bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Silverskold Test, Are We All Doing it the Same?
Authors: Cheney Nicholas , Rockwell Kyle , Weis John , Lewis Dylan , Long Joseph , Law Timothy , Carr Adam 
Published: September 2017

Category: Pathophysiology Introduction/Purpose: Gastrocnemius eqiunus has been associated with a wide range of foot and ankle pathologies in the literature, however, many still question it’s involvement or existence. A recent response in Foot & Ankle International pointed out an incorrect demonstration of the Silfverskold test in a prior study. With a growing body of literature supporting gastrocnemius equinus as a contributing factor in foot and ankle pain, why do many feel that it still does not exist? It was our hypothesis that unless the examination is performed correctly, the diagnosis can be missed and could be the potential cause for disbelief in its existence or effect on foot and ankle pain. We sought to demonstrate the difference in examination findings when performing the test correctly and incorrectly. Methods: Thirty consecutive patients with conditions associated with gastrocnemius equinus in the literature were included in the study. Each patient was consented and had a Silverskold test performed correctly by inverting and locking the subtalar joint as well as stabilizing the talonavicular joint in order to isolate the ankle joint. We then performed the exam incorrectly without stabilizing the same two joints, allowing motion through the ipsilateral hindfoot and midfoot joints. A long arm goniometer was used to measure the angles with each arm along the length of the fibula and fifth metatarsal. The senior author performed all of the examinations to maintain consistency. The angles were recorded for later review. Results: We found that when the subtalar and talonavicular joints were stabilized, there was almost fifteen degrees less dorsiflexion than when the same joints were not stabilized. The average dorsiflexion when performed in the correct manner was seventy-eight degrees, while the average dorsiflexion with the exam performed incorrectly was ninety-three degrees. Conclusion: We demonstrated that if the examination is not performed correctly, the equinus contracture could go undiagnosed as motion through the hindfoot and midfoot joints can alter the findings. It is important to understand and perform the technique correctly to evaluate for the contracture as it has been shown to be a contributing factor in many foot and ankle problems. If we standardize the examination, there may be less disagreement about its existence or affect on foot and ankle pain.
A Biomechanical Comparison of a Limited Open and Standard Open Technique for Achilles Tendon Rupture Repair
Authors: Dekker Robert , Qin Charles , Lawton Cort , Muriuki Muturi , Havey Robert , Alshouli Mohammed , Patwardhan Avinash , Kadakia Anish 
Published: September 2017

Category: Basic Sciences/Biologics, Sports Introduction/Purpose: The drive to reduce soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. The PARS Achilles Jig System is one option that has gained popularity as an alternative to open repair. For many surgeons, standard open repair consists of a Krackow locking-loop technique. We compared the load to failure of a limited open and open Krackow technique for repair of Achilles tendon ruptures. Methods: Nine pairs of human cadaver lower limbs were randomized to undergo either a Krackow locking loop repair with epitendinous weave or a PARS Achilles Jig System Repair. Specimen were loaded to failure on a servo-hydraulic material testing machine. From load- displacement curves, initial linear stiffness, load to failure, and work to failure were calculated. Results: The average load to failure for Krackow repair (353.8 ± 88.8 N) and PARS repair (313.3 ± 99.9 N) was not statistically different (p = .38). The average work to failure for open repair (6.4 ± 2.3 J) and PARS repair (6.3 ± 3.5 J) was also not statistically different (p = .904). Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than the PARS repair (11.8 ± 2.5 N/mm) (p = .011). The predominant location of failure for Krackow repair was at the suture itself. In contrast, the PARS repair predominantly failed at the suture-tendon interface. Conclusion: The results suggest no difference between the Krackow and PARS repairs in terms of ultimate strength or work to failure. The Krackow repair demonstrated a higher initial linear stiffness than the PARS, which may imply a greater ability to withstand gap formation. With less devitalization to surrounding soft tissue and equal repair strength, the PARS system should be considered a favourable option for repair of ruptured Achilles tendons.
Overtightening of the Syndesmosis Revisited and the Effect of Syndesmotic Malreduction on Ankle Dorsiflexion
Authors: Ghorbanhoseini Mohammad , Kwon John Y. , Gonzalez Tyler , Velasco Brian , Lechtig Aron , Nazarian Ara , Egan Jonathan 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: To assess the effect of syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of ankle dorsiflexion. To assess the effect of anterior & posterior syndesmotic malreduction after syndesmotic screw fixation on ankle dorsiflexion. Methods: Fifteen cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro- sensor system after application of a consistent load in the intact state, after compression fixation with a syndesmotic screw and after anterior & posterior malreduction of the syndesmosis. Results: Following screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7±0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior displacement of the syndesmosis resulted in dorsiflexion ROM that was 99.1±1.75% and 98.6±1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value =0.88). Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value= 0.99). Conclusion: Maximal dorsiflexion of the ankle is not required prior to syndesmotic fixation. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation has no effect on ankle dorsiflexion thus poor patient outcomes after syndesmotic malreduction does not appear to be the result of loss of dorsiflexion due to mechanical block.
