bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Ankle Arthritis More Disabling than Midfoot Arthritis and 1st MTPJ Arthritis?
Authors: Ramaskandhan Jayasree Ramas , Siddique Malik 
Published: September 2017

Category: Ankle Arthritis, Midfoot/Forefoot Introduction/Purpose: There is wide array of outcome tools available for assessment of level of pain and symptoms in osteoarthritis, there are less disease and region specific outcome measures to evaluate the level of disability caused by arthritis in ankle, mid foot arthritis (including Talo-navicular joint, Calcaneo-cuboid joint and tarso metatarsal joints) and 1st Metatarso phalangeal joints. We aimed to measure the level of disability incorporating elements of physical, mental and social well-being using patient reported outcome measures as recommended by the International classification of Functioning, disability and health (ICF) Methods: This is a prospective data series, patients with arthritis of ankle, mid foot or 1st MTPJ who were diagnosed in new patient clinic were asked to take part in this survey. They completed a questionnaire consisting of MOX-FQ (Manchester Oxford Foot Questionnaire), EQ-5D (General Health Status) and FAOS (Foot and Ankle Outcome Scores). Patients were grouped in to 3 groups (Group A - ankle arthritis. Group B - midfoot arthritis (either Talo navicular, Calcaneo-cuboid or TMT joint); Group C - arthritis of 1st Metatarso-phalangeal joint of the foot). The results of summary scores were calculated for responses to individual questions and compared between the groups. Demographic factors were included in the statistical analysis carried out using SPSS Version 22, Illinois. Results are reported as follows Results: There were 26 patients in (Group A); 12 patients in (Group B) and 19 patients in (Group C). There was no difference in mean age of patients between groups (p>0.05) For components in MOX-FQ, there was no difference in pain scores (p=0.353) between the groups. For difficulty with walking/standing, Group A patients reported significantly worse scores (77 ± 19.4) when compared to Group C (53.7 ± 35.5). There was no difference in scores between groups for social function component of MOX- FQ (p=0.487). For EQ-5D, although Group C patients reported higher scores they failed to achieve statistical significance (p>0.05). For FAOS, Group A patients reported significantly lower scores for pain and symptoms, ADL, ability to take part in Sports/Recreation (p=0.008) and Quality of Life (p=0.003). Conclusion: In conclusion, although patients with ankle arthritis, mid foot arthritis and 1st MTP joint arthritis report similar level of disability in terms of general health and social function, patients with ankle arthritis reported higher level of disability in terms of pain, difficulty with standing/ Walking, ability to do Activities of Daily living, ability to take part in recreational activities and overall Quality of Life.
Calcaneal Osteotomies in the treatment of Hindfoot Deformities
Authors: Sahranavard Bahman , Shah Ashish , de Cesar Netto Cesar , Araoye Ibukunoluwa , Hudson Parke , Cone Brent , Johnson Michael , Jones Caleb , Pinter Zachariah , Lee Sung 
Published: September 2017

Category: Hindfoot Introduction/Purpose: Calcaneal osteotomy is a common procedure for hindfoot deformities correction. Screw fixation is the most common technique used to stabilize these osteotomies. The clinical decision regarding the number of screws used is frequently based on the surgeon’s experience without sufficient data regarding outcomes and complications. The aim of this study was to compare the outcomes and complications of one versus two screws fixation technique of sliding calcaneal osteotomies. Methods: We reviewed 190 patients (112 female, 78 male) who underwent corrective calcaneal osteotomy for hind-foot angular deformity between 2010-2016. The average age was 48.4 years (18-83), and mean follow-up was 28 weeks (4-150). We divided patients into two groups, according to the number of screws used in the osteotomy fixation (one or two). 85 osteotomies were fixed by one screw and 105 by two screws. We compared both groups regarding incision type, positioning and type of the screws (headed or headless) and complications (non-union, infection, hardware related heel pain). Results: The average time for radiographic union was similar between the groups, around 5.6 weeks (4-10 weeks). Non-unions were not found. The overall Incidence of complications was not significant different in the one screw group compare two screw group (12.7% x 8%, p-value 0.465). Infection rate was similar in both groups (4.7% vs 3.5%, p-value 0.674). There was not significant difference of hardware related heel pain between two groups (15.2% vs 8.5%, p-value 0.149). Similarly, no difference in incidence of hardware related symptoms between patients who used headed screw when comparing with headless screws. Conclusion: Our study compared results in the use of one screw versus two screws fixation technique for sliding calcaneal osteotomies. We found similar time for union. Base of date there was no significant difference of complications, infection, and hardware related heel pain between patients who used one screw when comparing two screws fixation technique for corrective calcaneal osteotomy.
There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability
Authors: Shah Ashish , Cone Brent , Netto Cesar de Cesar , Araoye Ibukunoluwa , Hudson Parke , Sahranavard Bahman , Pinter Zachariah , Jones Caleb , Bergstresser Shelby , Lee Sung 
Published: September 2017

