bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subtalar Joint Alignment in Ankle Osteoarthritis
Authors: Krähenbühl Nicola , Zwicky Lukas , Deforth Manja , Hintermann Beat , Knupp Markus 
Published: September 2017

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is still a matter of debate. Although subtalar joint compensation of deformities above the ankle joint was proposed until mid-stage of ankle osteoarthritis, the evidence of this assumption is weak. In this study, we investigated the subtalar joint alignment in different stages of ankle joint osteoarthritis using weightbearing CT scans. The influence of the tibio-talar tilt and presence of subtalar joint osteoarthritis was additionally assessed. We hypothesized, that the subtalar joint compensates for deformities above the ankle joint in early- to mid-stage of ankle osteoarthritis. We also hypothesized, that subtalar joint compensation increases with a pronounced tibio-talar tilt and decreases with the presence of subtalar joint osteoarthritis. Methods: We included patients with ankle joint osteoarthritis treated in our institution from January 2013 to April 2016. A control group of 28 patients was additionally assessed. Varus and valgus ankles were subdivided according to the modified Takakura classification, the tilt of the talus in the ankle mortise and stage of subtalar joint osteoarthritis. The type of ankle osteoarthritis was diagnosed on a plain weightbearing anterior to posterior radiograph of the ankle. The medial distal tibial angle (TAS) and the angle between the tibial shaft and the surface of the talar dome (TTS) were measured. The subtalar joint alignment was assessed using weightbearing CT scans. Two angles were assessed: The subtalar inclination angle (SIA) was measured to investigate the subtalar compensation. For assessment of the morphology of the talus, the inftal-subtal angle (ISA) was determined. Results: This analysis showed significant differences of the subtalar inclination between varus feet and the controls (SIA, P=.001). Regarding the talar morphology, significant differences were found between varus/ valgus feet and the controls (ISA, P=.001 and .036, respectively). No significant differences of the subtalar joint inclination and talar morphology could be identified comparing different stages of ankle joint osteoarthritis inside the varus or valgus group. No relationship between the tilt of the talus in the ankle joint mortise and the subtalar joint inclination or talar morphology was identified. Neither presence nor absence of subtalar joint osteoarthritis influenced the subtalar joint inclination and talar morphology. Conclusion: Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation had no influence on the stage of ankle osteoarthritis, extent of the tibio-talar tilt and stage of subtalar joint osteoarthritis. Consequently, the progression of ankle joint osteoarthritis is more depended on the supramalleolar alignment and integrity of the periarticular structures (i.e. ligaments and tendons) than on the osseous alignment of the subtalar joint.
Treatment of Moderate Hallux Valgus by Percutaneous, Extra-articular Reverse-l Chevron (PERC) Osteotomy
Authors: Lucas Julien , Laffenetre Olivier 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a Percutaneous Extra-articular Reverse-L Chevron (PERC) osteotomy. Methods: A total of 38 patients underwent 45 PERC procedures. A medial approach is used just proximal to the flare of the metatarsal head. The osteotomy is performed using a burr, the thickness of which is selected according to the planned correction and shortening. A second dorsolateral approach is then performed and the osteotomy is fixed using a self-drilling, self-tapping 3 mm diameter cannulated and headless compression screw. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results: The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion: Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy. Its main asset is that it maintains an excellent range of movement; other advantages relate to the procedure being performed on an outpatient basis and the absence of tourniquet use.
