bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Efficacy of a Kaolin-impregnated Dressing for Hemostatic Control in Diabetic Foot Ulcer Patients Receiving Anticoagulant Therapy in an Outpatient Clinic
Authors: Hwang Yeokgu , Park Yoo Jung , Shim Dong-Woo , Lee Jin Woo , Han Seung Hwan 
Published: September 2017

Category: Diabetes Introduction/Purpose: Orthopedic physicians encounter many diabetes patients who receive anticoagulant treatment because vascular diseases are the chief causes of death and disability in these patients. In these patients, if surgery or other procedures are required, it is still unclear whether anticoagulation therapy administration should continue. After discontinuation of anticoagulation therapy, the risk of cardiovascular complications is increased, although complications of bleeding after surgery are decreased; this is a dilemma in the treatment of diabetic foot ulcer. The purpose of this study was to examine the effectiveness, safety, and hemostatic effect of kaolin-impregnated gauze on diabetic foot ulcer patients who continue to receive anticoagulants after surgical debridement. Methods: Twenty patients receiving anticoagulant medication with diabetic foot ulcers requiring surgical debridement were enrolled. Diabetic foot ulcers were treated using surgical debridement and a basic dressing protocol, which involved direct application of the dressing material to the wound bed. For the study group, a kaolin-impregnated dressing was used, and dry gauze was applied to patients in the control group. Patients were randomly assigned to either group, and we compared hemostatic efficacy and adverse effects between the two groups. The presence or absence of hemostasis was assessed 5 and 10 minutes after dressing application. Treatment was considered successful if bleeding ceased adequately and no extra hemostatic measures were required within 10 minutes. Results: In the 20 patients undergoing surgical debridement, there was no evidence of bleeding within 10 minutes of dressing application. Eight of the 10 patients treated with a kaolin-impregnated dressing achieved complete hemostasis within 5 minutes. Five of the 10 patients in the control group failed to achieve hemostasis within 10 minutes. No adverse effects were noted. Conclusion: The use of a kaolin-impregnated dressing appears to be a safe, feasible, and beneficial option for the management of diabetic foot ulcer patients with a high risk of bleeding.
Middle and Long -term Clinical Results of Dorsiflexion Osteotomy for Severe Hallux Rigidus
Authors: Ikezawa Hiroko , Usami Norio , Hiraishi Eiichi , Takahiro Yamada 
Published: September 2017

Category: Bunion Introduction/Purpose: Total arthroplasty or arthrodesis is often used as a surgical procedure for severe case of hallux rigidus. However, because these procedures involve problems such as loss of joint function, age, and postoperative motion restriction, joint-preserving surgery is desirable for achieving a better quality of life. To resolve these problems, we have performed dorsiflexion osteotomy of the first metatarsal head since 2000, yielding favorable outcomes. We report about middle to long-term follow-up for our clinical results and radiographic findings. Methods: The study involved 31 feet of 30 patients (20 male,11 female) with Grade 2 (joint space narrowed to about 1/2 or less) or Grade 3 according to the Hattrup and Johnson classification. The mean age at surgery was 61.6 years (range: 53-77). Surgical techniques: We have used dorsal approach and conducted closed wedge osteotomy of the first metatarsal bone neck. Then, the bone head was flexed dorsally to form an articular surface and fixation. PWB was permitted 3 weeks after surgery. Mean postoperative follow-up period was 4 years and 2 months (range: 3-13 years). Clinical outcomes, range of motion (ROM), and radiographic findings were investigated. Results: Clinical outcomes were rated as excellent in 24 feet, good in 7, and fair/poor in none. All patients returned to normal daily life. Stiffness while walking was noted in 10 feet. As for ROM, most patients had a 1/2 to 2/3 of the normal range. No complications such as infection, nonunion, or transfer metatarsalgia were seen in any case. An X-ray film showed joint space narrowing in about half of all cases. None of the patients experienced pain relapse requiring arthrodesis again. Conclusion: The mechanism of pain relief is Dorsiflexion osteotomy is by bone shortening, make a decreasing joint pressure and regaining of normal articular to the dorsal side so that it faces the articular surface of the proximal phalanx. The postoperative restriction of ROM may be attributable to changes in the bone alignment and in the tension of soft tissue around the joint as compared to the healthy condition. None of the patients experienced pain relapse. Our procedure appears to be useful as joint- preserving surgery for severe cases with hallux rigidus.
Lateral talocalcaneal ligament substitution for calcaneofibular ligament difficient chronic ankle lateral instability
Authors: Jiao Chen 
Published: September 2017

