bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Affecting the Formation of Post-Traumatic Subtalar Arthritis Following the Intra-Articular Calcaneal Fracture
Authors: Angthong Chayanin 
Published: October 2016

Category: Hindfoot Introduction/Purpose: The present study was performed to prospectively follow up the arthritic changes of subtalar joint following the intra-articular calcaneal fractures in 38 patients. Methods: A total of 38 patients with intra-articular calcaneal fractures were prospectively studied with a mean follow-up as 17.4 months. Conventional fixations were performed in 27 patients by several surgeons. Arthroscopic-assisted reduction and internal fixations were performed in 11 patients by a single foot-ankle fellowship trained surgeon. Baseline data, including postoperatively radiographic alignment, arthritic changes, osteochondral lesion characteristics via modified Outerbridge classification and locations of lesions at calcaneal/talar side, and arthroscopic treatment procedures, were collected. Statistical analyses were performed to compare the prevalence and characteristics of the osteochondral lesions between the group with or without post-traumatic arthritic changes. Results: Based on the interpretation of radiographic parameters by a single foot-ankle fellowship trained surgeon, there were 8 patients (21.1%) showed the arthritic progression. Acceptable reduction (fracture step/gap < 2 mm) was found in 31 patients (81.6%) in overall. No significant difference of the quality of fracture reduction was found among the groups (none, mild, significant progression of arthritis). In subgroup analysis in patients with arthroscopic-assisted reduction and internal fixations, there was no significant difference of the prevalence of osteochondral lesions among the groups. Conclusion: The prevalence of post-traumatic subtalar arthritis was found in X-rays around one in 5 patients with the intra- articular calcaneal fractures in short-term follow-up. No definitive factors affecting arthritic changes were found in this study. Further investigation is needed to identify these factors in longer term of follow-up.
Functional Range of Motion Following Total Ankle Replacement
Authors: Marks Richard M. , Huntington William P. , Brennan Stephen M. 
Published: October 2016

Category: Ankle Introduction/Purpose: Total ankle replacement (TAR) is an accepted option for the surgical treatment of end-stage ankle arthritis. The potential benefit of TAR over ankle arthrodesis is the preservation of motion following TAR, however, little is reported concerning the true gain of range of motion (ROM) following TAR. This study compares standard goniometric measurements with two radiographic measurement techniques, as well as reports the changes in ROM following TAR. Methods: Between 2007 and 2012, 48 TAR in 46 patients were performed by a single surgeon, using a modern, fixed-bearing design. 40 patients (19 female, 21 male) had complete clinical and radiographic follow-up greater than 2 years postoperatively. Mean age at surgery was 73 +/- 9 years. Patients were evaluated with pre-operative and 2 year post-operative goniometric weight- bearing exam, as well as plantarflexion (PF) and dorsiflexion (DF) lateral radiographs. Radiographs were analyzed using the talocrural method, which measures the angle between the long axis of the tibia and talus, as well as a “full foot” method, which utilizes the angle created by the long axis of the tibia and medial cuneiform. The difference between the PF and DF angles was considered the arc ROM. Means were compared using a Wilcoxon signed-rank test to evaluate the significance of the difference between means (p < 0.05) Results: Mean arc range of motion increased from pre-operatively to post-operatively for all methods analyzed. Goniometric arc ROM significantly increased from 27.1° +/- 9.4° to 39.6° +/- 14.0°, a difference of 12.5° +/- 13.6° (p< .001). Talocural arc ROM significantly increased from 22.7° =/- 11.9° to 27. 8° +/- 10.2°, a difference of 5.1° +/- 11.2° (p=.006). Full foot arc ROM increased, but not significantly, from 46.7° +/- 15.5° to 48.8° +/- 12.6°, a difference of 2.6° +/- 11.2° (p=0.154). There was no significant difference observed between the mean gain in arc ROM between the two radiographic measurements (p=.062). However, the mean gain in arc ROM for goniometry significantly differed from both the talocural and full foot radiographic methods (p=.012 and p= .001, respectively). Conclusion: In this study, goniometry measurements tended to overestimate motion gained following TAR when compared to 2 radiographic measurement techniques. Interestingly, the talocrural method, which evaluates the ankle in isolation, was almost double the motion noted with the full foot method (5.1° vs. 2.6°) The full foot method may take into consideration the compensatory changes through the hindfoot and midfoot to account for ankle arthritis, that is alleviated post-TAR, hence, more modest gains in “full foot” arc ROM.