Age-Related Outcome of Mobile-Bearing Total Ankle Replacement
Authors: Maccario Camilla , Vulcano Ettore , Indino Cristian , Manzi Luigi , Usuelli Federico Giuseppe 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is becoming increasingly popular amongst patients with end-stage ankle arthritis. This is in part related to the advances in design, technology, and technique that have improved TAR longevity. The ideal candidate for a TAR is not fully clear. For a long time patients over age 50 years, body mass index (BMI) under 30 kg/m2, and with low functional demands represented selection criteria for many patients. However, these criteria were based off a very limited number of scientific studies on older TAR designs. The aim of this study is to investigate clinical and radiographic outcome in patients of 50 years or less versus patients over 50 years undergoing a Hintegra® total ankle replacement (Integra, Plainsboro, NJ). Methods: This study includes 70 consecutive patients who underwent primary TAR from May 2011 to April 2014. The cohort was divided into 2 groups: the young group (YG) with age less than or equal to 50 years, and the older group (OG) with age above 50 years. Patients were assessed clinically and radiologically preoperatively and at 6, 12 and 24 months postoperatively. Results: A significant increase in the AOFAS and SF-12 and decrease in VAS scores was seen in both groups between preoperative and final followup (p < 0.001). There was a statistically significant difference between the YG and OG for the AOFAS score at final follow-up. The YG had significantly greater improvement compared to the OG (p = 0.046). In addition radiographic results showed no statistically significant difference in the coronal and sagittal alignment between the 2 groups. The mean postoperative angles in either study group demonstrated significant improvements compared to the preoperative alignment. Conclusion: This study demonstrates that total ankle arthroplasty is an effective short-term treatment for young, active patients with symptomatic end-stage ankle arthritis. Our findings are in disagreement with the widespread theory that ankle replacement is a more reliable treatment in the elderly
Reading the Future
Authors: MacDonald Ashlee , Houck Jeff , Baumhauer Judith 
Published: September 2017

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus is a common condition of the foot with 4.4 million patients seeking care yearly for this condition. A previous study suggested specific pre-operative cut-off scores based on Patient Reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PI), and depression (D) values could predict post-operative outcomes in foot and ankle surgery. Though hallux valgus correction, among other procedures, were identified as one of the most common surgeries in the previous study, specific conditions were not considered separately. The purpose of this study was to evaluate the validity of applying a published comprehensive pre-surgical PROMIS profile of PF, PI and D to patients undergoing bunionectomy surgery. Methods: PROMIS scores were prospectively obtained from patients evaluated in a specialty foot and ankle clinic between February 2015 and November 2016. Using ICD-9/10 and CPT codes, a total of 65 patients with hallux valgus who underwent a bunionectomy by a single surgeon were identified. Those with less than two-month follow-up, multiple procedures during the follow-up period, and incomplete PROMIS assessment scores were excluded, resulting in 42 patients. Using pre-operative scores and scores at the last follow-up visit, minimally clinically important differences (MCID), receiver operating characteristic (ROC) curves, and area under the curve (AUC) were obtained to determine if pre-operative PROMIS scores predicted achieving MCID with 95% specificity or failing to achieve a MCID with 95% sensitivity. New cut-off values were then compared to the previous study. Results: The AUC for PF (p=0.01) and Mood (p=0.03) were significant. However, PI AUC was not significant (p=0.14). The PF cut off for 95% specificity of exceeding MCID was 39.6 and 50.2 for 95% sensitivity for failing to achieve MCID. The D cut off for 95% specificity of exceeding MCID was 39.4 and 58.1 for 95% sensitivity for failing to achieve MCID. Patients below the 50.2 threshold (n=27) had significantly greater improvements on PF (2.3 95% CI 0.5 to 4.3) and PI (-3.8 95% CI -6.9 to -0.7) but not D. Patients above the 50.2 cut off (n=15) were significantly worse on PF (-7.3 95% CI -12.0 to -2.7) at this short follow up and were statistically unchanged on PI and D. Conclusion: This data confirms that pre-surgical PROMIS PF and Depression scores are significant post-surgical predictors. However, cut-off scores for 95% sensitivity/specificity were one standard deviation higher for PROMIS PF (>50.2 versus previous study >42) and similar for Depression (<39.4 versus previous study <41.5) as compared to all foot and ankle surgeries. Patients meeting the new cut-off (>50.2) experienced significantly better outcomes on all PROMIS scales and patients not meeting the cut- off (~30%) were significantly worse. Although longer term follow-up is desirable, this short term follow up suggests a significant clinical impact of using PROMIS scores for pre-surgical decisions.
