bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sagittal Alignment in Fixed Bearing Total Ankle Replacements
Authors: Nielsen Natalie , Sanders Austin , Nguyen Joseph , Demetracopoulos Constantine 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: Placement of the talar component in total ankle replacement (TAR) is technically challenging and malposition can occur. Implant alignment can affect both contact stresses at the articulation of the prosthesis, as well as forces at the bone implant interface, and survivorship of the implant. In mobile bearing implants, postoperative pain relief and functional outcome correlates with sagittal position of the talar component. The purpose of this study is to evaluate the sagittal alignment of the talar component between two fixed bearing total ankle replacements and determine the effect of alignment on patient outcomes. Methods: We performed a retrospective review of total ankle replacements at a single institution over a seven-year period. Seventy-one patients who underwent a fixed bearing TAR (Salto Talaris, Integra LifeSciences, and INBONE, Wright Medical) with two year minimum followup were included. Preoperative and one year postoperative radiographs were assessed to determine sagittal alignment of the talar component. The preoperative sagittal alignment was measured as the tibial-axis-to-talus ratio (T-T ratio) and the postoperative sagittal alignment was measured as the A-P offset ratio. Postoperative sagittal alignment was categorized as neutral (A-P offset ratio <0.1, N=39) or anterior (A-P offset ratio >0.1, N=32). Functional outcomes were assessed at 2 years utilizing SF12 scores and the FAOS outcome score, which has been previously validated for ankle arthritis. Differences in sagittal alignment between the two implant types and differences in postoperative outcome scores were assessed using T-tests. Interobserver reliability was assessed using intraclass correlation coefficient. Results: Interobserver reliability for the preoperative sagittal alignment using the T-T ratio had very good agreement, while the postoperative A-P offset measurement had only fair/moderate agreement. Preoperatively, there was no difference in the T-T ratio amongst patients receiving a Salto Talaris or INBONE implant. Postoperatively, patients with a Salto Talaris implant have a greater AP offset ratio than patients with an INBONE implant (p <0.01). There was no difference in FAOS or SF12 MCS/PCS scores between postoperative neutral and anterior sagittal alignment groups. Conclusion: Preoperative sagittal alignment can be reliably assessed using the T-T offset ratio. The A-P offset ratio is somewhat less reliable as a measure of postoperative sagittal alignment in fixed bearing implants. Patients with INBONE implants had more neutral sagittal alignment postoperatively. Differences in alignment between the two implants may relate to anterior-posterior coverage of the tibial component and the fixed bearing nature of the prostheses. Patient reported outcome scores did not differ between neutral and anterior sagittal alignment groups.
Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Ankle Instability
Authors: Nurm Triin , Torres Paulo , Ramaskandhan Jayasree Ramas 
Published: September 2017

Category: Ankle, Sports, Trauma Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. The aim of this study was to specifically analyse the reliability of MRI reported lateral ligament findings in relation to examination under anaesthesia and stress X-rays in patients with symptomatic ankle instability. Methods: A single centre, single surgeon consecutive series of patients who had undergone examination under anaesthesia and stress X-rays preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and procedure findings were extracted and analysed. Results: Between April 2012 and December 2016, 49 patients who fulfilled the above criteria were included. There were 25 male and 24 female patients, the average age was 43.1. The average time interval between MRI scan and examination under anaesthesia was 9.7 months (2-49 months). There is a significant association between MRI reported lateral ligament findings and status of ankle stability detected on examination under anaesthesia and stress views, p=0.003 (Chi-square analysis for association). In 34 patients who had abnormal lateral ligament findings on MRI, 20 patients (58.8%) had stable findings and 14 (41.2%) had unstable findings on stress views. There was, however, a 100% concordance between MRI reported normal lateral ligament findings and stability on examination under anaesthesia and stress views (N=15). Conclusion: MRI is accurate in diagnosing the status of ankle ligaments and in particular, in predicting true stability.