Category: Ankle, Hindfoot, Sports, Trauma Introduction/Purpose: Introduction: Treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament via tendon reconstruction or artificial grafts has several disadvantages. The method of substitution with lateral talocalcaneal ligament has never been reported. Purpose: To investigate the role of lateral talocalcaneal ligament substitution for the treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament. Methods: Repair of ankle lateral ligament was performed on 32 patients with chronic ankle instability. The mean age was 26.4±8.7 years. The calcaneofibular ligament was absent in all the patients and was confirmed surgically. The calcaneofibular ligament was repaired via transfer of talar insertion of the lateral talocalcaneal ligament. Patients were followed up for an average of 22.3±4.0 months. AOFAS, Mazur and Tegner scores, objective examinations (anterior drawer test and varus stress test) and re-injury were assessed before and after the operation. The anterior translation distance of the talus and the talar tilt angle were also measured. Results: In all the patients, postoperative AOFAS, Mazur and Tegner scores were significantly improved. Postoperative evaluation (drawer test and lateral stress test) yielded negative results. The anterior translation distance was reduced from 4.9±1.0 mm to 2.0±0.8 mm. The talar tilt angle was reduced from 12.7º±2.5º to 5.0º±1.4º. The average satisfaction score was 7.4. No subjective instability or re-injury, subtalar joint (tarsal sinus) pain or/and instability occurred. Conclusion: Lateral talocalcaneal ligament substitution was effective against chronic ankle lateral instability associated with the absence of calcaneofibular ligament, without any significant effect on subtalar joint clinically.
What Kind of Procedure Should be Indicated for the Comminuted Talar Fracture as Initial Treatment?
Authors: Katsui Ryuhei , Takakura Yoshinori , Samoto Norihiro , Taniguchi Akira , Tanaka Yasuhito 
Published: September 2017

Category: Trauma Introduction/Purpose: Open reduction is most difficult to perform in comminuted talar fractures, because it necessitates osteotomy of the lateral or medial malleolus. Furthermore, the incidence of aseptic talar necrosis after a comminuted fracture is extremely high. Fifty-seven tali in 55 patients with aseptic necrosis of the talus underwent replacement with an artificial ceramic whole talus from 2005 to 2015, and we obtained excellent and good results. Based on the results, we performed replacement with an artificial ceramic talus, as the initial treatment, for 6 patients with comminuted talar fractures with bony destruction or defects. Methods: From 2009 to 2016, six feet in 6 patients with comminuted talar fractures were replaced with ceramic whole-talus prostheses as the initial treatment. Of them, 5 were male and one was female, with a mean age of 40.3 years (range, 19–59 years). The causes of the fractures were fall from a high place in 2 patients and traffic accident in 4. The ceramic prosthesis was made based on the computed tomographic scan of the normal opposite talus. The production of the custom-made prosthesis required a period of 5 weeks. In 3 patients, the capacity of the original talus was acquired by external fixation before replacement. Plaster cast immobilization was retained for 2 weeks each of non-weight bearing and weight-bearing. Preoperative and postoperative assessments were performed in accordance with the American Orthopaedic Foot and Ankle Society ankle/hindfoot score system. Results: Follow-up was conducted for 12 to 84 months (mean, 53.8 months). The postoperative AOFAS score was 68-100 (mean, 81.8). The result of the replacement with ceramic whole-talus prosthesis was excellent in 4, good in one, and fair in one. Three patients had resumed participation in sports activities (golf, aerobics, and jogging). However, 2 patients with open fracture and bony defects had limitation of the range of motion of the ankle. The patient with a fair result is still undergoing therapy for femoral and tibial fractures. Conclusion: A ceramic whole-talus prosthesis was used to replace 6 comminuted talar fractures as the initial treatment. The results using these prostheses were excellent, and good except one patient with open fracture and bony defects. Replacement with a ceramic whole-talus prosthesis should be indicated for comminuted fractures with bony destruction or defects.
The result of the treatment in osteoporotic ankle fractures with small fragment using claw plate in elderly
Authors: Kim Jun-Beom , Park Byeong-Seop , Ahn Chi 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Osteoporotic fractures in ankle have often included small bone fragments and were very unstable. There had been tried to fix them for anatomical reduction, using variable methods. However, it was not easy to keep the reduction, especially in elderly. The purpose of this study was to evaluate the results of the treatment in ankle fractures with small fragment using claw plate in elderly. Methods: The nineteen patients with ankle fractures, which included the small fragments, from january 2012 to july, 2014 were evaluated retrospectively. All patients were more than 65 years and had osteoporosis. The authors have been tried to fix it using claw plate in all cases. The mean follow up period was 15 months(range, 12month to 18month). The claw plate was designed to catch the small fragment and made of tubular plate or locking tubular plate with bending it after cutting the distal end of them. It had two different hooks to keep the reduction and the fragment. Functional outcome scores were obtained using Olerud Molander Ankle score(OMA), VAS, and American Orthopedic Foot and Ankle Society (AOFAS) score at 2, 3, 6, 9, 12 month after the operation, when each patient underwent a physical examination and radiography. There was evaluated statistically by SPSS 19.0 Results: There were no complication, such as metal failure and loss of reduction. AOFAS score improved from 56.4±3.1 at 2 month to 93±1.5 at 12 month(p=0.01). The VAS improved from 6.2±0.9 at 2 month to 1.2±0.8 at 12 month(p=0.001). OMA score improved from 15.5±0.2 at 2 month to 75±2.5 at 12 month (p=0.001). There was significant difference, statistically. There was obstained the bony union in 3 months after the operation in all cases Conclusion: We suggested that the claw plate is the alternative method to fix the osteoporotic ankle fracture with small fragments in elderly, without complications
Radiological and clinical outcome of lateral ankle instability with medial compartment osteoarthritis
Authors: Kim Sungwook , Jung Hong-Geun , Lee Jong-Soo , Kang Hwa Jun , Sun Mao Yuan 
Published: September 2017

