bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long Term Outcomes Following Syme’s Amputation
Authors: Pinzur Michael , Schiff Adam , Finkler Elissa 
Published: September 2017

Category: Ankle, Diabetes, Trauma Introduction/Purpose: The metabolic cost of walking following Syme’s ankle disarticulation amputation is minimally more than similar non-amputees. The ability to end-bear makes prosthetic fitting relatively simple, and very few patients require extensive rehabilitation or placement in a skilled nursing or rehabilitation facility. In spite of these potential benefits, there is a paucity of objective information on the actual long term outcomes. Methods: Fifty-one patients were identified who underwent single stage Syme’s ankle disarticulation amputation with excision of the lateral and medial malleoli by a single surgeon during a twenty three year period. None of these patients had sufficient tissue to allow amputation at the transmetatarsal or tarsal-metatarsal levels. Thirty-three underwent amputation due to diabetic forefoot infection, eleven secondary to crush injury, three for non-diabetic infection, three for non-correctable acquired deformity and one for neoplasm. The average age at surgery for the di-abetic patients was 62.1 (range 36-81) years, with a follow-up of 6.8 (4-11.6) years. The nondi-abetic patients averaged 37.8 (range 21-65) years, with a follow-up of 9.3 (range 2.2-25.0) years. Patients who were alive and could be contacted were invited to complete a Short Musculoskele-tal Functional Assessment (SMFA) questionnaire that was scored for functional, mobility and bothersome indices. Results: Seventeen of the 33 diabetics died. Four (12.1%) were converted to the transtibial amputation level. One of the non-diabetics had died and one (5.5%) was converted to the transtibial amputation level. Eleven of the thirty-three patients who were con-tacted completed the SMFA. All of these patients demonstrated favorable outcome scores in the mobility, functional and bothersome indices (non-diabetic mean mobility score of 17.2, function-al index of 14.7 and bothersome of index of 16.7 compared to 34.7, 29.9 and 30.6 in the diabetic patients, respectively). Conclusion: The objective information derived from this investigation supports the opinion that patients with Syme’s ankle disarticulation amputation appear to fare better than sim-ilar patients with transtibial amputation. This data also refutes the notion of high complication rates and difficulties with prosthetic fitting. These patients require less rehabilitation and achieve improved levels of functional independence as demonstrated by favorable functional, mobility, and bothersome indices.
Pain course after foot and ankle surgery
Authors: Plaass Christian , Ettinger Sarah , Claassen Leif , Stukenborg-Colsman Christina , Daniilidis Kiriakos , Hayn Konstantin 
Published: September 2017

Category: Pain managment Introduction/Purpose: Most surgeons believe, that the postoperative pain course after foot and ankle surgery differs from other joints due to the initial protection and immobilization. The knowledge of the normal pain course after foot and ankle surgery is important to know for the surgeon and correctly inform patients preoperative and may help to identify abnormal postoperative healing courses. Methods: 180 patients were enclosed in a prospective study. 66,7% were female and 33.3% were male. All patients had primary surgery for foot and ankle diseases at a tertiary care foot and ankle center. The pain course was measured using a VAS over a one year period. The mean age was 53,2 (±13.6) years. Results: The mean pain level was 4.56 (± 2.0) preoperative. In the first postoperative week it was 3.5 (± 2.18) and declined until the 6th postoperative week to 1.57 (± 1.52) it increased again after the sixth week up to 1.95 (± 1.63) and decreased then again to 1.09 (± 1.51) one year postoperative. The pain level in patient with tendon surgeries tended to be higher in the first 12 weeks postoperative than that of patients with bony procedures. Conclusion: The pain course after Foot and ankle surgery shows a characteristic curve with a significant increase of the pain level after 6 weeks. A comprehensive patient information can increase satisfaction rates of the patient. Any abnormal postoperative pain course should arise suspection of a complicated healing period.
Chopart Joint Injuries – 10-Year Results in 75 Cases
Authors: Rammelt Stefan 
Published: September 2017

