bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-Surgeon Experience with Supramalleolar Osteotomy
Authors: Barg Alexej , Saltzman Charles 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Supramalleolar osteotomy is a joint-preserving option for patients with asymmetric ankle osteoarthritis. However, it remains unclear whether tibiotalar tilt can be effectively corrected by this procedure. The objective of this prospective study was to evaluate the short-term clinical and radiographic outcomes in patients who underwent a supramalleolar osteotomy procedure performed by one surgeon. Methods: A total of 16 patients with asymmetric ankle osteoarthritis and a concomitant supramalleolar deformity were included in this prospective study: 7 patients with valgus (medial closing wedge osteotomy) and 9 patients with varus deformity (medial opening wedge osteotomy). There were 11 male and 5 female patients with a mean age of 41.6 ± 10.9 years. Intraoperative and postoperative complications were recorded and analyzed. Clinical and radiographic outcomes were assessed after a mean follow- up of 3.6 ± 1.1 years. The clinical assessment included pain assessment (VAS), functional assessment (range of motion and AOFAS hindfoot score), and quality of life (SF-36). The radiographic assessment included alignment measurements (medial distal tibial angle, tibiotalar tilt, calcaneal moment arm) and osteoarthritis degree assessment in the tibiotalar joint. Outcomes were compared between both patient groups: valgus vs. varus ankle osteoarthritis. Results: In 10 of 16 patients, removal of hardware was performed. There was significant pain relief from 5.8 ± 0.8 to 2.4 ± 0.8. The AOFAS score increased significantly from 36 ± 12 to 84 ± 10. The average range of motion increased from 31 ± 5 to 33 ± 4. All categories of the SF-36 score showed significant improvement. Preoperatively, tibiotalar tilt was 4.8 ± 2.4 in the varus group and 1.8 ± 2.4 in the valgus group. Postoperatively, tibiotalar tilt improved significantly in both groups, however, there was significant difference between both groups with 2.3 ± 1.6 (varus) vs. 0.2 ± 0.5 (valgus) (p=0.005). Postoperative clinical outcomes were comparable in both groups. One patient showed progressive ankle osteoarthritis requiring ankle arthrodesis. Conclusion: Our prospective study demonstrated encouraging short-term results in patients with asymmetric ankle osteoarthritis who underwent supramalleolar osteotomy. A significant clinical and radiographic improvement can be expected. However, especially in patients with varus osteoarthritis, tibiotalar tilt cannot be fully corrected.
Early Postoperative Results of Endoscopic Transfer of Flexor Hallucis Longus for Chronic Achilles Rupture
Authors: Baumfeld Daniel , Raduan Fernando , Nery Caio , Macedo Benjamim , Silva Thiago , Baumfeld Tiago 
Published: September 2017

Category: Ankle, Arthroscopy, Hindfoot Introduction/Purpose: Background Achilles tendon chronic rupture lead to proximal retraction of the tendon and have a greater tendency to show poorer functional outcomes than acute ruptures. Numerous surgical procedures have been described to treat this pathology. The transfer of the flexor hallucis longus is a well-established treatment option, usually performed as an open procedure. The aim of this paper is to report a case series of six patients with chronic Achilles tendon rupture treated with endoscopic transfer of FHL. Methods: Six patients with Achilles tendon chronic injuries or re-ruptures were treated with endoscopic FHL transfer. There were four man and two women, average of 50 years, with four left and two right tendons involved, and no bilateral cases. All lesions were at zone 2 (between 2-6 cm proximal to insertion). We describe the surgical technique and report our results at an average of a nine-month follow-up. Results: The average follow-up of the series was 9 months (range, 5–12 months). Three patients had an associate procedure at the Achilles tendon to repair the pre-existent gap, using a minimally invasive technique. On average, we expend 56 minutes to perform the surgery, ranging from 45 to 70 minutes. All patients had a major increase in ATRS score values postoperatively, with an average of 17.8 preoperatively and 83,3 postoperatively No major complications or wound healing problems were noted. Tiptoe stance was possible for all patients without limitation. None of the patients noticed functional weakness of the hallux during daily life activity. Conclusion: Endoscopic FLH transfer is a reliable option for patients with higher skin risk and soft tissue complications. Other studies are needed to compare this technique with the open procedure, gold standard by now, to ensure its safety and efficacy.
Plate Fixation of Metatarsal Shaft and Neck fractures has high union rates and low rates of hardware removal
Authors: Beck David , Raikin Steven , Bryant Tony , Pedowitz David 
Published: September 2017