Category: Ankle, Ankle Arthritis, osteoarthritis, ankle instability Introduction/Purpose: When lateral ankle instability (LAI) is not treated for long period, unbalanced loading on medial ankle may proceed to osteoarthritis (OA). Outcome studies about osteoarthritis with lateral ankle instability after stabilization, however, have rarely been reported. The authors have investigated the radiological and clinical outcome of ligament stabilization for LAI with medial compartment OA. Methods: The study is based on 25 ankles of LAI with medial compartment ankle OA that underwent lateral ankle ligament reconstruction from 2007 to 2014 with at least 1 year follow-up. The medial ankle OA was diagnosed with degenerative change of medial ankle on plain X-ray or MRI or arthroscopic findings. The OA was classified using Takakura stage, and arthroscopic degenerative change was classified by modified Outerbridge grading. Ligament stabilization surgery was done using either modified Broström procedure or lateral ligament reconstruction using semitendinosus tendon allograft. Arthroscopic synovectomy, debridement, and microfracture for osteochondral lesion were performed when needed. Clinical outcomes were evaluated using visual analogue scale (VAS) pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson- Peterson score, and subjective patient satisfaction. Statistical analysis were done using Wilcoxon signed rank test. Results: The average instability duration was 98 (range, 12-480) months and the average follow up period was 46 (range, 13-108) months. Preoperative Takakura stage was mostly I (n=19, 76%) and II (n=4, 17%), and was same postoperatively. MRI OA findings of 18 ankles were medial cartilage denudation (17%), cartilage thinning/erosion (44%), medial osteophyte (50%), and loose bodies (30%). Modified Outerbridge grade 2 and 4 were most common (both 41%). The VAS pain score decreased from 6.1 ± 1.6 preoperatively to 1.8 ± 1.6 postoperatively (P<0.05). The AOFAS score improved from 61.8 ± 14.7 preoperatively to 90.0 ± 6.3 postoperatively, and the Karlsson-Peterson score improved from 54.5 ±14.4 to 89.4 ± 8.4 (P<0.05). There were no significant complications. All patients were satisfied. Conclusion: Ligament stabilization accompanied with arthroscopic procedure could draw good outcome, even without structural bony deformity correction. Even with no improvement in plain radiograph, functional score could be improved.
Can Ultrasound-Guided Nerve Block Be A Useful Method Of Anesthesia For Tumor Surgery In The Foot And Ankle
Authors: Lee Gi-Soo , Oh Byung Hak , Kang Chan , Won Yougun , Park Yoo Jung , Jun June Bum 
Published: September 2017

Category: Ankle, Tumor Introduction/Purpose: Tumors arising in the foot and ankle are often need surgical treatment. However, there is hesitation about the surgical treatment of anxiety about general anesthesia in some patients. Ultrasound-guided nerve block can be a useful method of anesthesia for tumor surgery in the foot and ankle.This study was performed to compare general anesthesia and ultrasound (US)-guided nerve block for tumor surgery in the foot and ankle. Also, whether US-guided nerve block is a useful method of anesthesia for tumor surgery was investigated. Methods: In this prospective, randomized study, 50 patients who underwent tumor surgery between February 2013 and February 2016 were allocated to two groups: general anesthesia (n = 25, or US-guided nerve block (n = 25). All patients completed a questionnaire with three questions 2 weeks after surgery. For the nerve block group, the procedure duration, interval between the procedure and onset of the anesthetic effect, the point of loss of the anesthetic effect, intraoperative, postoperative visual analog scale (VAS) pain score, and discomfort during surgery were assessed. Results: There was no patient in which the anesthetic was changed to another method during the operation. VAS pain score of postoperative 1 and 6 h was significantly different between the nerve block group (2.2 ± 1.5 and 3.0 ± 1.8, respectively) and general anesthesia group (5.2 ± 3.9 and 5.4 ± 4.5, respectively) Twenty three US-guided nerve block (92%) and 17 general anesthesia patients (68%) reported that they would prefer the same type of anesthesia if they were to undergo tumor surgery in the foot and ankle again; these differences were significant (P < 0.05). There were no long-term complications, such as neurological deficits or infection, after the procedure in all patients. Conclusion: Tumor surgery, such as tumor excision or biopsy, amputation, and other procedures, was performed safely and effectively under US-guided nerve block. These results indicated that US-guided nerve block for tumor surgery is a highly satisfactory and safe procedure without complications and is available for use by any orthopedist.
Sex differences in pedobarographic findings and relationship between radiograph and pedobarograph measurements in young healthy adults
Authors: Lee Kyoung Min , Lee Seung Yeol , Park Moon Seok , Sung Ki Hyuk , Koo Seungbum , Kim Sung Jin , Choi Hyun , Sangyeop Shin , Chun Sangho 
Published: September 2017