Category: Hindfoot, Midfoot/Forefoot, Trauma Introduction/Purpose: Fractures and dislocations at the mid-tarsal (Chopart) joints have a relatively low incidence but a highly variable clinical presentation. They are among the most commonly overlooked or misinterpreted injuries to the human body with potentially deleterious consequences for global foot function. There are only few reports available on the long-term outcome of operative treatment following a standardized protocol in these injuries. Methods: From 1994 to 2009 a total of 122 patients with mid-tarsal fractures and fracture-dislocations were entered into a pospective database. Injury patterns, comorbidities, treatment, and complications were documented. Seventy-three patients with 75 Chopart fracture-dislocations were available for follow-up treatment at an average of 10 years (range, 4-18 years). Mean patient age was 37.6 years, 68.5% were male. Foot function was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, the Foot-Function-Index (FFI-D) and the SF-36 physical and mental component summary scores. Weight-bearing radiographs were obtained to assess alignment and posttraumatic arthritis. Results: Motor-vehicle-accidents accounted for 53.4% of injuries, The navicular and cuboid bones were fractured more than twice as often as the talar head and anterior process of the calcaneus. In 54.7% of cases more than one of these bones was fractured. 29.3% of the patients were polytraumatized, another 26.7% had accopmanying injuries to the same foot. At latest followup the AOFAS score averaged 71.5, the FFI averaged 26.9, and the mean SF-36 physical and mental summary scores were 43.5 and 51.2, respectively. Negative prognostic factors were a high ISS, work-related accidents, open injuries, multiple fractures and purely ligamentous dislocations (4%) at the Chopart joint, two-step operations, delay of treatment for more than 4 weeks, postoperative infection, closed reduction and the use of primary or secondary arthrodeses. Conclusion: Fractures and fracture-dislocations at the Chopart joint are rare but severe injuries to the foot that lead to lasting functional restrictions in most cases in the long term. Purely ligamentous dislocations have the worst prognosis while injuries with fractures of a single bone have a better prognosis with open reduction and anatomical internal fixation. Fusions should be restricted to cases with completely destroyed joint surfaces.
Combination of PedCAT with Pedography Shows Relationship of Morphology (Bone) Based Foot Center (FC) and Force/Pressure Based Center of Gravity (COG)
Authors: Richter Martinus , Lintz Francois , Zech Stefan , Meissner Stefan 
Published: September 2017

Category: Basic Sciences/Biologics Introduction/Purpose: PedCAT (Curvebeam, Warrington, USA) is a technology for 3D-imaging with full weight bearing which has been proven to exactly visualize the 3D-bone position. Center of gravity (COG) and Foot Center (FC) are discussed to be important parameters for corrections/fusion around the hindfoot and for total ankle replacement. For this study a customized pedography sensor (Pliance, Novel, Munich, Germany) was inserted into the pedCAT. The aim of this study was to analyze difference of morphology (Bone/PedCAT) based FC and Force/Pressure (Pedography) based COG. Motion of COG during PedCAT/Pedography scan should also be registered and analyzed. Methods: In a prospective consecutive study starting November 28, 2016, 36 patients / 72 feet were included. Inclusion criteria were 18 years of age or older, and indication for PedCAT scan based on the local standard. A pedCAT scan with simultaneous pedography with full weight bearing in standing position was performed. The morphology based definition of the FC was performed with the pedCAT data following the TALAS algorithm. This algorithm takes different bony landmarks (Posterior calcaneal process, center of talar dome/tibial plafond, metatarsal heads) into consideration and calculates the FC. The force/pressure based COG was defined with the pedography data using a software based algorithm. The distance between FC and COG and the direction of a potential shift (distal-proximal; medial lateral) was measured and analyzed. COG motion during data acquisition was recorded and analyzed. Results: Mean age of patients was 54.5 (range, 27-80) years, 27 (75%) were female. COG motion was 1.4 mm on average (range, 0-4.8 mm). The distance between FC and COG was 22.6 mm on average (range, 5-52). FC was distally to COG in all feet (mean, 27.4 mm; range, 3-50), and laterally in 49 feet (68%; shift 0 mm in remaining feet; mean for all feet, 3.3 mm; range, 0-12). No difference between right and left side occurred (t-test, each p>.05). Conclusion: COG is not relevantly moving during combined PedCAT/Pedography scan. There is a difference between FC and COG. This expected finding was quantified with this study. There is a typical/standard shift between COG and FC in the investigated 32 subjects / 64 feet (26 mm distally and 3 mm laterally on average) which might allow for prediction of COG based on FC without additional pedography. Definition of COG might be taken into consideration for planning and followup for corrections/fusion around the hindfoot and for total ankle replacement.
Tibiotalocalcaneal Arthrodesis with a Retrograde Triple Bending Nail - Results of 200 Cases
Authors: Richter Martinus , Meissner Stefan , Zech Stefan 
Published: September 2017

