred in the younger cohort (0.11%) and no complications were reported in the older cohort. Conclusion: Outcomes of surgical correction of hammertoe deformities in older patients were similar to outcomes in younger patients at short-term follow-up. The study had sufficient power to detect differences in means as small as 5-8% depending on the specific outcome parameter. This study establishes a cohort of patients who will be followed to determine the effect of age on long-term outcomes of pain, SF-36 scores, and complication rates of surgical correction of hammertoe deformities. Future studies will also compare radiologic outcomes of hammertoe deformities preoperatively and postoperatively.
Anterior Talofibular Ligament Abnormalities on Routine Magnetic Resonance Imaging of the Ankle
Authors: O’Neil Joseph , McDonald Elizabeth , Chapman Talia , Casper David , Shakked Rachel , Pedowitz David 
Published: September 2017

Category: Ankle, Sports, Trauma Introduction/Purpose: The anterior talofibular ligament (ATFL) is one of the most commonly injured structures of the lower extremity after an ankle sprain. Evidence of remote injury to this structure is frequently encountered on magnetic resonance imaging (MRI) of the ankle, with uncertain clinical significance. Previous studies in the orthopaedic literature have discussed the prevalence of abnormal MRI findings in asymptomatic patients, most notably with regards to the spine and shoulder. More recently, a study on the prevalence of peroneal tendon abnormalities on routine MRI of the ankle was published. However, to our knowledge, no such study exists for the ATFL. The purpose of this study is to determine the prevalence of abnormal findings of the ATFL on MRI in asymptomatic individuals. Methods: All foot and ankle MRIs performed at our institution over a 4-month period were considered for inclusion in our study. Studies were excluded if performed on patients with documented ankle inversion injuries, ankle sprains, lateral ankle trauma, tenderness over the ATFL, or ankle instability. A total of 320 MRIs were eligible for inclusion. The integrity of the ATFL was noted in addition to the primary pathology. Results: The median age of the patients included in this study was 51 years with 203 females (63%) and 117 males (37%). One hundred eighteen (37%) of the 320 MRIs demonstrated some ATFL pathology. The most commonly encountered ATFL pathologies were thickening (38%), chronic tear (35%), attenuation (25%) and acute tear (2%). Conclusion: The results of this study demonstrate that a sizeable percentage of asymptomatic individuals (37%) will have ATFL abnormalities on magnetic resonance imaging of the foot and ankle. This study can have important clinical implications for patients who present with concerning MRI findings that do not correlate clinically. Based on our results, orthopaedic surgeons or any other physician providing musculoskeletal care can provide counseling and reassurance to patients who present with ATFL pathology on MRI but an absence of clinical findings. Much like MRI of the shoulder or spine, abnormalities must be correlated with the clinical exam.
Outcomes after Lengthening Calcaneal Osteotomy for Flexible Flatfoot Deformity– Evans versus Hintermann Osteotomy
Authors: Plaass Christian , Ettinger Sarah , Claassen Leif , Yao Daiwei , Stukenborg-Colsman Christina , Daniilidis Kiriakos , Mattinger Tim 
Published: September 2017

Category: Hindfoot Introduction/Purpose: Evans and Hintermann calcaneal osteotomies are commonly used to correct flexible pes planovalgus deformity. Both methods are well accepted with good clinical results. The aim of this study was to compare the outcomes after Evans or Hintermann osteotomy. Methods: We retrospectively examined 49 patients who were operated for the treatment of flexible flatfoot deformity between October 2007 and March 2014. Sixteen Evans and 36 Hintermann osteotomies were performed. The data was collected using clinical and radiological examination as well as clinical scores (FAOS, SF-36) during regular follow-up. A paired t-test was used for statistical analysis. A one-way anova with the Holm-Sidak’s multiple comparisons test was used to compare non-parametric data. Results: The mean age was 39.6 ± 18.69 years in the Hintermann (H) group and 32.8 ± 17.86 years in the Evans (E) group. The mean follow up was 67.67 ± 20.57 months in the E- and 39.71 ± 12.77 months in the H-group. In both groups FAOS and SF-36 improved significantly (p<0.05). The hindfoot alignment improved significantly in both groups (p<0.05). The mean time to return to work and sports was 14.25 ± 8.92 and 19.0 ± 18.62 weeks in the E-group, 19.36 ± 16.71 and 28.25 ± 20.07 weeks in the H- group. Seven patients of each group needed an implant removal; one patient underwent an arthrodesis of the subtalar joint in the E-group. There were no significant differences between the outcomes of both groups. Conclusion: Both surgical techniques lead to good correction of the flatfoot deformity and show a significant improvement of the clinical outcome scores. Neither of these two surgical techniques can be identified as being superior.
Three-dimensional Analysis of the Talocrural Joint Axis
Authors: Plaass Christian , Claassen Leif , Stukenborg-Colsman Christina , Yao Daiwei , Daniilidis Kiriakos , Ettinger Sarah , Nowakowski Andrej 
Published: September 2017