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Despite large numbers of traumatic 1st,2nd,3 rd, and 4th (1-4 MT) metatarsal shaft and neck fractures, there have be very few outcome studies related to their treatment. K- wire fixation of metatarsal fractures has been shown to lead to poor outcomes when residual displacement and angulation occurs. In order to maintain anatomic alignment, some surgeons use plates for fixation of metatarsal fractures. To the best of our knowledge, this is the first study to report the healing rates, fracture angulation and need for hardware removal of operatively treated 1-4 MT shaft and neck fractures with plate fixation. Methods: In this retrospective cohort study, we reviewed the medical records of all metatarsal fractures at our institution from October 1, 2006 – December 31, 2014 to identify all 1-4 MT shaft and neck fractures. All tarsometatarsal joint factures, isolated 5th metatarsal fractures, fractures treated at outside facilities, skeletally immature patients and fractures treated non operatively were excluded. Final available x-rays with a minimum of one year follow-up from the date of surgery were reviewed. Medical records and x-rays were reviewed for evidence of union, sagittal and coronal fracture angulation (degrees), time to full weight bearing, plate size, fracture location (neck vs shaft) and number of screws on each side of the fracture. Patients were also called to see if the plates were bothersome, if the plates had been removed, or if they desired to have the plate removed. Multiple linear regression analysis was used to make calculations of statistical significance. Results: 45 patients with 75 metatarsal fractures treated with plate fixation were included. All fractures went to union and full weight bearing. Average time to union and full weight bearing was 10.9 and 7.5 weeks respectively. The average coronal and sagittal plane angulation was 3.9 degrees and 2.2 degrees. No demographic variable showed statistical significance with regards to sagittal and coronal angulation. Fractures located in the neck were found to have higher coronal plane angulation malunion compared to fractures in the shaft (P=0.019). No variable was related to final sagittal plane angulation. 28/45 patients responded to our telephone interview with an average follow-up of 4.4 years. 10 stated the plate bothered them. No plates had been removed and 27/28 patients did not want the plate removed. Conclusion: Metatarsal fractures fixed with plates show high rates of union and low final fracture angulation. Patients did not report symptomatic hardware and did not desire to have plates removed. No patient included in this study underwent hardware removal.
Supramalleolar Osteotomy combined with Intra-articular Osteotomy for the Reconstruction of Malunited Supination-Adduction Ankle Fractures
Authors: Changjun Guo , Xu Xiangyang 
Published: September 2017

Category: Ankle Arthritis, Trauma Introduction/Purpose: The supination-adduction ankle fractures often showed vertical impaction of the tibial medial plafond. The malunion of these fractures cause the varus ankle deformity and secondary ankle arthritis. This retrospective control study looked at the use of supramalleolar osteotomy combined with intra-articular osteotomy in patients with malunited supination- adduction ankle fractures. Methods: Twelve patients were treated with malunited supination-adduction ankle fractures between January 2013 and December 2014. All of these patients had the varus ankle deformity and secondary ankle arthritis. Supramalleolar osteotomy combined with intra-articular osteotomy were underwent for the reconstruction surgery. The visual analog scale (VAS) score for pain during daily activities, Olerud and Molander Scale scores, subjective satisfaction survey rating and the modified Takakura classification stage were obtained. Ten patients were available for follow-up at a mean of 35.4 months (range, 28 to 40 months). Results: Average postoperative Olerud and Molander Scale score 24 months after surgery was 83±10 compared with 60±14 preoperatively. The mean VAS score decreased from 7±2 preoperatively to 2±2 at the latest follow-up. Six patients rated their result as excellent, 3 as good and 1 as fair. No significant difference in the modified Takakura classification stage was observed between the preoperative and the last follow-up. Conclusion: The use of supramalleolar osteotomy combined with intra-articular osteotomy was an effective option for the treatment of malunited supination-adduction ankle fractures.
Is a Flatfoot Associated with a Hallux Valgus Deformity?
Authors: Cheney Nicholas , Rockwell Kyle , Long Joseph , Weis John , Lewis Dylan , Law Timothy , Carr Adam 
Published: September 2017