Category: Ankle Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair. Methods: This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test. Results: Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively. Conclusion: Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.
Management of Hepple Stage V Osteochondral Lesion of Talus with Platelet-Rich Plasma (PRP) Scaffold
Authors: Shi Zhongmin 
Published: September 2017

Category: Ankle Introduction/Purpose: There is no consensus on treatment or prognosis for Hepple stage V Osteochondral lesion of talus (OLTs), especially for lesion more than 1.5 cm2. This research was to investigate surgical techniques and clinical outcomes of platelet-rich plasma (PRP) scaffold for Hepple stage V OLTs. Methods: 14 patients were treated by cancellous bone graft with PRP gel scaffold between 2013 and 2015 with average age of 38.9 years old and mean set of 23.5 months. Ankle X-ray and MRI were obtained at the final follow-up for evaluation. Functional outcomes were scored by the Visual Analog Scale (VAS) score, American Orthopaedics Foot and Ankle Society (AOFAS) ankle- hindfoot score and Short Form (36) Survey score (SF-36). Range of motion (ROM) of ankle joint and complications were also recorded. Results: 13 patients got the final follow-up with a mean duration of 18 months. MRI showed complete regeneration of subchondral bone and cartilage in all patients. The post-operative VAS, AOFAS ankle-hindfoot score and SF-36 score improved significantly (P<0.0001) without obvious complications. Conclusion: We suggest that for the patients of Hepple stage V OLTs, cancellous bone graft with PRP scaffold may be a safe and effective treatment.
Scaffolds Based Therapy for Osteochondral Lesion of Talus
Authors: Shimozono Yoshiharu , Yasui Youichi , Kennedy John 
Published: September 2017

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Numerous surgical treatment strategies for osteochondral lesions of the talus (OLT) have been proposed, but ideal treatment has yet to be established. Scaffold based-therapy for OLT is quickly becoming more popular as a new approach for reparative treatment. The purpose of this study was to systematically review published literature reporting clinical outcome of scaffold based-therapy for OLT and establish whether sufficient evidence exists to support use of scaffolds for OLT. Methods: A systematic search of the MEDLINE and EMBASE databases was performed in June 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), variable reporting outcome data and clinical outcomes. Modified Coleman Methodology Score (MCMS) was used to evaluate the QOE. Results: Twenty-five studies with 678 ankles were included; 96% were either LOE 3 or 4, and all studies were of poor or fair QOE. There were 6 different scaffold repair techniques, including one-step and two-step procedures. The categories of general demographics (93%) and patient-reported outcome data (84%) were well reported. The study design and imaging data were less reported with 72% and 78% respectively. Clinical variables (50%) and patient history (30%) were the least reported in studies. Clinical outcomes were evaluated using a number of different scoring systems. The weighted mean AOFAS score improved from 60.5 ± 6.3 preoperatively to 86.9 ± 8.4 at a weighted mean 41.3 month follow-up. Six studies reported that weighted mean 71.6% of patients returned to sport activity at previous level. Conclusion: This systematic review demonstrated that there is a lack of supporting data to justify current scaffold based therapy for treatment of OLT, although a lot of available commercial scaffolds for OLT exist. Further well-designed studies are necessary to determine the effectiveness of scaffold based therapy for OLT, especially compared with the available traditional treatments.
Clinical Implication of Os subfibulare
Authors: Shin Hyuk Soo , Lee Dong Yeon , Lee Doo Jae 
Published: September 2017