Functional Outcomes of Revision Total Ankle Arthroplasty
Authors: Michnick Stuart , Brage Michael , Lauder Alexander 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle arthritis treatment options have advanced over the recent years to include total ankle arthroplasty (TAA). There are known long term consequences of ankle arthroplasty such as aseptic loosening and infection. As the popularity of ankle arthroplasty increases, the need for revision total ankle arthroplasty is also increasing. There is a paucity of reported functional outcomes for revision ankle arthroplasty in the literature. This study aims to assess the functional outcomes following revision TAA and compare these with functional outcomes for patients following primary TAA. Our hypothesis is that patients with revision TAA will perform more poorly on functional tests than patients with a primary TAA. Methods: This is a non-randomized prospective and retrospective review. All patients who underwent revision TAA with a modern implant at our institution were included in a retrospective cohort analysis. Additionally, patients who underwent primary TAA with a modern implant were also included as a separate group. Included patients had complete records following TAA with a minimum of one-year follow-up from the time of surgery. Functional outcomes were measured in terms of patient self-reported questionnaires administered via mail survey. Short Form 36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were utilized to assess patient functional outcomes. Data was analyzed using a Mann-Whitney U test and an independent-t test to determine if there was a significant difference between each study population. A total of 44 patients who underwent a revision TAA were identified and 24 returned surveys. 89 men and women were identified and 43 returned a survey. Results: When evaluating SF-36 survey results between primary and revision TAA, a statistically significant correlation was found in the physical functioning (p<0.01), physical role functioning (p=0.01), vitality (p=0.02), social functioning (p=0.04) and bodily pain (p<0.01) categories. The revision TAA patients scored worse in each category. Additionally, FAAM results in both the activities of daily living and sport categories (p<0.01) yielded a significant correlation with the primary TAA patients scoring better. Conclusion: In our study, patients performed better after a primary TAA with better SF-36 scores in multiple categories, especially categories which tested the patient’s perception of their physical health. Additionally, patients performed better in both FAAM categories after a primary total ankle arthroplasty. Overall, patients functioned more poorly in physical activities and vitality after a revision TAA compared to a primary TAA. They were not affected as much from an emotional standpoint. This data can help educate prospective patients on what to expect after a revision arthroplasty when compared to their already completed primary TAA.
Does it Need Operation in Pediatric Triplane Fracture?
Authors: Park Chul-Hyun , Choi Hongjoon , Chun Dong-Il , Cho Jaeho , Park Jaewoo 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: The proper treatment of triplane fractures is still controversial. The purpose of this study was to compare the clinical and radiographic outcomes of nonoperative and operative treatments of triplane fractures and to clarify whether operative treatment is always necessary for triplane fractures with displacements of >2 mm. Methods: Thirty-three patients who were diagnosed as having triplane fractures between January 2007 and January 2014 were reviewed. The first 19 consecutive patients were treated conservatively with closed reduction regardless of age, sex, and fracture severity (nonoperative group), and the latter 14 patients were treated surgically (operative group). Clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and modified Weber protocol (MWP) scores. Bone union, plafond varus and valgus, presence of, leg-length discrepancy (LLD), premature closure of the growth plate, and posttraumatic arthritis were radiographically examined. Results: The mean AOFAS score was 100 for the nonoperative group and 98.1 for the operative group, showing no statistically significant difference between the groups (P = 0.304). The MWP scores were excellent in both groups. One patient in each group showed a LLD of >10 mm at the last follow-up. None of the patients had nonunion, plafond deformity, premature closure of the growth plate, and posttraumatic arthritis. Conclusion: Nonoperative treatment of triplane fracture is comparable with operative treatment in terms of clinical and radiographic results. Therefore, we suggest that nonoperative treatment may be a better option than operative treatment for triplane fracture, considering the risk of psychiatric trauma from surgery and the necessity of implant removal.