Treatment of 5th Metatarsal Shaft Fracture using MIPO (Minimally Invasive Plate Osteosynthesis) Technique
Authors: Park Yoo Jung , Hwang Yeokgu , Shim Dong-Woo , Lee Jin Woo , Han Seung Hwan 
Published: September 2017

Category: Lesser Toes, Trauma Introduction/Purpose: The standard treatment of 5th metatarsal shaft fracture is still not determined yet. Conservative treatment using cast immobilization can be applied for shaft fractures without displacement, but there are reports that open reduction is indicated for displacement more than 3 mm, rotational displacement, and angular displacement more than 30 degrees. In this study, we report the result of 5th metatarsal shaft fracture using MIPO technique, which can shorten recovery period by reducing soft tissue damage with minimal incision. Methods: This study consists of 25 patients who had undergone surgery for displaced 5th metatarsal shaft fracture from March 2013 to December 2015; 8 males and 17 females. Mean age at the time of surgery was 47.4(29~69) and mean follow period was 15.0(8~25) months. 11 cases were simple oblique fracture and 14 cases were comminuted fracture with fracture fragments. Mean fracture gap was 4.4(3.1~7.6)mm. MIPO technique with LCP Compact Hand Locking Condylar Plate 2.0(Depuy-Synthes, Zuchwil, Switzerland) was used for all cases. Partial weight bearing was allowed until 4th week post-op, then full weight bearing was allowed until 6th week post-op. Clinical and radiological follow-up was made at post-op week 2, 6, 12, 24. Clinical results were obtained using Visual Analogue Scale(VAS) and American Orthopedic Foot and Ankle Society(AOFAS) score. Results: VAS of 24 weeks post-op was decreased from 5.6 ± 0.8 (4~7) preoperatively to 1.2 ± 1.3 (0~4), and AOFAS score of 24 weeks post-op was increased from 42.0 ± 12.8 (24~54) preoperatively to 86.4 ± 7.7 (74~95), both showed significant difference. Anatomic reduction and complete bone union was noted in all cases. Mean union period obtained from follow-up radiograph was 6.0 week post-op. For 15 cases, plate removal was performed at 9.5(7~25) months post-op. Conclusion: Plate fixation can be the preferred option for 5th metatarsal shaft fracture, because 5th metatarsal shaft is surgically easily accessible and more stable fixation can be applied. Since it results complete bone union without any complications and enables early weight bearing, MIPO techinque for displaced 5th metatarsal shaft fracture can be considered as useful surgery technique.
The Predictive Value of MRI for Syndesmotic Instability of Ankle Fracture
Authors: Park Young Hwan , Kim Hak-Jun 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Although many ankle fractures are combined with syndesmosis injury, preoperative imaging studies rarely reveal instability of the syndesmosis. This study assessed the use of magnetic resonance imaging (MRI) for syndesmotic instability in patients who have an unstable ankle fracture. Methods: A total of 74 patients who were treated for Lauge-Hansen supination external rotation, Weber B type fracture or pronation external rotation, Weber C type fracture and who underwent MRI before surgery to evaluate syndesmosis injury were enrolled. The MRI findings of the syndesmotic ligament and the results of an intraoperative stress test were assessed. Results: Twenty-six patients had a positive result on the intraoperative stress test. Regarding the MRI findings of the syndesmotic ligaments, complete tear of the posterior inferior tibiofibular ligament (PITFL) was the most reliable predictor of syndesmotic instability (sensitivity, 0.62; specificity, 0.94; positive predictive value, 0.84). Interobserver agreements for the intraoperative stress test and MRI assessment were excellent, except for the MRI findings of the interosseous ligament (62% agreement; kappa, 0.3). Conclusion: On the basis of the study results, complete tear of the PITFL on MRI has additional diagnostic value for syndesmotic instability in ankle fracture.