Hyaluronic Acid Injection After Failed Arthroscopic Microfracture in Osteochondral Lesion of the Talus
Authors: Park Yoo Jung , Park Kwang Hwan , Suh Jae Wan , Hwang Yeokgu , Shim Dong-Woo , Han Seung Hwan , Lee Jin Woo , Choi Woo Jin 
Published: October 2016

Category: Ankle Introduction/Purpose: The optimal treatment for symptomatic osteochondral lesion of the talus (OLT) after failed arthroscopic microfracture has been a controversial issue. The use of viscosupplementation for treatment of OLT has been gradually increasing. The hyaluronic acid (HA) injection is believed to play an important role in reducing pain and inflammation, and promoting tissue repair. The purpose of this study is to evaluate the clinical outcomes of intra-articular HA injection for the patients with failed arthroscopic microfracture in OLT. Methods: This study included 12 patients who received three weekly injections of intra-articular HA after arthroscopic microfracture for OLT between October 2014 and October 2015. Five men and seven women were included in this study. The average age at the time of injection was 41 years (range, 19-63 years). All patients had recurrent pain for at least 6 months after the index surgery. The patients were followed for 6.1 months (range: 5.0-7.0). At each visit, the efficacy of HA injection was evaluated by a Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot and Ankle Outcome Score (FAOS) pain subscale. In addition, subjective satisfactions were assessed by the Alexander scale. Results: The mean period from the arthroscopic microfracture to the intra-articular HA injection was 26.5 months (range: 6.0- 87.0). Mean VAS decreased from 6.7 ± 1.1 at pre-injection to 2.4 ± 1.6 at post-injection six weeks (p < 0.001), 3.1 ± 1.5 at three months (p = 0.002) and 3.8 ± 2.3 at six months (p = 0.02). Mean AOFAS score improved from 61.0 ± 9.1 at pre-injection to 85.3 ± 11.3 at post-injection six weeks (p < 0.001), 82.9 ± 10.4 at three months (p < 0.001) and 80.4 ± 13.8 at six months (p = 0.001). Mean FAOS pain subscale also improved from 53.2 ± 4.2 at pre-injection to 71.1 ± 9.4 at post-injection six weeks (p < 0.001), 66.7 ± 7.2 at three months (p = 0.001) and 64.4 ± 9.5 at six months (p = 0.036). According to the Alexander scale, there were 58.3% (7/12) good, 25.0% (3/12) fair, and 16.7% (2/12) poor results at post-injection six months. There was no adverse effect. Conclusion: In this study, we found that the main improvement in clinical outcomes occurred during the first six weeks and significantly maintained until at least three or six months. We believe that the HA injection could be a useful treatment option after failed arthroscopic microfracture in OLT.
Limb Preserving Surgical Treatment of Osteomyelitis in the Foot
Authors: Waldecker Ute 
Published: October 2016

Category: Other Introduction/Purpose: Osteomyelitis of the foot and ankle is a challenging problem. In the literature the outcome of limb preserving surgical treatment is characterized by a high percentage of osteomyelitis recurrence and revision surgery. The aim of this study was to evaluate the outcome of limb preserving surgery of osteomyelitis in the foot. Methods: From 2013 to 2015 42 patients with a mean age of 66 years underwent surgical treatment of osteomyelitis in the foot. Patients who were treated with amputations were excluded from the study. In all patients initial surgery with debridement, bone resection, bone biopsy, jet lavage and gentamycin inlay was performed. Depending on the clinical findings revision surgery and finally resection arthroplasty or arthrodesis followed. All patients had an antibiotic treatment for 6 weeks. The location of the osteomyelitis, the applied surgical procedure, the number of surgical procedures, the number of postoperative complications, the recurrence rate of osteomyelitis, the recurrence rate of foot ulceration and the histological findings were documented. Results: Forty-two patients (28 diabetics) were included in the study. The mean follow up was 19.7 months. The location of osteomyelitis showed the following distribution: minor toes (24%), great toe (19%), metatarsals (33%), midfoot (13%), hindfoot (11%). Twenty-six patients showed a foot ulceration. Bone biopsy confirmed chronic osteomyelitis in 28, acute osteomyelitis in 7 patients. After control of wound infection surgery consisted of a resection arthroplasty in 14 patients, an arthrodesis in 12 patients. The mean number of surgical procedures was 3. The complication rate was 14.2%. Osteomyelitis recurrence was found in 4 patients. Patients treated with a resection arthroplasty showed no ulcer recurrence however in 50% of the patients who had been treated with a MTP1 or IP 1 arthrodesis a recurrent ulcer was seen( p < 0.05). Conclusion: Limb preserving surgical treatment of osteomyelitis in the foot shows a high complication rate. Resection arthroplasty of the forefoot in comparison to arthrodesis provides significantly better results with less ulcer recurrence.