Category: Ankle, Ankle Arthritis, Hindfoot Introduction/Purpose: The aim of the study was to analyse the clinical aspects including minimum 1-year-followup of tibiotalocalcaneal arthrodeses (TTCA) with a triple-bend retrograde intramedullary nail (A3, Stryker, Airview Boulevard, MN, USA). Methods: In a prospective consecutive non-controlled clinical followup study, all patients with TTCA using A3 from October 18th, 2011 to October 10th, 2015 were analyzed. The time and accuracy of the alignment and implant position (Visual analogue scale, 0-10) for implant placement, complications, radiological fusion, and Visual Analogue Scale Foot and Ankle (VAS FA) were recorded. Fusion (=50% bony bridge at ankle and subtalar joints assessed on radiographs) was assessed at 6, 9, 12 weeks, then latest follow-up. VAS FA was recorded at latest follow-up. Results: 200 cases were included (age, 59.3 (22-83) years; VAS FA, 31.9 (0-79.3)). Indications were specified as follows (multiple possible): osteoarthritis, n=182 (91%); instability, n=48 (24%); deformity, n=154 (77%), failed total ankle replacement, n=12 (6%); failed previous fusion, n=15 (8%), diabetes, n=28 (14%). The time for implant preparation and positioning was 17.2 (5-32) minutes. The accuracy of alignment and implant position was 9.4 (7 - 10). Complications were registered in 12 (6%; n=6 (3%) infection, n=6 (3%) wound healing delay. One hundred and sixty-eight (84%) patients completed follow-up at 32 (12-60) months: VAS FA 60.4 (t-test (comparison with preoperative scores), p=.01)), fusion rate 96%. Conclusion: TTCA with the A3 implant system showed accurate correction and implant position. Thirty-two month (average) followup of 168 patients (84%) showed good clinical outcome scores and 96% fusion rate.
Stabilization of Proximal Interphalangeal Arthrodesis of Lesser Toes Using K-wires vs. Implants
Authors: Rothermel Shane , Aydogan Umur , Lewis Gregory , Roush Evan 
Published: September 2017

Category: Lesser Toes Introduction/Purpose: Lesser toe proximal interphalangeal (PIP) joint arthrodesis is one of the most common foot and ankle elective operative procedures. Currently, the most common method for fixation of the PIP joints is utilization of intramedullary Kirschner wires (K-wires). Implantation of K-wires have been shown to be associated with a fair number of complications including hardware failure, loosening, bending, mal-union, non-union, wire migration, and infection. These complications have led to the development of intramedullary devices for fixation. Our hypothesis was that the memo-metal X-fuse PIP joint arthrodesis implant (Stryker, Kalamazoo MI) would provide a stronger and stiffer arthrodesis than Kirschner wire fixation. Methods: Six matched fresh frozen cadaveric second toe pairs were used in the study. Six PIP joints were prepared and fixed with K-wires and the six contralateral PIP joints were prepared and fixed with the X-fuse system. All specimens were then potted and fixed to a custom jig. Specimens were then cyclically loaded with extension bending force of the PIP joint mimicking natural upward bending force in walking using 2 N step increases of force with 10 cycles per step. Failure was defined as 4 mm of actuator displacement. Load to failure was then assessed. Paired t-test was utilized for statistical analysis. Results: The average force at failure (defined as 4 mm of displacement) for the Kirschner wire was 93.3 N (SD 25.8) which was significantly greater than the average for the X-fuse system, 65.0 N (SD 13.8). P-value was 0.0053. Failure of the K-wire resulted from bending of the K-wire itself or breaching of cortical bone. Failure of the X-fuse typically resulted from implant pullout. Conclusion: Contrary to our hypothesis, K-wires provided a stiffer and stronger construct than the X-fuse system. Successful bony fusion is the clinical outcome of interest, and this cadaver study was used to assess stability of the fusion site at time zero after surgery. Limitations of this study include a relatively small sample size.
Dismounted complex blast injuries
Authors: Ryan Paul , Anderson Claude , Wilding Steven 
Published: September 2017

