bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher In-Hospital Complications in Ankle Fusion Than Ankle Arthroplasty
Authors: Anderson Robert B. , Davis W. Hodges , Odum Susan M. , Van Doren Bryce 
Published: October 2016

Category: Ankle Introduction/Purpose: Ankle fusion and total ankle arthroplasty (TAA) are common surgical procedures used to treat ankle morbidity. Little is known about the comparative rates of in-hospital complications between patients treated with ankle fusion and TAA. Methods: Data from the 2002-2013 Nationwide Inpatient Sample releases were analyzed. 4,451 TAA patients and 16,277 ankle fusion patients were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 81.11 and 81.56 procedure codes, respectively. ICD-9-CM diagnosis codes were utilized to classify major or minor in-hospital complications. Fusion and TAA patients were exact matched on age, gender, race, hospital type, geographical region, comorbidities, and diabetes status. Minor and major in-hospital complications, including mortality were compared using chi-square and multivariate logistic regression. Results: Exact matches were identified for 4,174 (93.8%) TAA patients, with a mean age of 62.2 years. The major in-hospital complication rate for ankle fusion patients was 14.7% (615 of 4,174) versus 6.4% (269 of 4,174) for TAA patients (p< .01). The minor complication rate for ankle fusion was 3.9% (169 of 4,174) compared to 4.6% (167 of 4,174) for TAA (p=0.91). Fewer than 10 patients in either group died (p=0.59). After adjusting for case-mix, ankle fusion patients were 2.46 times more likely to experience major complications (OR: 2.46, 95% CI 2.11-2.88) than TAA patients. Conclusion: Compared to a matched cohort of ankle fusion patients, TAA patients are less likely to experience major in-hospital complications. These findings suggest that TAA may be a safer surgery than ankle fusion.
Medializing Calcaneal Osteotomy (MCO) and FDL Transfer as Therapy for Acquired Flat Foot
Authors: Bock Peter , Krenn Sabine , Chraim Michel , Trnka Hans-Jorg 
Published: October 2016

Category: Hindfoot Introduction/Purpose: MCO and FDL Transfer is established for grade II PTTD. The study shows a comparison of one-year and intermediate-term results. Methods: Thirty-eight patients (40 feet) with an average age of 58 years (36-75) were operated for a grade II tibialis posterior tendon insuffiency between january 2005 and december 2008. The patients were seen pre-operatively, one year and an average of 98 months (84 -120) post-operatively to assess the following parameters: AOFAS Score, VAS Score for pain (0-10), FAOS Score. Foot x-rays in full weightbearing position (dorsoplantar and lateral) were done at every visit in order to assess the following parameters: tarsometatarsal I angle on the dorsoplantar and lateral view, talo-navicular coverage angle on the dorsoplantar view, talo-calcaneal angle, calcaneal pitch angle and medial cuneiforme height on the lateral view. Results: The AOFAS hindfoot score improved from 46.4 to 89.5 points 1-year postoperatively und decreased to 87.8 points at the last follow-up. VAS for pain decreased from 6.6 pre-operatively to 1.1 at the one year follow-up and increased to 1.5 at the last follow-up. The FAOS with its subscores showed following results (pre-op, one-year post-op, final follow-up): pain subscore: 64.1, 94.3, 92.1; symptoms subscore: 80.5, 96.7, 97.3; ADL(function daily living): 67.1, 89.4, 85.3; Quality of life: 25.0, 83.6, 84.1. All clinical Scores showed a significant improvement from pre-operatively to one year post-operatively and no further significant change from one year post-operatively to final follow-up.All radiologic parameters except for the talo-navicular coverage angle improved and stayed without significant changes over time. Following complications were seen: one recurrence, two patients with irritation of the sural nerve, one patient with hypesthesia of the big toe. In ten patients the screws had to be removed. Conclusion: Flexor digitorum longus transfer together with medializing calcaneal osteotomy provides excellent results for the therapy of acquired flat foot deformity. The clinical and radiologic results improved from pre-operatively to one-year post- operatively and did not worsen over time.
Outcome of Stainsby Forefoot Arthroplasty for Severe Rheumatoid Feet
Authors: Qasim Sultan N. , Roberts Veronica I. , Allen Patricia E. 