Evaluation of anatomical structures after calcaneal Evans- or Hintermann osteotomy
Authors: Plaass Christian , Ettinger Sarah , Claassen Leif , Stukenborg-Colsman Christina , Yao Daiwei , Daniilidis Kiriakos 
Published: September 2017

Category: Hindfoot Introduction/Purpose: Both Evans- and Hintermann-osteotomies are commonly used for the treatment of flexible pes planovalgus deformity. The aim of this study was to examine, which anatomical structures are affected by the performed osteotomy. Methods: Two experienced foot and ankle surgeons performed an Evans- or Hintermann-osteotomy on each of 7 cadaver feet (Science Care, Arizona, USA). There were no defects on the preparations. All cadaver feet were prepared in the same way following predetermined preparation guidelines. All individual anatomical structures were prepared and, in particular, peroneal tendons, nervus suralis as well as articular surfaces evaluated. Results: The mean age of the donors was 80.8 years. Eight left and six right feet were prepared. After Hintermann osteotomy there was no damage of the peroneus longus tendon, after evans-osteotomy in one case (14.3%). The peroneus brevis tendon was once totally damaged after Hintermann osteotomy and once partially damaged after evans osteotomy. In one cadaver the suralis nerve was partially damaged after hintermann osteotomy, in no case after evans osteotomy. After Hintermann osteotomy the calcaneal anterior and medial articular surface were 100% and 85.7% intact, whereas after Evans osteotomy only 42.9% and 71.4% were not damaged. The posterior articular surface was affected in no cadaver. Conclusion: After both osteotomies anatomical structures can be damaged. Besides biomechanical advantages, with the Hintermann osteotomy the calcaneal anterior and medial articular surface can be protected in a higher percentage than with the Evans osteotomy. Further studies should be performed, if these findings correlate with the clinical outcome.
A Retrospective Review of Risk Factors and Conversion Rate of Transmetatarsal Amputations to Below or Above Knee Amputation
Authors: Sabatini Jefferson , Odum Susan , Ellington J. Kent , Jones Carroll P. , Davis W. Hodges 
Published: September 2017

Category: Diabetes Introduction/Purpose: Despite the presence of several studies examining the conversion from transmetatarsal amputation (TMA) to a more proximal amputation, few studies identified the possible predictors of failure. The objective of this study is to examine the rate of conversion of transmetatarsal amputation to below or above knee amputation, and to identify the risk factors for conversion. Methods: A retrospective cohort study was performed examining 71 transmetatarsal amputations performed by a single group of foot and ankle subspecialists within a single specialty group between October 1 2005 and August 25 2015. Demographic information and comorbidities were recorded, as were complications, readmission rate, and rate of conversion to a more proximal amputation. Results: Of the 71 patients who underwent transmetatarsal amputation during the study period, 74.7% progressed to a revision amputation or more proximal amputation at a mean of 9.7 months, but a median of only 3.2 months. 87.3% progressed to below knee amputation, 9.9% underwent revision transmetatarsal amputation, and 2.8% received an above knee amputation. Of the patients who progressed to more proximal amputation, 88.2% had diabetes mellitus, 72.4% had a pre-operative ulceration, and 81.7% had peripheral neuropathy. Only 52.7% had diagnosed peripheral vascular disease, 38.1% had a history of renal disease, and 35% were smokers. Conclusion: Transmetatarsal amputation has an extremely high short-term reamputation rate with the vast progressing to a below knee amputation. Comorbidities such as diabetes mellitus, neuropathy, and history of ulceration are often found in these patients, while renal and peripheral vascular disease as well as tobacco abuse are not necessarily present. This high rate of reamputation may bring into question the efficacy of performing transmetatarsal amputation as opposed to a more proximal amputation as a definitive procedure when lower extremity amputation is required.