Most Readmissions Following Ankle Open Reduction Internal Fixation are Unrelated to Surgical Site Issues
Authors: Fu Michael C. , Schairer William W. , Demetracopoulos Constantine A. , Ellis Scott J. 
Published: October 2016

Category: Trauma Introduction/Purpose: Ankle fractures are commonly-sustained injuries, and frequently require open reduction internal fixation (ORIF). It is generally a safe and effective surgical procedure, however, as quality-based reimbursement models become increasingly affected by readmissions within thirty days, it is important to determine causes and risk factors for patients to be readmitted after discharge. Methods: Patients that underwent ORIF for ankle fractures were identified from the prospectively-collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2013 to 2014. Baseline demographics, comorbidities, and fracture characteristics (open vs. closed, location of fracture such as lateral malleolus, medial malleolus, bimalleolar, or trimalleolar) were determined. Modified Charlson Comorbidity Index (CCI) was used as a measure of overall comorbidity burden. Rates of thirty-day adverse events and readmissions were determined, as well as the causes for readmission. Multivariable logistic regression analyses were performed to identify risk factors significantly associated with having any adverse events and being readmitted within thirty days of surgery. Results: 5,056 ankle ORIF patients were included. 167 (3.3%) were open fractures. The rate of any postoperative adverse event was 5.2%. There were 127 readmissions, with 116 (91.3%) being unplanned readmissions. Of the 116 unplanned readmissions, 49 (42.2%) were for reasons related to the surgery or surgical site, with the most common causes being deep surgical site/hardware infection (12.9%), superficial site infection (11.2%), and wound disruption (6.9%). Most readmissions were for reasons unrelated to the surgical site (51.7%), including cardiac disorders (8.6%), pulmonary disorders (7.8%), and neurologic/psychiatric disorders (6.9%). With multivariable logistic regression, the strongest risk factors for readmission were history of pulmonary disease (Odds Ratio [OR] 2.29), ASA ≥ 3 (OR 2.28), and open fracture (OR 2.04, all p < 0.05). (Figure 1) Conclusion: Postoperative readmissions following ankle fracture ORIF are important to consider in this era of quality-based hospital reimbursement models. In this cohort of 5,056 ankle ORIF cases, 2.5% of patients were readmitted within thirty days, with 51.7% of all unplanned readmissions due to causes unrelated to the surgery or surgical site. This suggests that close medical follow-up with non-orthopaedic providers may be necessary after discharge. To assist clinicians in preoperative risk stratification, predictors of readmission were history of pulmonary disease, increased ASA class, and open fracture. Higher bundled reimbursements may be justified for cases with these risk factors.