Published: October 2016

Category: Lesser Toes Introduction/Purpose: Treatment of the severely deformed rheumatoid forefoot generally involves resection arthroplasty of the lesser toe MTP joints. This can either involve resection of the metatarsal heads or, as described by Stainsby: resection of part of the proximal phalanx and extensor tendon interposition arthroplasty. The Stainsby procedure is a well accepted technique, however despite this there is little information on the outcome of this procedure especially long term results. We present, what we believe is, the largest series with longest follow up in literature apart from original authors’ work. Methods: Retrospective review of prospectively collected data was performed of 48 rheumatoid patients with 71 feet treated with the Stainsby procedure, between March 2006 and December 2013, by a single surgeon. American Orthopaedic Foot and Ankle Score (AOFAS) was recorded at both pre- and postoperative assessment alongwith a satisfaction survey at final follow-up. 5 patients had died at final follow up. The follow-up duration was 5.4 years (range 2.2-9.8). Results: 9/48 patients were on anti TNF therapy and 26/48 were treated with Methotraxate. 57 cases (80%) had 1st Metatarsophalangeal Joint (MTPJ) fusion (Group 1) alongwith Stainsby procedure for lesser toes. There was significant improvement in mean AOFAS from 32.5 to 67.4. The difference in improvement in mean AOFAS for Group 1 (29.4 to 72.0) as compared to Group 2 with Stainsby procedure alone (34.3 to 71.0) was statistically significant. 76% had no (50%) or painfree (26%) callosities at final follow up. Three patients had significant hallux valgus deformity (one for Group 1) at final follow up. There were four cases of superficial wound infection that resolved with oral antibiotics with no further consequences. Two patients had broken retained wires in metatarsal with no consequences and one patient had non-union of 1st MTPJ fusion not requiring revision. 77% were very happy (35%) or pleased (52%) with results of operation. 93% patients would recommend the operation – 78% definitely and 15% with reservation. Conclusion: Treatment of the rheumatoid forefoot involving resection of the metatarsal heads is an established procedure, with much published literature to support its use. Stainsby procedure in an effective procedure but unfortunately not as popular probably because of lack of long term results. This study highlights the long term benefits and very good satisfaction results with Stainsby procedure with even better results if combined with 1st MTPJ fusion.
Outcomes and Complications of Total Ankle Replacement in Patients with Post-traumatic, Primary, and Inflammatory Ankle Arthritis
Authors: Rungprai Chamnanni , Phisitkul Phinit , Femino John , Amendola Annunziato 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has been evolved and proven to be an effective treatment for varieties of ankle arthritis. Previous literatures reported higher complications in patients who underwent total ankle replacement resulted from post-traumatic and inflammatory arthritis compared to primary arthritis. However, there is a lack of comparative studies to demonstrate outcomes and complications among the three groups of patients who underwent total ankle replacement. Methods: Retrospective chart review of 247 consecutive patients with 268 ankles who were diagnosed with end-stage ankle arthritis from primary (73 patients /86 ankle), post-traumatic (149 patients/154 ankle), and inflammatory arthritis (25 patients/ 28 ankle) and underwent total ankle replacement between October 1997 and May 2015. Data was collected prospectively and minimum follow-up was 6 months to allow comparison of early complications and longer term survival in all groups (mean, 41.6 months (range, 6 to 132 months), mean 43.4 months (range, 6 to 180 months), and mean 75.1 months (range, 12-162 months) for primary, post-traumatic, and inflammatory arthritis, respectively). The primary outcome was Visual Analogue Scale (VAS), Foot Function Index (FFI, pain, disability, activity limitations, and total scores), Short Form-36 (SF-36, PCS and MCS), and the secondary outcomes included 5-year and 10-year survival rate, the length of hospital stay, time to return to work, sport activity, and activity daily living, ankle range of motion at final post-operative visit, and complications. Results: There were post-traumatic (57.5%), primary (32.1%) and inflammatory arthritis (10.4%). Total ankle replacement of all three groups demonstrated significant improvement in the VAS, FFI, SF-36(p < 0.05). However, FFI, SF-36, VAS, ankle dorsiflexion, and ankle plantarflexion were similar among the three groups (p>0.05). Ankle range of motion was significantly improved in both dorsiflexion and plantarflexion in all groups(p < 0.001). The 5-year and 10-year survival rate were lower in the primary arthritis group but it did not reach statistical significance(p>0.05). Tibial subsidence was significantly higher in the inflammatory group compared to the post-traumatic group (p=0.036), but others complications were similar among the three groups. Conclusion: Total ankle replacements demonstrated significant improvement in term of functional outcomes, clinical outcomes, and pain relief as measured with FFI, SF-36, VAS scores, and range of motion of the ankle joint for treatment of end-stage ankle arthritis. The functional outcomes and complications were comparable among the primary, post-traumatic, and inflammatory groups except the talar implant subsidence was significant higher in the inflammatory group. Further prospective clinical study is indicated.