Category: Ankle, Sports, Trauma Introduction/Purpose: Os subfibulare, defined as a separated ossicle of the distal fibular, has been linked to various clinical problems such as subfibulare pain and chronic lateral ankle instability. However, whether os subfibulare is congenital or traumatic remains unclear. The objectives of this study were: 1) to determine the incidence of os subfibulare development after ankle sprain in children and adolescents in a single primary care orthopedic clinic, and 2) to evaluate clinical implication of os subfibulare associated with ankle sprain in children and adolescents Methods: Among 896 pediatric patients (age ranging from 3 to 16 years) who visited a single primary care unit after sustaining ankle inversion injury, 627 patients who were followed up for over 2 weeks were included in this study. For each pediatric patient, physical examination and radiographic examination (anteroposterior, lateral, and mortise view of the bilateral ankle) were performed. The incidence of os subfibulare was evaluated based on initial radiographic examination. To analyze the incidence of new os subfibulare formation after ankle inversion injury, radiographs of 193 patients who were followed up for more than 6 months were evaluated according to the grade of injury. Results: At initial visit, 1% of examined ankles (13 from 1,254 ankles of 627 patients) showed well corticated ossicle not related to initial injuries. We cannot recognize the existence of accessory ossification center of the fibula in our study population. Overall incidence of os subfibulare at final follow up after ankle inversion injury was 23.9% (150/627). Os subfibulare at final follow up was correlated with initial injury grade (OR: 8.0, p = 0.001). In patients with initial avulsion fragment, 64.9% (61/94 cases) had residual ossicle at the final radiograph after being followed up for more than 6 months. As for the morphology of ossicle, 54 cases with wafer bone fragment at the time of initial injury showed oval or round shape ossicles at final radiograph. Conclusion: The incidence of os subfibulare at the initial radiograph was about 1%. The chance of ossicle formation after ankle inversion injury was substantially high in pediatric population. Based on the findings of our study, we carefully suggest that majority, if not all, of os subfibulare would be posttraumatic in pediatric period. Therefore, ankle inversion injury in children should be managed more actively to reduce the chance of posttraumatic os subfibulare formation.
Comparison of Fixation Stability of the Novel Lisfranc Plate to Transarticular Screws
Authors: Shymon Stephen , Harris Thomas , Cassinelli Spenser , Ebramzadeh Edward , Fleming John , Agrawal Virat , Sangiorgio Sophia 
Published: September 2017

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: The objective of this study was to compare the stability of fixation of ligamentous Lisfranc injuries stabilized using two devices: a novel Lisfranc plate and conventional transarticular screws. Methods: A biomechanical cadaver model was developed to compare the fixation stability of a novel Lisfranc plate to that of traditional fixation, using transarticular screws. Thirteen pairs of cadaveric specimens were tested intact, after a simulated injury, and after implant fixation. Optical motion tracking was used to measure the three dimensional (3D) motion between each of the following four bones: first metatarsal, second metatarsal, first cuneiform, and second cuneiform. Testing included both cyclic abduction loading and cyclic axial loading. Results: Both the Lisfranc plate and screw fixation method provided stability such that the average 3D motions across the Lisfranc joint (between the second metatarsal and the first cuneiform), were between 0.2 and 0.4 mm under cyclic abduction loading and between 0.4 and 0.5 mm under cyclic axial loading. Comparing the stability of fixation between the Lisfranc plate and the screws, the differences in motion were all 0.3 mm or lower, with no significant differences (p > 0.16). Conclusion: Average 3D motions of the Lisfranc joint were 0.5 mm or below, whether fixed with the Lisfranc plate or the screws. Therefore, the Lisfranc plate provided comparable stability to the transarticular screws, which have been established as the gold standard for arthrodesis in Lisfranc injuries. Due to its anatomical placement, the Lisfranc plate may provide adequate support without risk of iatrogenic injury to the articular cartilage.
Intramedullary fibular fixation is a versatile tool in the operative management of fractures of the distal tibia and fibula
Authors: Singh Anjani , Smith Michael , Hakim Zuned 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Intramedullary fixation of the fibula has been proposed as a minimally invasive alternative to traditional plate fixation in fractures of around the ankle. Previous studies have demonstrated a low complication rate, particularly when both distal locking and trans-syndesmotic screws are used. More recently, they have been used to act as a lateral buttress to prevent valgus malunion in fractures of the distal tibia and fibula. After four years of using fibular intramedullary devices in our unit we set out to audit our practice. Methods: We retrospectively searched our electronic operation database for operations in which fibular nails were used, from their first use in our unit in 2012 through to the end of 2016. Electronic operative and clinic notes were reviewed. We gathered basic demographic information and classified fractures according to the AO/OTA system, and studied pre- and post-operative radiographs for evidence of malunion. Results: Eighteen cases were identified. Median age at surgery was 66 (Range 23 to 83 years). Seven patients smoked, one was diabetic. Fibular nails were used in six in AO type 44 and twelve in AO type 42 and 43 fractures. Five were open. Fibular nails were used alongside tibial IM nails, tibial bridging plates, percutaneous tibial fixation and a tibial circular frame and were chosen because of concerns about poor soft tissues or wounds over the lateral side. Twelve cases had syndesmotic fixation. Median follow-up was five months (range 0-48 months). One nail was removed to compress a tibial fracture. All fractures united with no progressive malunion. One prominent distal locking screw was removed and one superficial wound infection required oral antibiotics. Conclusion: We have expanded the use of this device beyond the technique originally described. It’s use has been demonstrated across a range of fractures about the distal tibia and fibula in a variety of different operations with excellent results. Minimally invasive fibular nailing is particularly useful in patients with poor soft tissues or where there is high risk of post-operative infection.
Radiographic analysis of Hallux valgus. A study on foot arch by severity
Authors: Takahiro Yamada , Usami Norio , Hiroko Ikezawa , Takatori Naoko , Hiraishi Eiichi , Inokuchi Suguru 
Published: September 2017