Supine Surgical Achilles Tendon Repair
Authors: Sage Katherine , Guyton Gregory 
Published: September 2017

Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Open Achilles tendon repair is typically performed in the prone position for easy visibility of the tendon, but serious complications may be associated with general anesthesia in this position. Open Achilles tendon repair with supine position has been described and potentially avoids these issues, but it is not known whether this position is safe. We reviewed the complication rate of supine open Achilles tendon repair in a retrospective series of patients, looking specifically at wound healing, infection, re-rupture, and sural nerve injury. Methods: CPT codes for Achilles tendon rupture were used to search the records of one surgeon for the years 2010-2014. The charts were then reviewed. Patients were included if they had an Achilles tendon rupture that was surgically treated with primary repair in the supine position within 15 days of injury. Patients were excluded if further reconstruction or tendon transfer was performed. A paramedian incision was utilized 1 cm medial to the Achilles sheath. Results: A total of 37 patients met the inclusion criteria. Of these 37 patients, 31 were men and 6 were women. The average age was 40.0 years (range, 20 to 66 years). Average length of follow-up was 159 days (range 25 to 1589 days). The average BMI was 28 (range 24-36). There were no major complications, including no infections or wound complications. No reruptures and no sural nerve injuries were observed. Conclusion: In 37 patients with early follow-up, supine open Achilles tendon repair had a complication rate equivalent to reported historical data for the prone procedure.
Outcomes of Lisfranc Injuries Treated with Joint Preserving Fixation
Authors: Scofield Harrison , Lam Kenrick , Panchbhavi Vinod , Stautberg Eugene , Weiss William , Bender Sean , Mahmoud Ali 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: Open reduction and internal fixation with transarticular screws to stabilize Lisfranc injuries may increase the risk of arthritis or affect outcomes. Extra-articular or bridge plating to stabilize these injuries avoids this articular damage. This study analyzes the functional outcomes and complications in patients who underwent this type of joint preserving fixation for Lisfranc injuries. Methods: A retrospective review of all patients treated for a Lisfranc injury at a level 1 trauma center from July 2008 to October 2015 was conducted. Patients over 18 years of age who were not incarcerated and did not have any concomitant procedures in the lower extremities were included. Patient electronic medical records were reviewed. Outcomes were analyzed with AOFAS scores. Results: There were 16 patients included in the study with an average follow up time of 57 months (15 - 102 months). Average AOFAS score was 79 (SD 16) and time to return to regular activities was 35 weeks (SD 25 weeks). Seven patients (44%) had their hardware removed during the follow up period. There was 1 complication which comprised of a screw backing out and needing to be removed. Conclusion: In the present case series, joint preserving fixation for Lisfranc injuries offered similar AOFAS scores as those reported for ORIF with transarticular screws, but with a decreased rate of hardware removal and need for mid-foot fusion.
Osteotomy reconstruction surgery for Pilon fracture malunion
Authors: Shi Zhongmin 
Published: September 2017

Category: Ankle Arthritis, Trauma Introduction/Purpose: To evaluate the clinical outeonles of distal tibial osteotomy and alignment reconstruction for Pilon fracture malunion. Methods: Between January 2010 and May 2012, 15 cases of Pilon fracture malunion were treated with super-malleolar extra- articular or intra-articular osteotomy and alignment reconstruction.They were 12 males and 3 females with an average age of 30.8 years.The pre-operative X-ray and CT scan showed varus deformity in 9 cases and valgus in 6.All the patients complained about ankle pain, deformity, limited range of motion and walking difficulty. Results: 13 cases obtained an average final follow-up of 23.8 months.The average VAS score declined significantly from 5.1±3.2 preoperatively to 1.4±0.8 postoperatively (P<0.05).A complete pain relief was achieved in 8 cases.The AOFAS ankle and hindfoot score, SF-36 score, ankle ROM at the last follow-up were improved significantly compared with the pre-operative ones (P<0.05).No implant failure, soft tissue complications occurred during the follow-up. Conclusion: Distal tibial osteotomy and alignment reconstruction is an effective treatment of Pilon fracture malunion, because this strategy can restore the lower limb alignment, relieve pain and decrease the rate of long-term post-traumatic arthritis.