Patient-Centered Outcomes Following Total Ankle Arthroplasty vs Ankle Arthrodesis
Authors: Matheny Lauren M. , Liechti Daniel J. , Johnson Nicholas S. , Clanton Thomas O. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a debilitating disorder, which has been shown to significantly limit activities of daily living and lead to reduced quality of life. Total ankle arthroplasty (TAA) and ankle arthrodesis are common treatments for ankle arthritis; however, patient indications may differ based on individual patient needs. Few studies compare patient-centered outcomes following these two procedures, which may be useful in determining the appropriate procedure. Methods: This study was approved by an IRB. All patients between January 2009 and November 2013 who underwent TAA with a third generation implant or ankle arthrodesis by a single surgeon for treatment of ankle arthritis were included. Patients completed a subjective questionnaire at minimum two years following index surgery. Outcomes measures included Foot and Ankle Disability Index (FADI), Foot and Ankle Ability Measure (FAAM), Lysholm score, WOMAC, SF-12 physical component summary (PCS) and mental component summary (MCS), Tegner activity scale and patient satisfaction with outcome. Detailed operative data and intraoperative findings were documented at time of surgery. All data were collected prospectively. Results: There were 77 patients (46 males, 31 females) (mean age = 60.2 years (range 30.2-78.4), (mean BMI=27.7 (range 17.0- 39.1)) included in this study. There was 85% follow-up at an average of 3.5 years (range 2.0-6.6). The arthrodesis cohort was significantly younger than the TAA cohort (54.1 vs. 62.7) (P=.002). Five (7.8%) patients required revision surgery. There was no significant difference in failure rate between cohorts, with 3 patients in the TAA cohort and 2 patients in the arthrodesis cohort (P=.593). There was no significant difference in any outcome measures including FADI and subscales, FAAM and subscales, Lysholm, WOMAC and subscales, SF-12 PCS and MCS or patient satisfaction with outcome, except Tegner (Table 1). Conclusion: Patients who underwent TAA or arthrodesis as treatment for end-stage ankle arthritis had low failure rates and similar postoperative function at final follow-up. Activity level was significantly lower in the TAA cohort; however, patients were highly satisfied with their outcome regardless of cohort. Since good outcomes may be achieved with both TAA and arthrodesis, operative procedure should be matched based on patient expectations of activity and function.
Preoperative Templating in Total Ankle Replacement - A Case for 3D Imaging
Authors: Farrier Adam J. , Ramaskandhan Jayasree R. , Siddique Malik S. , Green Justin 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Pre-operative templating using plane radiographs is of great importance in planning arthroplasty of the hip and knee. Its role in total ankle arthroplasty (TAR) is less clear. Being able to use the best fitting implant is of paramount importance for transferring forces through the ankle joint. This contributes to the longevity of the TAR prosthesis. It is unclear whether pre-operative templating is more accurately performed using an AP radiograph or 3-Dimensional (3D) imaging using MRI or CT. We sought to compare the accuracy of pre-operative templating with an AP radiograph versus CT/MRI, in relation to the size of the implanted prosthesis. Methods: 29 patients undergoing TAR with BOX™ TAR between July 2014 and September 2015 were included in the study. Data was collected prospectively using a TAR database. Pre-operative templating of Tibial and Talar width using AP Radiographs was performed and recorded onto the database (Fig1). The implant sizes used was also recorded in the database (small, medium or large). Patients were part of an ongoing clinical trial which has ethics committee approval. 26 patients in this cohort underwent pre-operative CT or MRI assessment and were suitable for inclusion in the study (CT=6, MRI =20). These scans were reviewed retrospectively by two separate authors (AF and JR) to assess for Tibial and Talar width in the Coronal plane at the midpoint of the Tibia in the Sagittal plane (Fig2). A third author (MS), the lead surgeon, resolved any disagreements on measurements. The authors were blinded to the implant size used. Results: For templating the Tibial width the AP radiograph predicted the implant size 42.3% of the time while using CT/MRI scan predicted the implant size correctly 80.8% of the time. For templating the Talar width the AP radiograph predicted the implant size 42.3% of the time while using CT/MRI scan predicted the implant size correctly 84.6% of the time. The odds ratio for CT/MRI predicting the implant correctly over the AP radiograph was 5.72 (CI = 1.7 – 19.9) for the tibial component and 7.50 (CI = 2.0- 28.0) for the talar component. These values were statistically significant. Conclusion: For pre-operative templating we found 3D templating with an MRI or CT scan to be significantly more accurate than using an AP radiograph. We advise the use of MRI or CT as the most effective way to plan for TAR. MRI and CT are now frequently performed in orthopaedic centres as routine investigations. These modalities have the added benefit of assessing surrounding joints and soft tissues to aid accurate diagnosis. The limitations of this study lie in the small study size and the retrospective methodology.
