bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced Bacterial Growth on Titanium Screws With Nanophase TiO2 Surface Treatment
Authors: Bhardwaj Garima , Parekh Selene G. , Webster Thomas J. 
Published: October 2016

Category: Other Introduction/Purpose: An important strategy in the reduction of orthopedic infections is to develop implant materials that prevent initial bacteria adhesion and growth onto implant surfaces. Bacterial localization and biofilm formation may lead to acute and chronic infections[1]. Biofilm formation on implant surfaces protects bacteria from the immune system and antibiotic therapy, thus, requiring an aggressive treatment of antibiotics that frequently do not work post biofilm formation[2]. Thus, to prevent implant infections, various strategies have been developed aside from conventional systemic and local antibiotic treatment. Recently, there has been increasing interest for coating implants with other materials to improve osseointegration and prevent infection, chronic inflammation, and unwanted foreign body responses[3]. The current study focuses on modifying the surface of titanium implants by treating them with nanophase titanium dioxide using electrophoretic deposition. Methods: Nanophase titanium dioxide was synthesized using a wet chemical synthesis and was deposited on Ti-6Al-4 V titanium screws using a cathodic arc deposition plasma system. Bacterial assays were conducted using Staphylococcus aureus (ATCC® 29740™), Pseudomonas aeruginosa (ATCC® 39324™) and an ampicillin resistant strain of E. coli (BIO-RAD Strain HB101 K-12 #166-0408 and pGLO Plasmid #166-0405). 0.03% tryptic soy broth (TSB) (Sigma Aldrich, Cat # 22092) and agar (Sigma-Aldrich, Cat # A1296) were used as the media and colony forming assays were performed to determine bacterial adhesion. Results: Nanophase titanium dioxide was successfully synthesized and applied onto the desired surface. A statistically significant decrease in bacterial adhesion was observed across all 3 strains of bacteria; an example of confocal images for S. Aureus is given in figure 1. In addition, decreased macrophage functions and increase osteoblast functions were also observed in the nano TiO2 treated Ti6Al4 V screws. Importantly, this was all achieved without the use of drugs and/or antibiotics decreasing the chance for the spread of antibiotic resistant bacteria and drug side effects. Conclusion: The screws were successfully coated using EPD and reduced bacterial adhesion on the coated surface was observed.
Adductor Canal Block Versus Femoral Nerve Block for Anesthesia of Hindfoot and Ankle Surgery
Authors: Park Young-uk , Choo Ho-Sik , Park Jangho 
Published: October 2016

Category: Other Introduction/Purpose: Femoral nerve block (FNB) has been commonly used for anesthesia and analgesia in patients undergoing foot and ankle surgery as well as sciatic nerve block. (SNB) However, its effect on motor function, related fall risk and impact on rehabilitation has been the source of controversy. Adductor canal block (ACB) potentially spares motor fibres of the femoral nerve, but the comparative effect on foot and ankle surgeries of the two approaches has not yet been well defined due to considerable variability in pain perception.The authors hypothesized that ACB, compared with FNB, would exhibit less quadriceps weakness and demonstrate noninferior pain score at surgery and at 2 to 24 hours after the operation. Methods: Sixty patients scheduled for hindfoot and ankle surgeries (arthroscopy, achilles tendon surgery, medial ankle surgery) were randomised (stratified randomization for each surgery) to receive ultrasound-guided FNB or ACB in addition to combined SNB. The primary outcome was motor strength.(manually and via dynamometer) Secondary comparative outcomes included pain scales at each stages, time profiles (during procedure, time to full anesthesia, time to start recovery, time to full recovery, operation time), dose of ansthetics, complications and patient satisfaction. Degree of pain was measured using VAS (Visual Analog Scale) scores at the operation, 30 minutes after surgery, and at 2 h, 1 day, and 2 days after surgery. Results: Thirty patients received ACB; 30 patients received FNB. At 30 minutes to 2 h postanesthesia, ACB patients had significantly higher average dynamometer readings versus FNB patients (39.7±21.1, 37.5±18.3 vs 0.0±0.0, 0.0±0.0), but was not inferior to FNB at 24 and 48 hours. There were no significant differences were seen between two groups at any time point with regard to pain in the quantitative comparison using visual analogue scale (VAS) scores, motor strength, dose of anesthetics, time profiles or patient satisfaction. Conclusion: Adductor canal block preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative pain. ACB may represent a safer alternative to FNB.
Randomized Controlled Trial of Intense Therapeutic Ultrasound for the Treatment of Chronic Plantar Fasciitis
Authors: Latt L. Daniel , Christensen Dallin N. , McNelly Ashley L. , Slayton Michael H. , Amodei Richard C. , Fastje Cindy D. 