Category: Trauma Introduction/Purpose: The United States Medical Corps has continued to evaluate and define the injury patterns of our service members in an effort to prevent injury and improve combat casualty care. The pattern of injury can be predicted by the mechanism of injury. One of the more recently described and studied mechanisms has been coined the ‘dismounted complex blast injury. This injury pattern involves traumatic amputation of at least one leg with a second injury involving another extremity in addition to an injury to either the pelvis, the abdomen, or the urogenital region. The purpose of this study was to better define and describe the injuries occurring to the non amputated extremity. Methods: This is a retrospectively review of data from the US and UK Joint Theater Trauma Registries (JTTR) of consecutive patients admitted to the UK Role 3 hospital at Camp Bastion, Afghanistan, from January 1, 2009, to February 29, 2012. Data was obtained from the US JTTR (Joint Theatre Trauma Registry). Each patient was assigned an Injury Severity Score (ISS) and an Abbreviated Injury Scale (AIS) score. Only those patients with an AIS of 3 or greater (a serious injury) were included. All xrays and CT scans were evaluated by two board certified orthopaedic surgeons and one board certified musculoskeletal radiologist. Fisher’s exact test was used to compare categorical data and binomial logistic regression was be used to compare proportions of types of injuries by traumatic amputation level observed. Results: There were 295 patients with lower extremity injuries identified. 201 had traumatic lower extremity amputations, 140 with bilateral lower extremity amputations, 61 with single leg amputations. The mean age was 23.38 +/-3.77 years. All were male. Below the knee amputation was the most frequent amputation type observed, representing 55.7% of the amputations (29/52), the next most frequent was the through knee amputation representing 25%. The least frequent was the through ankle amputation. The presence of a symes level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the rear lower extremity. There was also an association found between AKA level amputation and skeletal injury in the contralateral upper extremity . Conclusion: This is among the first studies to correlate level of injury and associated musculoskeletal injury for the Afghanistan theater of operations. The results of this data set demonstrate that proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. In addition, the Symes level of amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often present with associated Genitourinary injuries. Unique to this study is the demonstration of a significant association of upper extremity injury with a more proximal lower extremity amputation level .
A National Comparison of Total Ankle Replacement Versus Arthrodesis. Is There a Paradigm Shift?
Authors: Sabour Andrew , Alluri Ram , Tan Eric 
Published: September 2017