Comparison of Clinical Outcomes after Modified Broström Procedure with or without Calcaneofibular Ligament Repair for Chronic Lateral Ankle Instability
Authors: Sung Ki Sun , Yim Hyun Seok 
Published: September 2017

Category: Sports Introduction/Purpose: Modified Brostrom procedure has been the choice of treatment for chronic lateral ankle instability(LAI). However, there is a controversy about the necessity for repair of calcaneofibular ligament(CFL). Thus, we designed a prospective randomized control study to investigate if there is any difference according to calcaneofibular repair. Methods: Between June 2012 and September 2015, 48 patients with chronic LAI were enrolled in this study after our IRB(file No. 2012-02-046-035) approved it. They were divided into two groups(24 for each) by a random manner. Inclusion criteria are as following: age of 20 to 60 and chronic mechanical LAI who had failed in conservative treatment for more than 6 months. Patients with inflammatory diseases and history of previous surgery for the same ankle were excluded. Modified Brostrom procedure was done for the patients with informed consent. For group A we repaired both ATFL and CFL, and for group B only ATFL was repaied. Postoperative rehabilitation protocol was the same after 2 week period of immobilization. For clinical and functional outcome, Karlsson-Petersson score was measured pre and post operatively. Stress radiographs were checked to evaluate objective stability. Isokinetic strength test was also recorded. Results: There was no difference in age, gender, BMI, and the number of combined intraarticular pathology between two groups. Forty three patients(22 in group A, 21 in group B) were followed up for more than 1 year after the index surgery. Karlsson score was improved from 55.8(17-80) to 78.4(32-100) in group A, from 56.4(37-82) to 83.6(49-100) without any statiscal difference between 2 groups. Anterior drawer and talar tilt in stress radiographs showed a significant improvement in both groups still without any difference between 2 groups. Similar result was found in isokinetic strength test. Conclusion: There was no clinical, radiographical and physical difference regardless of CFL repair in modified Brostrom procedure for chronic LAI. However, we cannot conclude that CFL repair is not necessary for chronic LAI. Further studies of high level of evidences with more patients and longer term follow-up are mandatory.
4-5 Year Results Following AMIC Procedure with Collagen Matrix in Cartilage Reconstruction of the Talus
Authors: Thermann Hajo 
Published: September 2017

Category: Ankle, Arthroscopy Introduction/Purpose: In recent years, the autologous matrix-induced chondrogenesis (AMIC) has established itself in the treatment of cartilage defects of the talus. In this prospective study, the 4-5 year results following arthroscopic AMIC technique at the Talus will be presented. Methods: 97 patients has been treated with this method from August 2009 until September. 48 patients (26 F, 22 M) with a mean age of 36.5 ± 3.9 years (15-69) and a BMI of 24.8 ± 3.9 (19.1 to 39.6) met the inclusion criteria. The Hannover scoring system (HSS) and VAS score for pain, function and satisfaction at baseline and 1 year (FU1), 2 years (FU2) and 4.4 years (FU3) postoperatively have been evaluated. Following arthroscopic exploration to control the inclusion criteria, the cartilage defect was debrided thoroughly. Subsequently, microfracturing has been performed with a special swan neck awls and then PRP was injected over the subchondral plate. Afterwards, covering of the defect area was carried out with the collagen matrix (AMIC) which was impregnated with PRP, which was then fixed with fibrin glue. Results: The HSS improved from 55.6 ± 12.18 baseline to 82.3 FU1 ± 15.64 (p <0.05 compared to baseline.), FU2 88.8 ± 7,43 (p <0,05 see to baseline) and FU3 89.7 ± 8.3 (p <0.05 compared to baseline) with a significant improvement over the entire period of p = 0.008. VAS for pain was 4 ± 2.74 at the Baseline and improved at FU1 to 7.8 ± 2.73 (p <0.05, compared to baseline.), FU2 8.9 ± 1.01 (p <0.05) and FU3 9.3 ± 1.26 (p <0.05) with a significant improvement over the entire period of p = 0.001. Similar results were observed in the VAS scores for function and satisfaction. There were no infections or surgical complications. Conclusion: The arthroscopic AMIC procedure also shows good mid-term results in treatment of cartilage defects of the talus. It is a promising and safe procedure in the cartilage therapy with a low complication rate through an arthroscopic surgery.