Category: Bunion Introduction/Purpose: An arch collapse model has been described for a multitude of foot and ankle problems that is based on a gastrocnemius equinus contracture producing a predictable collapse that has been described in five distinct phases. Previous studies have evaluated the presence of pes planovlagus in hallux valgus patients and concluded that this is a rare occurance. The Grand Rapids arch collapse model reviews adult foot pathology and believes there is a link between bunions and flatfeet. We wanted to evaluate patients with flatfeet and determine if they had an associated bunion deformity. Based upon the arch collapse model, there should be a significant number of flatfeet with an associated bunion deformity and our goal was to see if this proved to be true. Methods: We retrospectively reviewed the radiographs of patients diagnosed with a flatfoot based upon their ICD 9 and 10 codes in the senior author’s practice. For each patient, we used standard anteroposterior and lateral foot radiographs obtained on all new patients. Initially, we had 254 feet but had to exclude 93 feet due to inadequate radiographs, normal radiographs (normal meary’s angle and talonavicular coverage angle) or in patients who already had surgical procedures to the foot. This left 161 feet radiographs for review. We then measured the Meary’s angle on the lateral images and the talonavicular coverage angle, hallux valgus angle, intermetatarsal angle and sesamoid position on the anteroposterior radiographs. Results: Of the 161 feet that remained in the study, only 6 feet (3.7%) had no radiographic evidence of a bunion based upon sesamoid position, hallux valgus angle or the intermetatarsal angle. We did find a correlation with the severity of the flatfoot based upon the Meary’s angle and the talonavicular coverage angle with the severity of the bunion deformity defined by the sesamoid position, hallux valgus angle and the intermetatarsal angle. As the flatfoot got worse, the bunion did so as well. Conclusion: Our findings would seem to fit with the Grand Rapids arch collapse model. The hypermobility of the first ray that creates the bunion deformity then allows the arch to ultimately collapse. It also does not seem to contradict what has been found previously. Earlier studies showed a low association between patients with bunions who also had flatfeet. This would make sense as the deformity may not have progressed to the flatfoot yet. However, in our study the deformity has already progressed to a flatfoot and almost all have some radiographic evidence of a bunion.
Clinical Outcomes of the Modified Broström Procedure Using Distal Fibular Periosteal Flap Augmentation for Chronic Lateral Ankle Instability
Authors: Choi Hongjoon , Kim Daewook , Park Chul-Hyun , Cho Jaeho , Chun Dong-Il , Kang Yeong Hun 
Published: September 2017

Category: Sports Introduction/Purpose: Modified Broström procedure (MBP) is the most widely accepted primary operative treatment for the operative treatment of chronic lateral ankle instability (CLAI). However, in cases of generalized ligament laxity, severe attenuation of the soft tissue, previous failed surgery, high demand activity, and obesity, unsatisfied results of the MBP have been reported. We hypothesized that if the soft tissue can be augmented enough to support body activity, the clinical outcomes are comparable with those of the anatomical reconstruction. The purpose of this study is to compare the clinical results between the MBP using a distal fibular periosteal flap augmentation and anatomical reconstruction using free tendon allograft for CLAI in cases of concerning poor outcome by MBP. Methods: Thirty-eight patients [(39 ankles), (25 men, 13 women) (mean age: 27.6 years)] who underwent both procedures were retrospectively analyzed. The mean symptom duration before surgery was 31.7 months and the mean follow up duration was 21.6 months. The indications for operation were: (1) severe subjective ankle instability feeling and objective ankle instability, (2) previous failed MBP, (3) generalized joint laxity, (4) obesity, (5) severe attenuation of the ligament. The patients were divided into 2 groups: a group of anatomical lateral ligament reconstruction (reconstruction group, 17 ankles) and a group of MBP using distal fibular periosteal flap augmentation (augmentation group, 22 ankles). Radiographic assessments were made with weightbearing anteroposterior, lateral radiographs of the ankle, hindfoot alignment radiographs, and stress radiographs using a Telos device. Clinical evaluations were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Karlsson-Peterson score. Results: The mean AOFAS score significantly improved from 54.65 to 92.94 in the reconstruction group and from 60.14 to 94.86 in the augmentation group. (p=0.000, p=0.000) The mean Karlsson score also significantly improved from 46.41 to 92.65 in the reconstruction group and from 52.64 to 94.09 in the augmentation group. (p=0.000, p=0.000) There were no significant differences in the postoperative mean AOFAS and Karlsson score between the groups. (p=0.214, p=0.299) Conclusion: If satisfied results can be expected with both procedures, we believe that surgeons will prefer the MBP using periosteal augmentation, which is more familiar and less invasive. The MBP using distal fibular periosteal flap augmentation is an alternative surgical option for CLAI in cases of generalized ligament laxity, severe attenuation of the soft tissue, previous failed surgery, high demand activity, and obesity.
Stress Radiographs Under Anesthesia for Painful Chronic Lateral Ankle Instability
Authors: Choi Jun Young , Suh Jin Soo 
Published: September 2017