Optimum Insertional Direction of the Suture Anchor in Arthroscopic Lateral Ankle Ligament Repair
Authors: Yoshimura Ichiro , Hagio Tomonobu , Noda Masahiro , Minokawa So , Fukuda Nobuyoshi , Kanazawa Kazuki , Naito Masatoshi 
Published: October 2016

Category: Arthroscopy Introduction/Purpose: The gold standard for chronic lateral ankle ligament injury is ligament repair via the modified Broström- Gould procedure. Recently, lateral ankle ligament repair has been performed arthroscopically. This requires the insertion of one to three suture anchors in the fibula from anterior to posterior via the accessory portal. It is important to insert the suture anchors completely into the fibula bone. Because the distal fibula is tapered and has a fossa on the posterior surface, unfavorable insertional direction of the suture anchor can lead to complications such as inadequate suture anchor stability or friction between the suture anchor and the peroneus tendons. This study aimed to investigate the distance between the insertion point of the suture anchors and the posterior surface of the fibula on computed tomography (CT) images. Methods: Twenty ankles from 16 patients who had undergone three-dimensional CT scans for foot or ankle disorders without deformity of the fibula were assessed (10 male, 10 female; mean age, 32 years; age range, 12–78 years). The shortest distance from the insertion point of the suture anchor to the deepest point of fossa/the top of the convex of fibula was measured on the axial planes tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. We also measured the distance from the insertion point of the suture anchor to the posterior surface of the fibula, in a direction parallel to the sagittal plane of the lateral surface of the talus on the axial planes tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. Results: The posterior fossa was observed in all cases on the 90° and 75° images. The distance from the insertion point to the posterior surface of the fibula in a parallel direction was 15.6 mm at 90°, 18.0 mm at 75°, 21.5 mm at 60°, and 24.8 mm at 45°. The posterior points in a parallel direction were located on the posterior fossa in 40% of cases at 90°, in 10% at 75°, and in 0% at 60° and 45°. Conclusion: We suggest that the suture anchor should be directed from anterior to posterior at an angle of less than 60° to the longitudinal axis of the fibula, parallel to the lateral surface of the talus, in order to avoid passing through the fibula.
Pathogenesis of Fifth Metatarsal Stress Fractures in College Soccer Players
Authors: Sugimoto Kazuya , Kumai Tsukasa , Kurokawa Hiroaki , Isomoto Shinji , Tanaka Yasuhito , Fujitaka Kohei , Taniguchi Akira 
Published: October 2016

Category: Sports Introduction/Purpose: The pathogenesis of fifth metatarsal stress fractures remains uncertain. We hypothesized that physical characteristics and environmental factors, which have received limited attention in the literature thus far, might be involved in the development of such fractures. To test our hypothesis, we performed a medical checkup and a survey of the living environment of athletes in college soccer teams, and subsequently, we investigated the existence of fifth metatarsal stress fractures, and examined the differences between the injury group and the non-injury group. Methods: The survey and measurements were conducted in 273 male athletes from the same college soccer team between 2005 and 2013. A medical checkup, comprising assessment of stature, body weight, body mass index, arch height ratio, toe-grip strength, quadriceps angle, leg-heel angle, functional reach test, one-leg standing time with eyes closed, straight leg raise test, finger-floor distance, heel-to-buttock distance, ankle joint range of motion, and general joint laxity test, and a questionnaire survey were performed once a year. A survey was conducted at the time of injury that resulted in fifth metatarsal stress fractures. The study participants were separated into an injury group and a non-injury group, depending on whether they had a fifth metatarsal stress fracture. The measurement items and survey items were compared, and the association between the presence or absence of injury and the measurement items was analyzed. Results: Toe-grip strength was significantly weaker in the injury group, compared with the non-injury group, suggesting that a weak toe-grip is associated with fifth metatarsal stress fracture (p < 0.05). In addition, injury on the non-dominant leg was more frequent in the fifth metatarsal stress fracture injury group (p < 0.05). Between-group comparisons of the other items showed no statistically significant differences. Conclusion: The association between weak toe-grip strength and fifth metatarsal fracture suggests that a weak toe-grip may lead to an increase in the load applied onto the lateral side of the foot; this may cause mechanical stress on the bone. In addition, the effect of the non-dominant leg on the fifth metatarsal bone may need to be studied further.
