bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient Total Ankle Arthroplasty is a Safe Alternative to Traditional Inpatient Admission or Overnight Observation
Authors: Mulligan Ryan , Parekh Selene 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Safe and cost-effective health care has become a priority in the United States. Total joint surgeons have successfully performed hip, knee, and shoulder arthroplasty procedures in the outpatient setting without compromising safety, satisfaction, or results. The purpose of this study was to evaluate outpatient total ankle arthroplasty (TAA) compared with overnight or more extended hospital stay, with regard to 90-day global period medical and surgical complications, reoperations, readmissions or emergency room visits, and pain control. Methods: The medical records of patients who underwent TAA over a three-and-a-half-year period with a single, fellowship- trained orthopedic foot and ankle surgeon were retrospectively reviewed. Outcome measures included surgical complications, adverse medical events, readmission or emergency room visit for any reason, reoperation within the first 90 days following surgery, any notation of phone call or email to the surgeon’s office prior to first-operative visit regarding pain or other issues, Visual Analog Scale (VAS) pain score at the first post-operative visit, and need for narcotic refill. Outcomes were assessed by admission status; outpatient (discharge home the same day), overnight observation, or inpatient admission (hospital stay of two or more nights). Standard statistical analysis was used and p < 0.05 was considered significant. Results: 82 patients underwent TAA who met inclusion criteria. No statistical differences were found between outpatient, overnight observation, and inpatient admission groups with regard to age, preoperative American Society of Anesthesiologists (ASA) score, gender, laterality, operative indication, or additional number of procedures. A significant difference in complication rate was seen between the three groups (p=0.02), but not rate of readmission or reoperation. Five of sixteen patients (31.2%) admitted for two or more nights following surgery had a complication after discharge versus four of sixty-six (6.1%) in those who were outpatient or admitted overnight (p=0.01). There were no differences in frequency of post-operative phone calls, narcotic refills, or VAS pain score at the first post-operative visit. There were no adverse medical events in any group. Conclusion: With appropriate patient selection and proper instruction, TAA may be performed safely in the outpatient setting. Patients who were discharged home the day of surgery did not require more attention or care in the immediate post-operative period and adverse medical events did not occur. The inpatient group was more likely to have complications, but these mostly consisted of minor superficial wound problems, which may be attributed to patient factors unaccounted for in this study. As health care policy continues to evolve, efficient and cost-effective practices will be a priority and should be further studied.
Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Osteochondral Lesions (OCL’s)?
Authors: Nurm Triin , Torres Paulo , Ramaskandhan Jayasree Ramas 
Published: September 2017

Category: Ankle, Arthroscopy Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. Musculoskeletal radiologists aim to determine and report both chondral and/or osseous stability/instability of each lesion. The aim of this study was to specifically analyse the reliability of MRI reported findings in predicting the stability of OCL’s in symptomatic patients. Methods: A single centre, single surgeon consecutive series of patients who had undergone an ankle arthroscopy procedure 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 arthroscopic findings were extracted and analysed. Arthroscopy findings were taken as the gold standard. Results: Between April 2012 and July 2016, 48 patients who fulfilled the criteria were included. There were 27 male and 21 female patients, the average age was 43.4. Average time interval between MRI and arthroscopy was 9 months. There was a significant negative relationship between OCL’s reported as stable on MRI to arthroscopic findings, r=-.31, p=0.03. Of the 21 patients who had OCL’s reported as stable on the MRI, all had unstable lesions on arthroscopic evaluation (100%). One patient had an unstable OCL reported on the MRI and it was also unstable arthroscopically. In 27 patients, there was no mention of the stability of the reported OCL on the MRI, 22 patients (81.5%) had unstable lesions and 5 patients (18.5%) had stable lesions on arthroscopic findings. Conclusion: This study demonstrates that MRI has a poor predictive value for the stability of OCL’s of the ankle. Therefore we recommend that in the symptomatic patient an arthroscopy is indicated irrespective of MRI findings.
Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws
Authors: Ortiz Cristian , Díaz Andres Keller , Mococain Pablo , Wagner Pablo , Radkievich Ruben , Wagner Emilio 
Published: September 2017

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws 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). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. 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). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.
Polymorphisms of Alpha and Beta Estrogen Receptors in Post-Menopausal Women with Posterior Tibial Tendon Dysfunction
Authors: Pontin Pedro , de Cesar Netto Cesar , Dos Santos Alexandre Godoy , Carvalho Katia , Fernandes Tulio Diniz , Fonseca Fabio , Baracat Edmund Chada 
Published: September 2017