Radiographic Evaluation of the Normal Ankle Joint in Children and Adolescent
Authors: Lee Seung Yeol , Kwon Soon-Sun , Park Moon Seok , Lee Kyoung Min , Moon Seung Jun , Chung Myung Ki , Jo Byung Chae , Sung Ki Hyuk 
Published: October 2016

Category: Ankle Introduction/Purpose: Although comparison to radiographic standards for ankle joint is critical for evaluation of syndemosis injuries, such standards are not well defined for children and adolescents. The purpose of this study was to determine the reliability of numerous radiographic measurements of the skeletally immature ankle joint, timing of ossification of medial malleolus and appearance of tibial incisura and differences in the values of radiographic measurements based on age and sex. Methods: This study included 590 subjects (0 to 15 years), who underwent ankle AP, lateral and mortise radiographs. Presence of the medial malleolus and incisura fibularis were recorded (Fig 1). Tibiofibular overlap, tibiofibular clear space, medial clear space, talar tilt, talocrural angle, relative fibular width and fibular position were measured (Fig 2). A inter- and intrareliability test was conducted before the main measurements using intraclass correlation coefficients (ICC). To determine the timing of the ossification center of medial malleolus and appearance of tibial incisura, multinomial logistic regression was used. The generalized linear model was used to estimate the radiographic measurements by age and sex. The 100-quantiles were calculated to determine the normal value of the tibiofibular clear space, tibiofibular overlap and medial clear space. Results: All radiographic measurements showed good to excellent intraobserver(ICC, 0.603–0.934) and interobserver reliability(ICC, 0.704–0.972). The timing of ossification of medial malleolus and appearance of tibial incisura between boys and girls were not different. Tibiofibular clear space on mortise view, and medial clear space on AP and mortise view significantly decreased by age. Tibiofibular overlap on AP and mortise views, relative fibular width on AP view significantly increased by age. Talocrural angle, tibiofibular overlap on AP view, tibiofibular clear space on AP and mortise views, medial clear space on AP and mortise views and fibular position were significantly larger in boys than in girls. The difference in tibiofibular overlap, tibiofibular clear space and medial clear space on mortise view of both sides was < 50% in 98.1%, 99.3%, and 100% of patients, respectively. Conclusion: Tibiofibular clear space, tibiofibular overlap and medial clear space can be parameter to assess distal tibiofibular syndesmosis or deltoid ligament injury in skeletally immature patients. For these patients, the criteria of absolute radiographic values used in adults cannot be applied, but comparison of both sides could help physicians to predict the need for additional evaluations.