Category: Ankle, Ankle Arthritis, Diabetes Introduction/Purpose: Total ankle replacement (TAR) and tibiotalar arthrodesis (TTA) are both utilized in the surgical management of ankle osteoarthritis. Over the past decade, foot and ankle surgeons have broadened the indications for TAR, and subsequently have performed less TTA. Currently, no studies exist evaluating the epidemiological, pre-operative, and temporal trends between TTA and TAR. The purpose of this study was to compare nationwide trends of TAR and TTA in the treatment of ankle osteoarthritis. Methods: The Nationwide Inpatient Sample (NIS) from 2007 to 2013 was used to extract data on patients over 50 years of age who underwent either primary TAR or TTA. Patients who underwent both procedures or revision procedures were excluded. Univariate and multivariate analysis were performed to assess for differences in temporal, demographic, and primary diagnosis trends between TAR and TTA. Results: 15,060 patients underwent TAR and 35,096 underwent TTA between 2007 and 2013. Patients undergoing TTA had significantly more comorbidities (2.17 vs 1.55, P<0.001). Temporal analysis demonstrated a significant 15% increase every 3 years in TAR performed from 2007 (14%) to 2013 (45%) (Figure 1) (P<0.001). Multivariate analysis comparing TAR and TTA demonstrated that in patients with a primary diagnosis of post-traumatic osteoarthritis, the odds of having a TAR in 2013 was 12 times higher than in 2007 (P<0.05). Similar increases in TAR utilization was demonstrated in patients with primary osteoarthritis (4.93 times) and rheumatoid arthritis (3.12 times) (P<0.001). Analysis of comorbid diagnoses revealed that patients with diabetes, hypertension, or CAD were 4.66 times more likely to have a TAR in 2013 compared to 2007 (P<0.001). Conclusion: Over the past decade the indications for TAR have increased, and foot and ankle surgeons are performing TAR with greater frequency. This has been most evident in patients undergoing TAR for post-traumatic arthritis and rheumatoid arthritis. Foot and ankle surgeons still prefer to perform TAR in patients with fewer comorbidities compared to TTA. However, as technology has advanced and surgeons have become more facile with the technique, patients with specific comorbidities are undergoing TAR at a significantly higher annual incidence.
Evans Osteotomy with Locked Plate with Wedge Block for Stage IIB Flat Foot
Authors: Araujo Maria Gala Santini , Carrasco Nelly , Sotelano Pablo , Parise Ana Cecilia , Conti Leonardo , Villena Daniel 
Published: September 2017

Category: Hindfoot Introduction/Purpose: Elongation of the lateral column is indicated only in patients who have a flexible deformity Stage 2B of flat foot. The Evans osteotomy is performed 1.5 or 2 cm from the cuboideal calcaneal joint, and in many publications is maintained by different kind of devices. Our hypothesis is that Evans osteotomy, with blocked plates with a wedge block, without the use of bone graft, maintain the correction obtained at one year after surgery. The primary objective was to evaluate the radiological results at the postoperative year of the osteotomy Secondary objectives were to evaluate the persistence of the correction obtained between the 3 months and the year of the postoperative period and to evaluate the functional outcomes with AOFAS score. Methods: We studied a total of 12 patients, 14 feet. with stage 2 B flat foot, in all cases surgery was performed by the same specialist between March of 2011 and March of 2014 in the Service of foot and ankle of our institution. Inclusion criteria were: patients with type 2B flat foot, submitted to external column elongation, with plates blocked with a 6 to 10 mm wedge block, without the use of bone grafting, minimum follow-up of 1 year. Exclusion criteria: revision of previous surgery, another type of material used for elongation of the external column, neurological sequelae. The study was performed retrospectively through clinical records database, data collection and measurements were performed by 2 second-year Foot and ankle fellow trained in the same institution. Statistical analysis was performed with the T-student test. Results: A total of 12 patients / 14 feet were evaluated during the study period, with a diagnosis of flatfoot type 2B. The average age was 57 years (32-65 years), 11 (78.5%) were female. No statistically significant difference was observed in any of the radiographic variables measured, at 3 months and at 12 months postoperatively. The preoperative AOFAS score, was 54 points. At the first year was 93 points. Consolidation was achieved at 3 months in all cases. The complications found were 2 superficial infections and 1 wound dehiscence. As a late complication, there was only 1 case of cuboidal calcaneal osteoarthritis that did not require surgical resolution. Conclusion: Evans osteotomy for elongation of the external column provides a reproducible and reliable method to restore the normal functional stability of the midfoot and hindfoot. According to the results obtained in our work, we can conclude that the blocked plates with a wedge lock manage to preserve the corrections obtained with the Evans osteotomy in patients with type IIB flat foot. There is no need of autograft with the consequent risk of comorbidities produced by a second approach to the grafting as well as the complications that could happen with the use of allografts.