Category: Basic Sciences/Biologics Introduction/Purpose: Posterior tibial tendon dysfunction (PTTD), the most common cause of flatfoot deformity in adults, is more frequent in the female gender with peak incidence in the sixth decade of life. Multiple risk factors - intrinsic and extrinsic - and associated systemic conditions have been described in the literature. Genetic predisposition secondary to hyperexpression of genes related to hormonal metabolism, particularly the estrogens, may play a role in the pathogenesis of this disease acting in association with behavioral and endogenous risk factors. Methods: 202 female patients over the age of 40 were included in the study (N = 202). They were then divided into 2 different groups (n = 101): cases and controls. We defined as cases postmenopausal women with symptomatic PTTD, diagnosed by clinical and MRI examinations. Females with similar epidemiology, but clinically asymptomatic and with normal MRI evaluation for the posterior tibial tendon were defined as controls. Oral mucosa epithelial cells were collected from the patients and genomic DNA was extracted from the samples. The SNPs for the ER1 (XbaI and PvuII) and ER2 (AluI) genes were assessed by PCR-RFLP. Results: Patients with SNP Xbal genotype xx had 2.38 higher estimated risk (p = 0,029) in developing PTTD, when compared to patients with the other genotypes. No associations were found for the SNP PvuII and AluI. Conclusion: The present study demonstrates that patients with the Xbal single nucleotide polymorphism of estrogen receptor 1 gene have higher risk of developing posterior tibial tendon dysfunction.
Proximal Rotational Metatarsal Osteotomy for Hallux Valgus
Authors: Wagner Pablo , Wagner Emilio , de Solminihac Diego Zanolli , Ortiz Cristian , Díaz Andres Keller , Radkievich Ruben 
Published: September 2017

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus combines two deformities, the metatarsus varus and metatarsal internal rotation. The rotational deformity is seldom corrected during surgery, but is a known recurrence factor. Most techniques only correct the metatarsus varus (scarf, chevron, etc). We present a prospective case series using a novel metatarsal rotational osteotomy called PROMO (proximal rotational metatarsal osteotomy) which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone resection. Our objective was to report this new technique, preliminary results, its advantages and complications. Methods: 20 consecutive patients (17 women) with Hallux Valgus, average age 45 (25-55), were operated using this technique. The average preoperative intermetatarsal angle (IMA) was 15 degrees with an average Hallux internal malrotation of 30 degrees and a sesamoid malposition of grade V or more in all cases. Postoperatively, sesamoids position, Hallux rotation, IMA and metatarsal length were registered. They were followed for 1 year (8-14 months). The surgical technique is described, with its potential benefits and drawbacks. The radiological outcome, postoperative LEFS score, recurrence rate (IMA increase >5 degrees) and complications were registered. Results: Well positioned sesamoids (grade IV or less) were obtained in all patients postoperatively, with a complete Hallux rotational correction. Postoperative IMA was 5 degrees. achieving a complete metatarsal varus correction. No metatarsal shortening was observed whatsoever. No recurrence has been observed until final follow up. Preoperative and postoperative LEFS scores were 58 and 73 respectively. Conclusion: The PROMO has the advantage over other osteotomies that it can reliable correct, both metatarsal malrotation and varus deformities, achieving a complete deformity correction and hopefully decreasing recurrence rate. The surgical technique has been studied and refined extensively, in order to simplify it and make it reliable. Although more patients and follow-up are needed, the authors believe it is a promising surgical technique which addresses a previously not considered hallux valgus deformity component.
Effectiveness of arthroscopically assisted surgery for ankle fractures
Authors: Ahmed Sonya , Lee Kyoung min , Park Moon Seok , Sung Ki Hyuk , Koo Seungbum , Lee Seung Yeol 
Published: September 2017