Surgical Treatment for Stenosing Peroneal Tenosynovitis
Authors: Karnovsky Sydney , Drakos Mark , Levine David , Watson Geoffrey 
Published: September 2017

Category: Ankle Introduction/Purpose: Stenosing Peroneal Tenosynovitis is an uncommon entity that is equally difficult to diagnose. In our practice, we have found 14 patients with this diagnosis. They were all successfully treated with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Further, the ultrasound guided anesthetic injection of the tendon sheath preoperatively essential in confirming this diagnosis and evaluating for successful outcomes after surgical intervention. Methods: 14 patients were diagnosed with Stenosing Peroneal Tenosynovitis. Upon initial presentation, the patients all reported a persistent history of pain along the ankle and had exhausted conservative treatment options. Patients with MRIs had images that appeared normal. In order to confirm the diagnosis as Stenosing Peroneal Tenosynovitis, ultrasound guided injections of anesthetics were administered into the peroneal tendon sheath. If the injection alleviated the pain, this confirmed the diagnosis of Stenosing Peroneal Tenosynovitis. Patients also had neurological consults to rule out possible sural neuritis. In patients with a confirmed diagnosis of stenosing peroneal tenosynovitis, we proceeded with surgical intervention. They underwent surgery between 2006 and 2014 by two fellowship trained orthopedic surgeons at one institution. Retrospective chart review was performed and functional outcomes were assessed pre-and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Results: All patients that underwent this procedure were given the Foot and Ankle Outcome Score (FAOS) and Short Form 12 (SF-12) general health questionnaire pre-operatively. Questionnaire results were collected post-operatively and were successfully obtained at one year or greater from 11 patients. Of these 11 patients, all showed significant improvements (student t test used, p<0.05) in four of five categories of the FAOS (pain, daily activities, quality of life) as well as significant improvement in their overall SF-12 score and pain scale score (Table). Conclusion: Stenosing peroneal tenosynovitis is an uncommon entity. The presentation of the disease is one of persistent lateral sided ankle pain with minimal radiologic findings. We present a case series in which the peroneal tendon sheath was diagnostically injected with an anesthetic to determine if the pain could be relieved. In each of the cases, symptomatic improvement was obtained following the injection, helping to confirm the diagnosis. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe, this diagnostic injection is paramount in assisting with determining the success of surgical outcome.
Mobility Changes in the First TMT Joint after Proximal First Metatarsal Osteotomy for Hallux Valgus Evaluated by Weightbearing CT and a 3D Analysis System
Authors: Kimura Tadashi , Kubota Makoto , Hattori Hidekazu , Minagawa Kazuhiko , Suzuki Naoki , Hattori Asaki , Marumo Keishi 
Published: September 2017

Category: Bunion Introduction/Purpose: In a previous study, we found that feet with hallux valgus show significantly greater three-dimensional mobility than normal feet in all joints of the first ray. Displacement was particularly pronounced in the first TMT joints, indicating that this is the primary cause of first ray hypermobility. We developed a plate used specifically for proximal first metatarsal osteotomy to perform three-dimensional correction of hallux valgus and associated deformities. In this study, we evaluated changes in mobility of the first TMT joints after surgery in 3D using weightbearing CT. Methods: The subjects were 5 feet of 5 female patients with hallux valgus (mean age 56 years, mean hallux valgus angle 38°). We performed non-weightbearing and weightbearing (using a load equivalent to body weight) CT scans before surgery using an original loading device (Fig a). We reconstructed 3D models from captured images by segmentation and defined axial coordinate system (Fig b). Next, we measured the three-dimensional displacement of the first metatarsal bone relative to the medial cuneiform bone under weightbearing conditions. At 1 to 1.5 years after proximal metatarsal osteotomy for all patients, we performed a follow-up CT scans using the same method and compared preoperative and postoperative displacement. Student’s t- test was performed to statistically compare data and statistical significance was set at p < 0.05. Results: Postoperatively (when performing a follow up CT), the mean hallux valgus angle improved from 38° to 10° and the mean first-second metatarsal angle improved from 23° to 7°. The mean score on the Japanese Society for Surgery of the Foot hallux scale improved from 62 points to 97 points. Displacement of the first metatarsal bone relative to the medial cuneiform bone between non-weightbearing and weightbearing conditions decreased significantly in all directions, from 4.2° ± 1.8° to 1.6° ± 1.1° of dorsiflexion (p = 0.02), 4.9° ± 1.8° to 0.7° ± 0.9° of inversion (p = 0.001), and 4.4° ± 1.9° to 1.7° ± 0.8° of adduction (p = 0.01). Conclusion: Displacement of the first TMT joints under weightbearing conditions decreased after our surgery. This indicates that the surgery corrected hallux valgus and associated pes planus and produced favorable functional outcomes by improving the shape of the foot and hypermobility of the first ray through correction of the orientation and tension of surrounding tendons and ligaments and the plantar aponeurosis. In the future, we plan to further examine the pathology and treatment of hallux valgus with a focus on postoperative changes in soft tissue orientation.