Minimally Invasive Fasciotomy for Chronic Exercise-Induced Compartment Syndrome
Authors: Pellegrini Manuel , Carcuro Giovanni , Muñoz Gerardo , Somarriva Marcelo , Cuchacovic Natalio , Birman Eddie , Muñoz Francisco 
Published: September 2017

Category: Sports Introduction/Purpose: Chronic? exercise-induced compartment syndrome (CEICS) is a commonly misdiagnosed source of pain. Although CEICS is seen infrequently in the general population, its incidence in high-performance athletes is estimated to be 0.49 per 1000 per year. Delayed diagnosis should be avoided, as irreversible sequelae can result, often causing sports retirement. We present our experience in diagnosis and treatment of CEICS. Methods: After IRB approval, we conducted a retrospective patient chart review. Patients were included if they were older than 18 years, experienced leg pain after 30 minutes of intense exercise, had a normal-appearing leg MRI, and failed conservative therapy for a minimum of six-months. Patients were excluded if they were diabetic or neuropathic. Significant increments in post-exercise compartment pressure were demonstrated in all patients using Whitesides’ measurement technique. All patients were operated on with minimally invasive fasciotomy and followed for a minimum of 6 months. Complications, functional outcomes (FAAM, FAOS & LEFS), and return-to-sports time were documented. Results: Seven male patients met inclusion criteria, with a mean age of 29 years (20-45). Four patients presented pain in the left leg, and three patients were symptomatic in both the right and left legs. All patients had an incremented pressure differential in the anterior compartment, while two exhibited a concomitant pressure increment in the lateral compartment. Postoperatively there was a significant subjective improvement in pain, functionality, and sports performance. High functional scores (FAAM x=92.4, FAOS x=90.3, and LEFS x=72) were documented at 6 months follow-up. Patients returned to sports at an average of 15 weeks and resumed a pre-surgery sports level at an average of 24 weeks. No complications were observed. Conclusion: Our results suggest that CEICS can be approached safely through a minimally invasive fasciotomy, with satisfactory functional outcomes and return to sports in the short term follow-up.
Non-restricted weight-bearing after modified Lapidus arthrodesis
Authors: Pellegrini Manuel , Carcuro Giovanni , Cuchacovic Natalio , Muñoz Gerardo , Somarriva Marcelo 
Published: September 2017

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.
Utilization of Retrofusion screw for PIP fusion for treatment of hammertoes
Authors: Ran Henry , Palisch Andrew , Ahuero Jason 
Published: September 2017

Category: Lesser Toes Introduction/Purpose: The rigid hammertoe deformity requires realignment of the proximal interphalangeal joint. Traditionally this has been achieved with resection arthroplasty with K-wire fixation of the joint. However, this method is prone to complications such as pin migration, pin tract infection, pin breakage, nonunion, and malunion. Recently, a variety of treatment options have been developed to achieve appropriate PIP joint fusion while minimizing these risks. This study investigates the fusion rate and outcomes of a novel internal fixation screw. Methods: A retrospective review was done to determine the short term fusion and satisfaction rate of hammertoe corrections performed by 2 surgeons utilizing a specifically designed longitudinal compression screw. A typical dorsal approach to the PIP joint was performed, followed by a resection arthroplasty, and the screw was inserted in the appropriate described manner. At the last follow up, the radiographs and clinical condition was observed. The fusion and alignment of the joint were then analyzed by an orthopaedic resident (PGY3), an orthopaedic attending, and a musculoskeletal radiologist. Clinical satisfaction and appearance was derived from chart review. A total of 55 screws were placed in 40 patients. Thirty-nine of these toes were second toes, 12 were third toes, and 4 were fourth toes. This implant was not designed for the fifth toe. The median final X-ray follow up was 10 weeks (range 5 to 40 weeks). Results: After evaluation of the post-operative X-rays by all 3 evaluators, at least 76% of these toes were definitively fused. About 13% of the joints were difficult to judge for radiological union based on the available X-rays. Approximately 11% of the joints went into nonunion or were not fused by final (typically asymptomatic) follow up. Two toes (3.6%) had persistent pain and swelling at the last visit. Two toes (3.6%) had slight misalignment (more than 5 degrees of varus/valgus), and only one was a cosmetic issue. No toes changed in alignment from the immediate post-operative position. There was no evidence of post- operative infection in the entire series. None of the toes required a return to the operating room for any reason. Conclusion: Compression screw fixation for the treatment of hammertoe deformities is a relatively effective method in that it demonstrates reasonable rates of radiographic union with very high rate of symptomatic relief. There were no complications associated with infection or loss of alignment. Furthermore, even in patients without firm evidence of bony union, the presence of an intramedullary implant maintains alignment while relieving symptoms.