Category: Basic Sciences/Biologics Introduction/Purpose: Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated normative data. This study examined pedobarographic findings in young healthy adults with regard to sex-related differences and correlations among measurement indices. Methods: Twenty young healthy adults (mean age 22.4 years, SD 1.2 years; 10 males and 10 females) were included. Weightbearing anteroposterior and lateral foot radiographs were taken, and dynamic pedobarographic data during treadmill walking and maximum ankle dorsiflexion were obtained. AP talo-first metatarsal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and plantar soft tissue thickness were measured on foot radiographs. Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel. Results: Male and female subjects significantly differed in BMI (p<0.001), AP talo-first metatarsal angle (p=0.018), soft tissue thickness under the metatarsal head (p=0.04) and calcaneal tuberosity (p<0.001), maximum dorsiflexion during stance phase (p=0.041), peak pressure on the MFF (p=0.005) and LFF (p=0.004), and pressure-time integral on the MFF (p=0.018) and heel (p=0.001). Maximum dorsiflexion demonstrated significant negative correlations with pressure-time integral on the MFF (r=-0.595, p=0.007) and total pressure-time integral (r=-0.492, p=0.032). Pressure-time integral varus/valgus index was significantly correlated with pressure-time integral forefoot/heel index (r=0.472, p=0.036). Conclusion: Sex-related differences in pedobarographic examination were observed. Achilles stretching exercise was considered to reduce foot pressures, and subtalar joint was hypothesized to play an important role in pressure distribution.
Influence of surgery involving tendons around the knee joint on ankle motion during gait in patients with cerebral palsy
Authors: Lee Seung Yeol , Lee Kyoung min , Kwon Soon-Sun , Chun Sangho 
Published: September 2017

Category: Ankle Introduction/Purpose: The gastrocnemius, a biarticular muscle that crosses the knee and ankle, acts as a knee flexor as well as an ankle plantar flexor. Although simultaneous motion of the knee and ankle joints is required for many activities including standing, running, swimming, and cycling, the change in ankle motion during gait has not been described in patients with cerebral palsy who underwent distal hamstring lengthening or distal hamstring lengthening with rectus femoris transfer. Therefore, we aimed to evaluate the influence of surgery involving tendons around the knee on ankle motion during gait in cerebral palsy patients. Methods: The analysis included data regarding 55 limbs from 34 patients with spastic cerebral palsy, who were followed-up after they had undergone distal hamstring lengthening with or without additional rectus femoris transfer. Mean age of the patients at time of the knee surgery was 11.2 ± 4.7 years. Preoperative and postoperative kinematic variables that were extracted from three-dimensional gait analyses were compared to assess the change in ankle motion after surgery involving tendons around the knee. The postoperative 3D gait analysis was performed at a mean of 0.9 ± 1.3 years after the surgery. The outcome measures were relevant kinematics parameters including peak ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, ankle peak dorsiflexion during swing, and dynamic range of motion of the ankle. A linear mixed model was constructed to estimate the changes in ankle motion after adjusting for multiple factors. Results: We estimated that peak ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, ankle peak dorsiflexion during swing, and dynamic range of motion of the ankle decreased, respectively, by 0.4º (p=0.016), 0.6º (p<0.001), 0.2º (p=0.038), and 0.5º (p=0.006) per degree increase in total range of motion of the knee after knee surgery (Table). Estimated ankle peak dorsiflexion in the swing phase increased by 0.4º per degree increased in postoperative peak knee flexion in the swing phase (Table). Age at the time of the knee surgery did not significantly affect ankle kinematics. Conclusion: Improvement in total knee range of motion was correlated with a decrease in ankle kinematics after surgery involving tendons around the knee. Knee surgery may reduce the need for an additional surgical procedure involving the ankle joint. Because the simultaneous motion of the knee and ankle joints is cross-linked, surgeons should be aware of potential changes in the ankle joint after knee surgery.