Published: October 2016

Category: Sports Introduction/Purpose: Initial treatment of plantar fasciitis (PF), consisting of anti-inflammatories, stretching and in-shoe orthosis (heel pad, heel wedge, or arch support), leads to symptomatic resolution in over 90% of patients but takes 3-6 months. This study was conducted to test the effectiveness of a minimally invasive modality, intense therapeutic ultrasound (ITU), in accelerating the healing of chronic plantar fasciitis (PF). ITU uses high-frequency high-intensity focused ultrasound to create small thermal injury zones inside soft tissue without damage to surrounding structures. ITU has been shown to initiate a tissue repair cascade and promote collagen generation in dermal and musculoskeletal tissue and is FDA approved for use in non-surgical brow lifts [1,2]. The goal of this study was to determine if ITU when combined with standard therapy could speed the healing of chronic PF. Methods: 47 patients with chronic (greater than 3 months) heel pain due to PF were randomized to standard therapy (anti- inflammatory pills, stretching, and gel heel cups) plus ITU (“ITU”, n=33) or standard therapy plus sham ITU (“control”, n=14) groups. ITU treatments were administered at enrollment and two-weeks later using a custom 3.3 MHz therapeutic ultrasound system (Guided Therapy Systems, Mesa, AZ). Sham treatment utilized the same protocol but with the energy set to 0 Joules. Treatment effect was assessed at 2, 4, 6, and 12 weeks after the initiation of treatment using diagnostic ultrasound and patient reported outcomes (PROMIS physical function computer adaptive test, PROMIS global health, Foot Function Index pain subscale, and a non-validated heel pain specific questionnaire). Ultrasound images were analyzed to determine the size of lesions within the PF. Both the sonographer and the study coordinator administering the patient reported outcome instruments were blinded to group assignment. Results: 38 patients completed the 12 week study (ITU: n=37, Control: n=11.). The ITU group reported a significantly greater reduction in heel pain scores [Mean 8.27, SD 4.69, P=0.027] compared to the control group [Mean 2.25, SD 5.92] (Figure 1). Ultrasound imaging showed an 81% decrease in perifascial lesion size in the treatment group, compared to a 26% increase in lesion size in the control group (Figure 2). Conclusion: Preliminary results of this clinical study of noninvasive ITU for the treatment of chronic PF showed that ITU treatment as compared to sham control lead to a larger and more rapid reduction of heel pain and perifascial lesion size. ITU holds promise as a potential therapy to accelerate the healing of chronic plantar fasciitis
Arthroscopic Deltoid Ligament Repair
Authors: Acevedo Jorge I. , Mangone Peter 
Published: October 2016

Category: Arthroscopy Introduction/Purpose: Background: Recent studies have underscored the importance of open repair of the deltoid ligament for rotational ankle instability in purely ligamentous injuries as well as with ankle fractures. With the advent of successfull arthroscopic lateral ligament techniques the authors have explored the use of similar arthroscopic techniques for deltoid repair. This study aimed to describe a novel arthroscopic technique for deltoid ligament repair and relate the proximity of anatomic structures at risk. Purpose: To evaluate the proximity of anatomic structures for a novel arthroscopic deltoid ligament stabilization technique and to define ideal landmarks and “safe zones” for this repair. Methods: Methods: Five human cadaveric ankle specimens were screened for the study. All specimens underwent arthroscopic deltoid ligament repair with a suture passer and suture anchor technique. Five cadaveric specimens were dissected to determine the proximity of anatomic structures after repair. Several distances were measured, including those of different anatomic structures to the suture knot to determine the “safe zones.” Measurements were obtained and statistical analysis was performed. Results: Results: None of the specimens revealed entrapment of the suture knots to the posterior tibial tendon (PTT) or saphenous nerve. The safe zone between the PTT and saphenous vein was a mean of 20 mm (range, 16-25 mm). On average, a 16 mm (range, 12-20 mm) safe distance was maintained from the suture knot to the PTT. The saphenous vein was in close proximity to the suture knot at a mean distance of 3 mm (range, 0-9 mm). Conclusion: The results indicate that there is a relatively wide safe zone between the PTT and the saphenous vein when performing the arthroscopic deltoid ligament stabilization technique. While none of the critical anatomic structures (except for saphenous vein) were entrapped by the suture knot, it was evident that the variable course of the saphenous vein renders it at risk for entrapment. This study further defines the proximity of adjacent anatomic structures and establishes the anatomic safe zones for the arthroscopic deltoid ankle stabilization procedure. By defining this relatively risk-free zone, surgeons less experienced with arthroscopic ligament repair techniques may approach arthroscopic suture passage with more confidence.