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: This meta-analysis was performed to determine whether the arthroscopically assisted open reduction and internal fixation (ORIF) for ankle fractures is more beneficial than the conventional ORIF. Methods: Articles in electronic medial databases were searched between March 1983 and August 2016, including Pubmed and SCOPUS. We included the studies with comparative design comparing the surgical outcomes between the arthroscopically assisted ORIF for ankle fractures and the conventional ORIF. Finally, two RCTs and two retrospective comparative studies were included for analysis. Mean and standard deviation (SD) of postoperative functional scores, number of subjects, and P-values were extracted from the studies. In addition, postoperative follow-up period, fracture type, and study quality were collected. Results: The pooled effect size of the four studies 0.535 (95% CI, 0.247 to 0.823) in Hedges’s g, which favored the arthroscopically assisted ORIF over conventional ORIF. There was no evidence of publication bias in funnel plot and in Egger’s test (p=0.534). Conclusion: The arthroscopically assisted ORIF for ankle fractures were more beneficial than the conventional ORIF in the current evidences. However, since it needs more medical cost and longer operation time, possible additional complications and cost effectiveness are to be validated in future studies.
The influence of vitamin C on the outcome of ankle fractures. A protocol of double-blind RCT
Authors: Alhammoud Abduljabbar , Ahmed Ghalib 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Ankle fracture is one of the most common orthopedics injuries. Poor functional outcome, residual pain and discomfort is a major burden to the patients daily activities Complex regional pain syndrome (CRPS) is one of serious complication after orthopedics injuries .The incidence of CRPS is 0.3% after foot and ankle surgery. CRPS is well studied in wrist fracture. Vitamin C has been proposed to improve outcomes after a distal radius fracture by promotion of bone and soft-tissue healing and reducing the prevalence of complex regional pain syndrome (CRPS). We aim to detect the effect of vitamin C on the functional outcome, post op pain, incidence of CRPS, wound healing and fracture healing after an ankle fracture Methods: Prospective, Double blind, Randomized control study of 110 subjects (55 subjects in each group). Subjects in study group will receive 500 mg vitamin C for 50 days and standard of care, whereas control group will receive the stander of care alone. Subjects with age from 18-50 years old, with ankle fracture which treated surgically will be recruited, whereas open fracture, Peripheral vascular disease, Allergy to Vitamin C will be excluded. Subjects will be followed up in regular basis for one year. Primary end point will be diagnosis of CRPS and secondary end point will be failure of initial management Results: Although CRPS is more common in wrist injuries comparing to ankle injuries, subclinical of CRPS is more common after ankle fracture. Vitamin C showed promising results in decrease the incidence of CRPS in distal radius fracture. Literature lack of studies looking for CRPS and foot and ankle fracture without high evidence of effect of vitamin C on the functional outcome and post op pain after ankle fractures. Conclusion: We assume that vitamin C will improve functional outcome, decrease post op pain, decrease the incidence of CRPS and improve wound and fracture healing.
Mobile- vs. Fixed-Bearing Total Ankle Prostheses
Authors: Barg Alexej , Phisitkul Phinit , Saltzman Charles 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is a well-accepted treatment option in patients with end-stage ankle osteoarthritis. In general, TAR designs can be classified based on their number of components: 2-components (fixed-bearing) vs. 3- components (mobile-bearing). In the U.S. the STAR prosthesis is the only one mobile-bearing TAR with FDA approval. It remains unclear whether 3-component TAR designs have superior clinical outcomes including prosthesis survivorship. Therefore we performed a systematic review and meta-analysis of the available TAR designs to determine prosthesis survivorship and whether there is a statistically significant difference between mobile- and fixed-bearing TAR designs. Methods: We reviewed literature using common data bases. All searches were unlimited. For the search we used the subject heading terms: “ankle”, “replacement”, “arthroplasty”, and “prosthesis”. For meta-analysis a checklist was used as described by Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. The quality of included studies was assessed using Coleman’s Methodology Score. The following parameters were reviewed: type of study, inventor bias, number of patients/ankles, mean age with range, gender, etiology of underlying ankle osteoarthritis, average and maximum follow-up, number of TAR failures, and total exposure time. For each study, failure rate was estimated as the number of failures/total exposure years. N-year (here, 5 or 10 years) failure rate was calculated as 1-exp(-N*failure rate). The pooled estimate of failure rate was a weighted average across studies using the inverse variance weighting method. The test for heterogeneity was not significant so fixed effects models were used. Results: In total, 32 studies with 3968 ankles were included into the analysis. Nine studies included 844 fixed-bearing TARs and 23 studies included 3124 mobile-bearing TARs. Patient characteristics were comparable in both study groups. For fixed-bearing TAR, the 5-year and 10-year failure rate was 0.077 and 0.149 with an average annual failure rate of 0.016 (95%CI 0.008-0.025). For mobile-bearing TAR, the 5-year and 10-year failure rate was 0.074 and 0.142with an annual failure rate of 0.015 (95%CI 0.011- 0.020). Two studies with fixed-bearing TAR and six studies with mobile-bearing TAR had inventor bias. The average annual failure rate was comparable in both groups (P = 0.88), with and without inventor bias, 0.013 vs. 0.018 (P = 0.87). Conclusion: We have shown that TAR has an overall failure rate of 0.149 and 0.142 at 10 years in patients with fixed-bearing and mobile-bearing TAR design, respectively. No superiority of one implant design over another can be supported by the available data.
Leicester Achilles Management Programme (LAMP)
Authors: Bhatia Maneesh , Patel Mohammed , Aujla Randeep , Jones Annette 
Published: September 2017