Prevalence of Symptomatic Venous Thrombo-Embolism in Patients with Total Contact Cast for Diabetic foot Complications; A Retrospective Case Series
Authors: King Roland , Platt Simon , Jackson Gillian 
Published: September 2017

Category: Ankle, Diabetes, Midfoot/Forefoot Introduction/Purpose: Venous thrombo-embolism (VTE) is a costly and potentially life threatening complication of limb immobilisation in a plaster of Paris cast. It is now generally recommended that patients undergoing limb immobilisation in cast are given LMWH therapy. The gold standard of treatment for diabetic patients with Charcot feet is total contact casting (TCC). TCC is also employed in the management of diabetic foot ulceration (DFI). Such casting is often prolonged with a time frame greater than 6 weeks. In general diabetic patients with established complication, (Charcot, DFI) often have comorbidities which increase the risk of VTE when the limb is immobilised. One would anticipate these patients to have a high rate of VTE given the immobile limb and comorbidities contributing to higher risk. Methods: A retrospective review was undertaken. A search on patients’ records up to April 2015 was undertaken to identify patients placed into total contact casting. These patients all had DFI or Charcot treated with a TCC. The patient’s electronic and paper records were reviewed for any documentation of VTE, as well as other co-morbidities. Results: 18 patients aged between 43 and 78 (mean 60) were identified. These patients were casted between one week to 3 months. None of these 18 patients sustained a documented VTE. None of them were on prophylactic anti-coagulation for the time they were in cast. All of the patients had a documented significant cardiovascular history (as well as Diabetes Mellitus), with HbA1c values ranging from 45 to 122 (median 74). Body mass index values for all of the patients were unavailable. Conclusion: Despite high risk for the developing a VTE, none of the patients in our series suffered a documented symptomatic PE or DVT. We recognise the limitations of our study; small numbers with retrospective review. Nonetheless, we hypothesised that with prolonged contact casting in patients with significant comorbidity the prevalence of VTE would be higher than that observed. We believe that this is the first study looking for VTE in a TCC and diabetic population.
Liposomal Bupivacaine versus Continuous Popliteal Nerve Block in Total Ankle Arthroplasty
Authors: Mulligan Ryan , Morash Joel , DeOrio James , Parekh Selene 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: The use of liposomal bupivacaine (LB) has recently gained popularity in joint arthroplasty. Despite it’s proven safety and efficacy, there is little reported on the use of LB in foot and ankle surgery. Catheter placement for a continuous popliteal sciatic nerve block (CPSNB) has an excellent track record for pain relief, and is commonly used by our group for major foot and ankle reconstructions. The purpose of this study was to compare the use of intraoperative LB injection to CPSNB as a regional anesthetic for total ankle arthroplasty (TAA), with attention to postoperative pain scores, narcotic use, and complications. Methods: Retrospective review of TAA patients treated by two fellowship-trained orthopedic foot and ankle surgeons was performed. Patient demographic data, operative, and postoperative details were collected, including type of regional anesthetic used. Patient’s received either preoperative single-shot popliteal sciatic nerve block with 0.25% bupivacaine followed by intraoperative injection of LB, or preoperative CPSNB alone. Outcomes examined were VAS pain score at 8 hours, 24 hours, 1 week, and 3 weeks following surgery, need for opioid pain medication refill, physician office notification for pain issues or other adverse events, and complications within the first 90 days following surgery. Standard statistical analysis was performed and p < 0.05 was considered significant. Results: 75 patients were identified who underwent TAA and met inclusion criteria. 41 received LB and 34 received CPSNB. No statistical difference was seen between groups with regard to complications, emergency department visits, readmissions, reoperations, VAS pain score at any time point, physician office contacts, and narcotic refills. Mean VAS with LB use was 1.8, 3.5, 2.6, and 2.2 at 8 hours, 24 hours, 1 week, and 3 weeks respectively, compared with mean VAS 2.1, 3.2, 2.2, and 1.9 at similar time points for CPSNB (p=0.59, 0.65, 0.27, and 0.40, respectively). 16 of 41 LB patients needed narcotic refills, versus 12 of 34 CPSNB patients (p=0.81). 3 of 41 LB patients had a complication postoperatively, versus 4 of 34 CPSNB patients. Conclusion: This is the first study evaluating the use of LB for total ankle arthroplasty. LB was both safe and effective for postoperative pain control, with comparable results to CPSNB. As LB gains more widespread use in foot and ankle surgery, further investigation is warranted to determine potential unseen complications and cost-effectiveness.