Blood Transfusion During Total Ankle Arthroplasty is Associated With Increased In-Hospital Complications and Costs
Authors: Smith Kenneth S. , Ewing Michael A. , Ponce Brent A. , Johnson Michael D. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis and is increasing in utilization. Need for blood transfusion is one potential complication of TAA. While numerous studies have associated blood transfusions with increased complications in hip and knee arthroplasty, little is known of its effect in TAA. This study aims to use a large nationally representative database to determine the effect of blood transfusion on inpatient complications and total hospital costs following TAA. Methods: Using the Nationwide Inpatient Sample (NIS) database from 2002-2012, 19,190 patients undergoing TAA were identified, with 294 (1.5%) receiving a blood transfusion. Univariate analysis was performed to determine patient and hospital factors associated with blood transfusion during inpatient stay following TAA. Multivariate analysis was performed to determine if blood transfusion was associated with other inpatient complications after controlling for age, race, gender, and comorbidities. Results: Patients receiving a blood transfusion were more likely to be older, female, African American race, on Medicaid insurance, and in a non-teaching hospital. The average length of stay for patients undergoing blood transfusion was 5.4 days compared to 2.5 days for those who did not (P < 0.001), while the average inpatient cost was $101,214.77 vs. $58,076.23. Blood transfusion was associated (P < 0.001) with acute renal failure, acute myocardial infarction, pneumonia, length of stay and inpatient cost greater than 75th percentile. After controlling for age, race, gender, and comorbidities, blood transfusion was determined to be an independent risk factor for acute renal failure (P=0.001, OR=3.17), acute myocardial infarction (P < 0.001, OR=66.76), extended length of stay (P < 0.001, OR=5.82), and increased inpatient cost (P < 0.001, OR=2.68). Conclusion: Peri-operative blood transfusions are associated with increased inpatient complications and increased hospital costs following total ankle arthroplasty. Careful preoperative assessment and medical optimization of these patients should be performed in order minimize the risk of peri-operative blood transfusion.
Comparison of Early Functional Rehabilitation and Cast Immobilization after Minimally Invasive Repair of an Acute Achilles Tendon Rupture
Authors: Park Young-uk , Choo Ho-Sik , Lim Seongyeon 
Published: October 2016

Category: Hindfoot Introduction/Purpose: The optimal treatment for acute Achilles tendon ruptures is still a subject of debate. Operative repair of an acute Achilles tendon rupture (ATR) reduces the risk of re-rupture and has therefore gained popularity as a standard treatment for ATR. There is ongoing controversy over the best surgical technique and postoperative treatment. The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with minimally invasive repair and early functional rehabilitation with the outcomes of similar patients treated with cast immobilization. Methods: 41 patients were enrolled in this study. All included patients underwent minimally invasive surgery, after which a below-knee splint with the foot in 120 degrees of plantar flexion was applied for the first week. Patients were then divided to the cast immobilization group (IG) or to the functional group (FG). The ankle in the IG was immobilized in a fiberglass cast in 110 degrees of plantarflexion during next 1 week and in 100 degrees in next 1 week and neutral position with full weightbearing in weeks 3 to 4. From the second week, patients in the FG were mobilized, full weightbearing, in a CAM Walker boot with weekly removing heel wedges. (first wedge removed at 2 weeks, second wedge removed at 3 weeks, third at 4weeks) Data were collected during the outpatient checks at 6 weeks; 3 and 6 months; and 1 year. Results: There was no clinically important difference between groups with regard to heel height, range of motion, return to work or sports, calf circumference, VAS, AOFAS, ATRS except ROM difference at 6weeks and heel height at 3 months. Rerupture occurred in one patient in each group. Conclusion: The minimally invasive repair of ATR was a safe and reliable technique with good results. Early mobilization and weightbearing seemed to be as safe as more traditional postoperative immobilization with similar functional result and complications.
Does Ankle Arthritis Cause More Disability Than Other Pathologies of the Foot and Ankle?