Realignment Osteotomy in Fibular Malunion
Authors: Barg Alexej , Wiewiorski Martin J. , Henninger Heath B. , Valderrabano Victor 
Published: October 2016

Category: Ankle Introduction/Purpose: The exact incidence of distal fibula malunions after fibular reconstructions is not known, but incidence up to 33% is described in the literature. The most frequent malunions of the fibula are shortening and malrotation, resulting in the widening of the ankle mortise and talar instability. It has been demonstrated that substantial fibular displacement may substantially increase the contact pressures in the ankle joint. Therefore distal fibular malunion is a risk factor for development of posttraumatic ankle osteoarthritis. The objectives of this study were to (1) describe our treatment algorithm and surgical technique in patients with posttraumatic fibula malunions; (2) determine intra- and postoperative complications rates, and (3) to describe mid-term clinical and radiological outcomes and quality of life. Methods: 19 consecutive patients (11 male, 8 female, mean age 42 years, range 19 – 68) with symptomatic fibular malunions were included into this prospective study. The initial injury was Weber B and C fracture in 7 and 12 ankles, respectively. The mean time between the injury and reconstructive surgery was 17 months (range 6 – 101). In all patients a z-shaped osteotomy of the fibula was performed to achieve the appropriate length/rotation of the fibula. Fixation was performed using a plate. If necessary, supramalleolar and inframalleolar deformities were corrected by supramalleolar tibial and calcaneal osteotomies, respectively. Prior to the osteotomies an anterior ankle arthroscopy was performed in all patients. All patients were evaluated pre- and postoperatively (mean follow-up 4.9 years, range 3.2 – 6.7). Radiological outcomes were assessed using standardized weight- bearing radiographs. Clinical outcomes were assessed using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale, and SF-36 questionnaire. Results: There were no intraoperative complications. In two patients early wound healing problems were observed, and resolved with i.v. antibiotics. Osseous healing was observed in all ankles within 10 weeks after surgery. The length and rotation of the fibula was improved in all patients, according to Weber criteria. All patients experienced significant pain relief (VAS: 6.5 ± 1.1 to 0.9 ± 0.8, P < 0.001) and functional improvement (AOFAS hindfoot scale: 48.4 ± 14.5 to 85.7 ± 7.4, P < 0.001; ROM:37° ± 6° to 46° ± 5°, P < 0.001). The SF-36 score also significantly increased in all 8 subgroups. In 11 patients hardware was removed due a discomfort after a mean of 11.8 months (range 7.2 – 22.8). Conclusion: A z-shaped osteotomy is an efficient and successful method to restore fibula length and rotation in patients with posttraumatic malunion. Our findings in this series confirm that this realignment surgery results in significant pain relief and functional improvement.
Reliability and Validity of Lower Extremity Computed Tomography as a Screening Tool for Osteoporosis
Authors: Lee Seung Yeol , Kwon Soon-Sun , Park Moon Seok , Lee Kyoung Min , Chung Myung Ki , Jo Byung Chae , Moon Seung Jun , Sung Ki Hyuk 
Published: October 2016

Category: Ankle Introduction/Purpose: Although previous studies have demonstrated the potential of conventional computed tomography (CT) as a screening tool for osteoporosis, the assessment correlation of BMD in those studies was limited to the spine. This study aimed to evaluate the reliability and validity of CT as a screening tool for osteoporosis and to estimate the correlation between central BMD and peripheral bone attenuation using lower extremity CT. Methods: In total, 292 patients who underwent a lower extremity, lumbar spine, or abdomen and pelvic CT scan within a 3- month interval of a dual-energy X-ray absorptiometry (DEXA) examination were included (Fig 1). Following reliability testing, bone attenuation of the L1, L2, L3, L4, femoral head, femoral neck, greater trochanter, distal femur, proximal tibia, distal tibia, and talus was measured by placing a circular region of interest on the central part of each bony region on a coronal CT image (Fig 2 and 3). Partial correlation was used to assess the correlation between CT and DEXA, after adjusting for age and body mass index. Results: In terms of reliability, all bone attenuation measurements, except the femoral neck, showed good to excellent interobserver reliability (intraclass correlation coefficients, 0.691–0.941). In terms of validity, bone attenuation of the L1 to L4, femoral neck, and greater trochanter on CT showed significant correlations with BMD of each area on DEXA (correlation coefficients, 0.399–0.613). Bone attenuation of the distal tibia and talus on CT showed significant correlations with BMD of all parts on DEXA (correlation coefficients, 0.493–0.581 for distal tibia, 0.396–0.579 for talus). Conclusion: Lower extremity CT is a useful screening tool for osteoporosis, and peripheral bone attenuation on lower extremity CT adequately reflects central BMD on DEXA.