Posterior Talar Shifting in Mobile-Bearing and Fix-Bearing Total Ankle Replacement
Authors: Usuelli Federico G. , Manzi Luigi , Maccario Camilla 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Sagittal implant malalignment after total ankle replacement (TAR) has been considered to be a possible cause for premature implant failure. In a prior study, the change of the tibiotalar ratio (T-T ratio) over time in TARs was assessed in an unconstrained, three component implant. A significant increase in the T-T ratio between 2 and 6 months after surgery (from 34.6% to 37.2%) was documented. This variation of the talar position in the sagittal plane may be due to the presence of an inlay between the tibial and the talar components. Aim: The aim of this study was to compare the translation of the talus in TARs performed with an unconstrained, three-component design (Hintegra, Newdeal, Lyon, France; Integra, Plainsboro, NJ), and those performed with a semi-constrained, two- component design (Zimmer Trabecular Total Ankle, Zimmer, Warsaw, IN). Methods: The study included 71 consecutive patients (71 ankles) who underwent TAR with the Hintegra implant and 24 consecutive patients (24 ankles) who received the Zimmer implant between May 2011 and December 2014. The most common indication for TAR was post-traumatic arthritis (80.3% and 75.0% in the Hintegra group and in the Zimmer group, respectively). Patients were assessed clinically and radiologically preoperatively (T0), at 6 months (T2) and 12 months (T3) post-surgery. There was also a radiological assessment 2 months after surgery (T1). Results: The comparison of the T-T ratio between the two groups and over time indicated an interaction between time and group, therefore the changes of the T-T ratio with time were affected by the implant type factor (p < 0.0001). The changes of the post-operative T-T ratio over time were not significant in the Zimmer group (35.7%±6.7% at T1, T2, and T3; p=1.0 for each pairwise comparison). In the Hintegra group, the T-T ratio at 2 months (34.4%±5.5%) was significantly different to the T-T ratio at 6 months (37.0% ± 5.8%; p < 0.0001). The American Orthopaedic Foot & Ankle Society (AOFAS) score significantly increased from pre-op to 6 months post-surgery in both the Hintegra group (53.3±16.0 at 6 mos; p < 0.0001) and the Zimmer group (76.8±7.0 at 6 mos; p < 0.0001). There was no statistical difference in the preoperative scores (Hintegra: 32.7 ± 12.8; Zimmer: 34.6 ± 11.9; p=0.5347). Conclusion: The significant antero-posterior translation of the talus documented only in the cohort receiving the unconstrained, three-component implant may have associated with, and produced by the presence of the mobile bearing interface between the polyethylene insert and the tibial prosthesis.
Primary vs. Revision Ankle Arthrodesis
Authors: Barg Alexej , Lyman Mikayla , Morris S. Craig , Saltzman Charles L. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: The current standard treatment for failed ankle arthrodesis is a revision ankle arthrodesis. However, there is limited literature addressing postoperative outcomes in patients with revision tibiotalar arthrodesis. The objectives of the retrospective study were to compare (1) demographics, (2) surgical technique, (3) postoperative fusion rates, and (4) postoperative complication rates in patients with primary vs. revision tibiotalar arthrodesis. Methods: Between March 2002 and November 2014, 455 ankle arthrodeses were performed in our institution. There were 234 male and 221 female patients with a mean age of 55.6 ± 15.1 years (18.0-88.8). The mean weight, height, and body mass index (BMI) were 90.3 ± 21.3 kg (46-218), 172.8 ± 13.6 cm (147-208), and 30.2 ± 6.3 kg/m2 (18.9-61.7), respectively. Both patient groups were compared with regard to demographics including gender, weight, height, BMI, ASA classification, smoking, alcohol use, and comorbidities. The surgical technique has been analyzed in both groups including surgical approach, main fixation type, allograft/autograft use, and use of bone morphogenic protein. Finally, fusion rate and time to complete osseous fusion were analyzed. Complication rates including wound complications, deep vein thrombosis/pulmonary embolism, and any secondary procedures were described in both groups. The mean time to final follow-up was 38.3 ± 27.4 months (12.0-150.4). Results: There were 385 and 70 patients with primary and revision arthrodesis, respectively. Demographics and comorbidities were comparable in both groups. All revision surgeries were open procedures, while 63 of 385 primary ankle arthrodeses were performed arthroscopically. The most common main fixation type in patients with primary ankle arthrodesis was a screw construct, while plates were most common for revisions (P < 0.001). The use of autograft was comparable in both groups (P = 0.886), however allograft was used more frequently in the revision arthrodesis group (P < 0.001). The rate of osseous union was comparable in both groups with 90.4% and 91.4% in patients with primary and revision arthrodesis, respectively (P = 0.735). The complication rate was comparable in both groups. Conclusion: The osseous union rates and complication rates were comparable in both patient groups, with primary and revision ankle arthrodesis.