Authors: Siddique Malik S. , Ramaskandhan Jayasree R. , Ashworth Nicola 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is been extensively studied for disease severity and outcomes of surgery. It is a condition resulting in significant pain and disability. There is a lack of literature on pain and disability in ankle arthritis compared to other pathologies of the foot and ankle. We aimed to study the level of disability caused due to ankle arthritis and how it compares to other commonly reported conditions of the foot and ankle. Methods: We collected PROMs using MOX-FQ questionnaire from newly diagnosed patients under the care of 1 consultant from May 2014 to July 2014. Data was collected for 13 commonly reported conditions for forefoot (3), midfoot (3), hindfoot (5) and ankle arthritis. We grouped patients as Group A, B, C and D for forefoot, midfoot, hindfoot disorders and ankle arthritis respectively. The responses to each of the 3 domains of MOX-FQ were analysed using statistical tests for analysis of variance. Results: 136 patients took part in this study. There were 52 patients with ankle arthritis, 56 patients with forefoot conditions (19- big toe arthritis, 18 - hallux valgus and 19 – morton’s neuroma/metatarsalgia); 22 patients with midfoot disorders (15 – TMT joint arthritis, 4 – TNJ arthritis and 3 – CC joint arthritis) and 31 patients with disorders of hindfoot (9 – STJ arthritis, 6 – tib post pathology, 4 – plantar fasciitis, 3 – Haglund’s disease and 3 – achillis tendinitis). Although patients with hindfoot problems reported a trend for higher pain scores (72.0) when compared to groups A (62.6), B (64.7) and D (66.2), this failed to achieve statistical significance.Group D patients reported highest scores for difficulty with walking/standing (p=0.008) and similar levels of pain to other foot conditions (p>0.05). For Social interaction domain, all 4 groups reported similar level of restrictions in social activity, (p=0.679). Conclusion: Patients with ankle arthritis experienced higher levels of difficulty with walking and standing and similar levels of pain and restriction with social activities to patients with other foot and ankle pathologies. Further research is required to explore general health and functional limitations in lines with ICF (International Classification of Function and Disability) for ankle arthritis. (We aim to present a breakdown of pain, walking/standing and social function domains by each foot condition in comparison to ankle arthritis in the event of this abstract being accepted)
Early Weight Bearing on a Fixed Syndesmosis. Does it Matter?
Authors: Mocoçain Pablo P. , Ortiz Cristian A. , Wagner Emilio E. , Keller Andres A. 
Published: October 2016

Category: Trauma Introduction/Purpose: Introduction: There is no consensus about when to allow weight bearing in ankle fractures in which a screw was used to maintain reduction of the syndesmosis. There has been no evaluation, of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged. The aim of this study was to evaluate the radiographic parameters of the syndesmosis over time in patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Methods: We analyzed 42 patients with ankle fractures treated in our institution, with at least one syndesmotic screw in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). We measure medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS) and talar shift (TS). Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Also no difference was found in measurements within patients with intact versus broken screws (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable consequences on plain X rays regarding ankle joint parameters. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We believe aggressive functional rehabilitation after ankle fractures including early weight bearing is beneficial for our patients and may lead to improved functional results.
Effects of Variations in Dwyer Osteotomy Determined by 3D-Printed Patient-Specific Modeling
Authors: Weinheimer Kent T. , Aydogan Umur , Lewis Gregory S. , Roush Evan P. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Dwyer osteotomy is commonly used in surgical correction of heel varus deformity but few studies have reported on the size of wedge removed, and none have reported on location of the osteotomy or angle at which the osteotomy should be made. The purpose of this study is to determine these optimal parameters for surgical correction in patients undergoing Dwyer osteotomy using pre-operative imaging analysis with 3D-printed modeling. Methods: Patients with hindfoot varus deformity who had undergone Dwyer calcaneal osteotomy in a single institution were evaluated. Pre-operative CT scans were used to create a 3D-printed model of the ankle and foot sparing the calcaneus. Multiple identical calcaneus models were 3-D printed to perform different variations of the osteotomy. Osteotomies were done at 10, 15 and 20 mm distal to the posterior calcaneal tuberosity at 3 different angles of 30, 45, and 60 degrees of obliquity and taking out 5 or 10 mm of bony wedge giving us 18 osteotomies for each patient. After fixation, each model was mounted to a fixed platform and posterior and Harris heel views was obtained. The angle between the tibial-talus axis and calcaneal-tuber axis was measured digitally and compared to pre-osteotomy state. We used paired t-test to compare corrections (Figure 1). Results: 54 osteotomies were done on 3 patient specific models. We focused on angles 30 and 45 degrees cuts. 60 degree cuts were excluded from the study, because most of them were impossible to do due to anatomical landmarks. The average degree correction of deformity per mm of bone resected was found to be 2.99 degrees in the posterior view and 1.84 degrees in the Harris Heel view. This correction was not statistically different between 30 and 45 degree cuts or between the location of the osteotomy from the posterior calcaneal tuberosity. Conclusion: This is the first study that a 3D-printed model was used in the analysis of pre-operative imaging prior to Dwyer osteotomy to help determine optimal realignment of the hindfoot. The average degree of correction per mm bone resected was 2.99 degrees in the posterior view and 1.84 in the Harris heel view. A 60 degree cut is not advised because it is not possible for many of the iterations due to limitations of the calcaneal or peroneal tuberosity. This study provides insight into the amount needed to resect to correct the deformity, but the optimal position varies between the patients.