Category: Trauma Introduction/Purpose: Conservative treatment of acute AT ruptures with functional rehabilitation has demonstrated superior results to surgery with equal reported re-rupture rates without the added complications of surgical treatment. The variation in patient selection for functional rehabilitation as well as the duration and type of rehabilitation regime utilised adds to the confusion of this clinically proven method of treatment. Since 2011, all patients presenting to our department with an acute AT rupture have been treated with a standardised functional rehabilitation regime in a Vacoped boot for 8 weeks with immediate weight bearing (the LAMP regime). The aim of this paper is to present ATRS scores and objective measures at 12 months follow up of patients treated with the LAMP regime. Methods: A prospective study of all AT ruptures treated conservatively with the LAMP regime between February 2011 and September 2015 was performed. The LAMP regime consists of the use of a Vacoped boot locked in 30° plantar flexion for the 1st 4 weeks. The boot is then dynamised allowing movement between 15-30° over the following 2 weeks, and finally completely dynamised allowing movement from 0-30° over the final 2 weeks. After a total of 8 weeks treatment, the boot is removed. During treatment, patients are allowed to remove the boot once a day to enable them to shower without putting any weight on the affected leg. Patients who had 12 months follow up data of ATRS scores were included. Subsequent evolution of the service has resulted in objective measures including the calf girth, heel raise height and heel raise repetitions being recorded. Complications of treatment were noted. Results: 442 patients were treated conservatively with the LAMP functional rehabilitation regime. Ultrasound imaging was only performed in 10% of cases where clinical assessment was equivocal. The incidence of a venous thromboembolic event was 5.9% with a re-rupture rate of 2%. 200 patients had 12 months ATRS scores available and 46 patients had ATRS scores as well as objective measures of calf girth, heel raise height and repetitions at 12 months. The average ATRS score was 75.3 at an average follow up of 25 months post injury. Men had significantly better outcomes compared to women. There were statistically significant differences in the muscle girth and heel raise height when compared with the uninjured side but these did not correlate with the ATRS score. Conclusion: This is the largest series of acute AT ruptures treated conservatively with the use of a standardised functional rehabilitation regime demonstrates satisfactory patient reported outcome measures at 12 months follow up. Objective measures demonstrate inferior results when compared to the uninjured side but this does not correlate with the ATRS score
Macrodystrophia Lipomatosa of the foot. Extensile dorsal approach for Reductive Surgery. Report of 4 cases
Authors: Briceño Jorge , Nussbaum Jorge Filippi , Villa Andres , Ponce Pablo Mery , Palma Joaquin , Abarca Mario 
Published: September 2017

Category: Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Macrodystrophia lipomatosa (ML) is a rare cause of local gigantism affecting hands or feet of congenital non-hereditary origin and unknown etiology. The main characteristic of this disease is the overgrowth of the mesenchymal structures as bone, tendons, vessels, nerves and, predominantly, the fibroadipose tissue. The low frequency of this pathology implies a difficulty to establish management guidelines. The most recommended treatment for this condition is the reductive surgery as an alternative to amputation of the affected segment. Our objective is to report the clinical results of the reductive surgery in four patients with ML in the forefoot. Methods: Four cases of ML surgically treated in our center between 2008 and 2016 were retrospectively analyzed after approval from our institutional review board. For each case, clinical history at admission, pre and post-operative radiographs and pre and post-operative clinical images were obtained. Results: Patients were adults between 28 and 38 years old and followed between 1 and 4 years. The toes involved were: 1 hallux, 2 second toes and 1 fourth toe. All had failed conservative treatment prior to surgery. SURGICAL TECHNIQUE: An extensile dorsal approach preserving the neurovascular bundles was performed. Bone was resected until a harmonic appearance of the toe related to the rest of the foot was obtained. In one case, removal of the distal phalanx was necessary to achieve adequate reduction. The remnant soft tissue was resected from dorsal and distal. Skin was closed using non-absorbable sutures. Wound dehiscence was observed in 2 patients and managed conservatively. No major complications were observed. All the patients were satisfied and able to wear regular shoes postoperatively. Conclusion: The reductive surgery for adults with symptomatic ML of the foot offers good functional results. The extensile dorsal approach allows an excellent surgical exposure, preservation of neurovascular supply and adequate tissue resection. Based on our clinical results and the high satisfaction observed in our 4 patients, we suggest reductive surgery as a good alternative to amputation in selected patients with ML.