Outcomes of Revision Ankle Arthroplasty using a Fixed-bearing, Stemmed Intramedullary Prosthesis
Authors: Schipper Oliver , Haddad Steven , Van den Avont Alexander 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: As in all total joint arthroplasty, longevity is finite, and the need for predictable revision surgery is mandatory. Literature is sparse describing revision total ankle arthroplasty (TAA) feasibility and outcomes. Revision total ankle arthroplasty involving implant exchange remains in its infancy, making critical assessment of outcomes necessary to guide future treatment options. The purpose of this study was to analyze the clinical outcomes of revision TAA using a minimum 2-year follow-up to evaluate for early failure and outcomes. Methods: Retrospective chart review identified 18 patients that underwent revision of their TAA to a third generation FDA approved fixed-bearing, intramedullary stemmed implant with a minimum 2 year follow up. Once identified, all patients were contacted for an in-office outcomes questionnaire, examination, and radiographic follow up. Outcomes included the Foot & Ankle Disability Index (FADI) Score, Foot Function Index (FFI), Visual Analog Scale (VAS) used for pain, and ankle range of motion. Results: The mean age of patients at the time of revision was 59.6±9.7years and the mean follow up was 4.2±2.1 years. The mean FADI score was 69.9±17.9, the mean FFI was 49.1±15.2, and the mean VAS score was 33.3±25.8. Mean ankle dorsiflexion was 19.6±7.8 degrees and mean ankle plantar flexion was 18.6±7.5degrees. Postoperative complications included one infection requiring irrigation and debridement with hardware removal for a medial ankle soft tissue abscess, and one medial malleolus fracture that underwent open reduction and internal fixation. Three revision prostheses failed during the follow-up period, requiring additional surgery. Reasons for failure included talar subsidence in 2 patients secondary to osteolysis and/or avascular changes to the talus, and medial/lateral gutter impingement due to an oversized talar component in 1 patient. Conclusion: Revision of ankle arthroplasty requires significant planning in extraction of the failed prosthesis, implantation of the revision prosthesis, and alignment of the foot. Major complications are potentially avoidable through careful bone assessment prior to revision surgery, and results are acceptable in this early follow-up study using a fixed-bearing intramedullary stemmed implant system.
Functional Outcomes after Fracture-Dislocation of the Ankles
Authors: Tantigate Direk , Vosseller J. Turner , Greisberg Justin , Ascherman Benjamin , Kirschenbaum Joshua , Freibott Christina , Ho Gavin 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Fracture-dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. Although there is a wealth of reported outcome after operative treatment of ankle fractures, there has been a limited focus on functional outcome of surgically treated ankle fracture-dislocations. The purpose of this study is to compare short-term functional outcome after open reduction and internal fixation (ORIF) in ankle fractures with and without dislocation. Methods: A retrospective chart review of ankle fractures surgically treated by ORIF over a three year period was performed. All ankle fracture patients 18 years or older with a minimum of 12 months follow-up were included. Demographic data, type of injury (bimalleolar, trimalleolar, etc.), operative time, complications, and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow up visit. Comparison of demographic variables and the subcategories of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) were performed in ankle fractures with dislocation and without dislocation. A total of 62 patients were eligible for analysis, 38 (61.3%) were female. Twenty patients (32.3%) were fracture-dislocations and 42 (67.7%) had no dislocation. Mean age of patients was 48.44 ± 17.89 years (range, 19-85 years). Mean follow-up time is 39.79 ± 13.53 months (range, 12-76 months). Results: The fracture-dislocation cohort demonstrated worse FAOS than the nondislocation cohort (symptoms 73 vs 79, pain 75 vs 85, ADL 80 vs 88, Sport 63 vs 76 and QOL 54 vs 60, respectively), although none of these differences were statistically significant. Patients with ankle fracture-dislocation had more bony injury (i.e. more bimalleolar and trimalleolar injuries) (P = .007) and had a higher rate of subsequent hardware removal (11.9% vs 35%, P = .031) There was no statistically significant difference in patient demographics or the rate of complications. Conclusion: Fracture-dislocations of the ankle presented with more bimalleolar and trimalleolar fractures, although there was no statistically significant difference in terms of functional outcome. Subsequent surgery for hardware removal was higher in the dislocation cohort. Although our data showed no difference in outcome, there was a trend towards worse outcomes in the dislocation cohort that a larger study may be able to discern.