Category: Ankle Introduction/Purpose: Anterior drawer and varus stress radiographs are commonly used for chronic lateral ankle instability. We compared pre-operative stress radiographs to intra-operative ones under anesthesia to figure out the accuracy and efficacy of stress radiographs at outpatient clinic. Methods: Data was collected from the patients underwent Modified Broström operation for painful chronic unilateral lateral ankle instability from January, 2014 to June, 2016. Subjects were divided by three groups (complete tear, partial tear and instability without rupture) according to the status of preoperative MRI findings of anterior talofibular ligament. Results: Ninety six patients were enrolled with a mean age of 29.63±12.04 (male: female=65: 31). Complete, partial tear and instability without rupture were 39, 46 and 11 respectively. On anterior drawer and varus stress radiographs on the affected limb, talar translation and tilting were increased significantly (2.57 mm and 2.01o). The differences between the unaffected limbs were increased by 2.47 mm and 1.32 o. Despite the stress radiographs were performed under anesthesia, the results often showed relatively small value which was not matched to the diagnostic value, even for complete tear group. Conclusion: Stress radiographs for chronic painful unilateral lateral ankle instability performed at outpatient clinic would be inaccurate. Therefore, additional diagnostic tools such as, ultrasonography or MRI are highly necessary.
Comparison of Total Ankle Replacement and Ankle Arthrodesis During the Recovery Period
Authors: Colanese Justin , McCormick Jeremy J. , Johnson Jeffrey , Klein Sandra 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Two reliable surgical alternatives exist for end-stage ankle arthritis, ankle arthrodesis and total ankle replacement. Several comparative studies have shown similar clinical results between the two procedures at intermediate-term follow-up (2 to 6 years). Despite this comparative literature, no studies have been dedicated to determining which of the two procedures allows better function and pain during the recovery period (the first 6 months following the procedure). This information is especially beneficial to patients for whom a more difficult and longer recovery is particularly adverse, such as elderly patients or patients with medical comorbidities. It is also unclear if pain or dysfunction during the recovery period correlates with intermediate-term complications such as nonunion or prosthetic loosening. Methods: This is a single site retrospective case-control study. Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been completed by patients at the orthopedic foot and ankle clinic at each visit since October 2014. Patients who have undergone either a total ankle replacement or an ankle arthrodesis during that timeframe were evaluated to determine their level of pain, function, anxiety and depression at a given interval (from preoperative to 6 months) during their recovery. Data acquisition was via chart review. Exclusion criteria included Charcot neuroarthropathy and inadequate data. Results: 138 procedures (58 total ankle replacements, 80 ankle arthrodeses) were performed at our institution during the study period. Chart review of patients meeting inclusion criteria is currently being conducted to record PROMIS scores, adjuvant procedures, complications, return to work and post-operative protocol during the first 6 months following the procedure. Data analysis will be undertaken, to detect a minimally important difference between PROMIS scores, with a 95% confidence interval and power of 0.8, the minimal sample size was calculated to be 44 subjects in each group. For patients who developed a complication from surgery (non-union, implant loosening, infection, etc.), scores will be reviewed to determine if abnormal PROMIS scores early on in the recovery period correlate with future complications. Conclusion: Patient pain and function during the first 6 months following surgery is an important consideration for those contemplating both ankle arthrodesis and replacement as options. Data collected from this study to be completed by Spring 2017 will help to clarify if differences between the two procedures exist.
The role of bone marrow edema on autologous matrix induced chondrogenesis for the treatment of osteochondral lesions of the talus
Authors: D’Ambrosi Riccardo , Maccario Camilla , Usuelli Federico Giuseppe 
Published: September 2017

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: to assess the functional and radiological outcomes after AT-AMIC® (arthroscopic talus autologous matrix induced chondrogenesis) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for osteochondral talar lesion. MRI and CT-scan evaluations, as well as clinical evaluations measured by the VAS score for pain, AOFAS and SF-12 were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. Results: GNE consisted of 24 patients while GE consisted of 13 patients. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points(p<0.001). In GNE, AOFAS improved significantly at each follow-up(p<0.05); while CT and MRI showed a significant decrease between T1 and T2 and T2 and T3(p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3(p<0.05); CT decreased between T1 and T2(p<0.05), while MRI showed a reduction at each follow-up(p<0.05). Lesion size was significantly higher both in MRI and CT in GE in respect to GNE(p<0.05). In the GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusion: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.