Category: Ankle Introduction/Purpose: The total ankle replacement (TAR) is increasingly used in cases of severe ankle arthritis. Although the knowledge about joint kinematics is crucial for designing and positioning of TAR there is no consensus about the talocrural joint axis. The aim of the present study was the determination of the kinematic rotational axis of the talocrural joint as an orientation for prosthesis positioning. Methods: We analyzed 96 CT-scans of full cadaver caucasien legs. With the software Mimic, 3-Matic (both Materialize) and GOM inspect we generated three-dimensional reconstruction models of the talus and a best fitting cone orientated to the talar articular surface. The kinematic rotational axis was defined to be the axis of this cone. Results: The determination of the kinematic rotational axis showed a high inter- and intrarater reliability. The kinematic rotational axis of the talocrural joint is orientated from lateral-distal to medial-proximal (84.9° ± 8.5 compared to mechanical tibial axis in frontal plane), from dorsal-proximal to anterior-distal (93.1° ± 42.3 compared to mechanical tibial axis in sagittal plane) and from dorsal-lateral to anterior-medial (169.0° ± 6.7 compared to mechanical tibial axis in axial plane). A high standard deviation especially in the sagittal plane was noteworthy. Conclusion: With the present study we present a new reproducable single-axis model of the talocrural joint. Our data showed relevant interindividual variations. The consideration of these variations might support the development of patient-specific TAR implantation techniques.
Enhanced Treatment
Authors: Raheman Firas , Ahluwalia Raju , Kavarthapu Venu 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Ankle fracture fixation has commonly been undertaken with an inpatient process due to swelling and surgery may not always be conducted on the next available operating list. In the UK there has been a move over the last 5 years to manage many trauma cases semi-electively and within the day case departments, to give patients more choice in their treatment. We conducted a study looking at the impact of a home therapy ankle pathway combined with day case- surgery on the length of stay and safety of patients with ankle fractures requiring surgical fixation conducted by group consultant trauma surgeons and their teams. Methods: Patients were assessed in two periods from Jan 2015 to Dec 2016; all patients were placed in a plaster of paris back slab in casualty with the ankle reduced, limb care advice given – elevation, cooling and DVT thromboprophylaxis. A group of patients were assessed for home therapy and day case surgery and were then discharged home on crutches after a slot was determined on a rapid access trauma list typically six days later. Patients who were not suitable for home therapy were excluded from review. We compared two cohorts of patients with weber B fractures whom choose surgical fixation, which would have been suitable for both day case and in-patient care over a 12-month period. We performed a prospective audit of the cases undertaken and analysis of the number of cases, complications and the cost benefits Results: 143-patients identified; 21 patients identified for home-therapy & day-case, and 32 patients for inpatient management. Within home-care & day case group: 1-tri-malleolar-fracture, 11-bi-malleolar fractures and 9-uni-malleolar and within inpatient group there were a similar mixture of fracture patterns. Time-to-surgery for inpatient management was 2.38 (1-16d) days; length of stay was 4.94 days (2-31d). Home-care & day-case time to surgery was 5.8 days (2-7). No patient admitted following surgery. All patients followed to pre-morbid ambulation levels. One DVT confirmed in the inpatient group no-wound-complications or failures of fixation reported. A mean 1.5 hrs operating time was required (59.3 min tourniquet time); day-case-surgery is £228 per patient cheaper than in- patient surgery. Cost efficiency based on 4.94 bed-day-improvement is 158 bed-days a cost-saving of £1,235 per patient. Conclusion: We believe home-care and day-case ankle fracture surgery is both valid and cost effective in optimizing the management of the appropriate ankle fractures without any significant rise in co-morbidity. For the patient there is little difference in waiting times and a pre planned surgical episode can give them flexibility to plan their treatment. The total potential saving per patient to the health care provider could be approx. £1,486 per patient. Furthermore, in our healthcare system it reduces demand for inpatient beds, provides significant cost savings for the provider and improves patient satisfaction due to choice and reduction wasted bed days
Prevalence and Associated Factors of Severe Disease in an Athletic Population
Authors: Sartorelli Elena , Martinelli Nicoló , Hosseinzadeh Mohammad , Bonifacini Carlo Corrado , Romeo Giovanni , Prati Alberto Bianchi Castagnone 
Published: September 2017

Category: Hindfoot, Sports, Children Introduction/Purpose: Sever disease is a common cause of pain in growing kids, but there is no consensus among researchers regarding its etiology. Recently several papers studied the role of sport on the physical and the psychological development of the child, including the possibility that these activities can cause overuse injuries in childhood. The purpose of the present study is to identify any association between heel pain due to calcaneal apophysitis and level of sport activity, type of sport, type of terrain, body mass index (BMI) and foot posture. Methods: We studied 430 athletic children in a population-based sample of soccer (29.53%), basketball (48.37%) and volleyball (22.79%) players, aged between 6 and 14 years. Physical examination, Foot Posture Index (FPI), Oxford ankle and foot questionnaire Italian version for children and parents and a custom made questionnaire on sport were collected from each athlete. Diagnosis of Sever disease was made with a positive heel squeeze test. Results: Our data showed that body mass index, sex, type of terrain, type of sport, FPI should not be considered risk factors for calcaneal apophysitis, while exists a statistical significant higher risk for younger age (p < 0.01), lower number of training session/week (p = 0.02) and shorter session (p < 0.01). Conclusion: The prevalence of Severe disease in athletic children in the study sample was higher in younger and low active patients. BMI was not associated with an increased risk neither sport specialization. Investigating association between the type of terrain and Sever disease it does not appear to have a significant role. Analysis of the FPI produced no significant risk factors. The strengths of this study consists in a large population size, all participants underwent clinical assessment, and the use of a detailed, previously validated test, scales and questionnaire.