Category: Bunion Introduction/Purpose: X-ray measurement for hallux valgus has been conducted with various results in the evaluation. However, it was not quite clarified yet and it still remains questionable why a mild case shifts to a severe case during the course. We report about the difference between the severity and the foot shape. Methods: The study subjects were 206 feet of 138 patients. Mild case: 80 feet, mean age 53 y.o (A) Moderate case: 61 feet, 62 y.o (B) Severe case: 65 feet, 67 y.o (C) For the examination items, HVA, M1-2 angle, and M1-5 angle were measured with the x-ray frontal radiograph for loading position, and First, Second, Fifth intermetatarsal angle (M1Y/M2Y/M5Y) on sagittal plane were also measured. We also evaluated the foot arch ratio with Yokokura Method, then compared/examined those results after dividing the cases into the mild, moderate, and severe group with age bracket. Results: The age of Group C were older than Group A, B. M1-2 angle: In younger generation, three is significant difference between Group A and B. M1-5 angle: Significant in 60 s between A and B. In 70 s, significant: all group. Navicular height: all group is low arch with aging. Significant between A and C It is becoming low arch at Lisfranc level with aging in all group. There is significantly low height at M5 with aging in all group. On sagittal plane, bone axis of M1 and M2 is lowered at 40 s in Group A and B and 70 s in Group C. Conclusion: In hallux valgus, the foot shape was changed in coronal and sagittal plane. It means the collapse of bone structure at foot and ankle. It may possibly be shifting to a severe case with aging. However, we could not find any result definitely suggesting such condition.
Treatment Of Intra-Articular Calcaneal Fractures Using Sinus Tarsi Approach And Only Screws
Authors: Urbina Christian , Olmedo Cristian , Gallardo Fernando Vargas , Lagos Leonardo , Chaparro Felipe , Soto Christian Bastias , Parra Mauricio , Rivera Maximiliano 
Published: September 2017

Category: Hindfoot, Trauma Introduction/Purpose: Displaced intra-articular calcaneal fracture have been usually treated with open reduction and internal fixation using extensile lateral approach, however this management has been associated with high rates of soft tissues complications. Minimally invasive approaches might be an alternative to reduce these complications and improve the outcomes. Our aims were to describe the radiological and clinical outcomes of patients with intra-articular calcaneal fractures treated with a minimally invasive surgical technique. To determine if the Böhler’s angle is restored and maintained through the time. To determine the posterior facet joint reduction using CT scan. To report the frequency the soft tissue complications, days of hospitalization after the surgery, and the need of secondary procedures or additional admissions using this technique. Methods: Retrospective review of patients with intra-articular calcaneal fractures treated with sinus tarsi approach and fixation only with screws between January 2014 and July 2016. Twenty fractures in 15 patients were included. The clinical files and imagenology studies were analized. Results: The mean age was 47 years. Eighteen males and 2 females. One open fracture. Ten smoker patients. Two with diabetes mellitus. Ten cases were joint depression fractures and 10 were tongue fractures of the Essex Lopresti classification. Ten cases were Sanders II and 10 Sanders III. The mean Böhler’s angle was 2º preoperative, 22º in the postoperative and 19º at the last follow up. Postoperative posterior facet joint reduction was good o excellent in 19 cases. The mean days of hospitalization was 2.9. Two cases needed hardware removal. One patient had minor soft tissue complications. No patient had major complications. Conclusion: Our experience showed a low soft tissue complications rate, an adequate correction of the posterior facet joint reduction and adecuate correction and maintenance of the Böhler’s angle, few days of hospitalization after the surgery, and no need of secondary surgical procedures due to acute complications. We conclude this is a suitable alternative in order to reduce the soft tissue complications with accurate correction and preservation of the radiological parameters.
The painful total ankle replacement
Authors: Vulcano Ettore , Myerson Mark 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: The last decade has seen a considerable increase in the use of in total ankle arthroplasty (TAA) to treat patients with end-stage arthritis of the knee. However, the longevity of the implants is still far from that of total knee and hip arthroplasties Methods: To introduce a systematic approach to the painful TAA based on the literature and on the senior author’s experience Results: See algorithm attached Conclusion: This new diagnostic and treatment algorithm may be useful to guide less experienced surgeons navigate through the possible causes and treatments of a painful TAA