bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomised Controlled Trial of Ankle Block Versus Metatarsal Block for First Ray Surgery
Authors: Qasim Sultan N. , Bhatia Maneesh , Roberts Veronica I. , Attwal Manjit , Fombon Felix N. 
Published: October 2016

Category: Bunion Introduction/Purpose: First ray arthrodesis or osteotomy is a day surgery procedure performed commonly under general anaesthetic. One of the aims with such procedures is to ensure our patients are discharged on the day of surgery and are relatively pain free on discharge. This is often achieved by the use of local anaesthetic blockades, either as an ankle block or as a metatarsal block. There are studies published on the effectiveness of ankle block for first ray surgery but there is a dearth of studies on metatarsal block. Therefore the aim of this study is to compare the effectiveness of ankle block versus metatarsal block in conjunction to general anaesthetic for first ray surgery. Methods: Both local trust board approval and National Research Ethics Committee approval were granted for the study. Statistical analysis to ensure an adequately powered study was performed. Fifty patients undergoing arthrodesis or osteotomy of the first ray were recruited into this study and randomly allocated to the cohort to receive either a metatarsal block or an ankle block. All patients had general anaesthesia. Those patients randomized to ankle block had this performed after induction of general anaesthesia using ultrasonography. Those patients randomized to metatarsal block had this performed at the end of the operative procedure. Patients scored their pain level using a visual analogue scale (0-10) at 2, 6 and 24 hours. A physiotherapist, who was blinded to their treatment arm, assessed patients at hourly intervals from two hours. Patients were contacted by telephone by a research nurse, who was also blinded to their treatment arm, over 24 hours from discharge. Results: Forty-eight patients completed the study: 25 in the ankle block treatment arm and 23 in the metatarsal block arm. The majority of the patients were female (44 patients) with an average age of 53 years (range 31-76 years). Analysis of pain scores showed that there was no statistically significant difference between the two groups at any of the measured time periods. Analysis of their analgesic requirement in the first 24 hours after surgery again revealed no striking difference between the two cohorts. Similarly analysis of the time taken to safely mobilise revealed that there was no difference between the two groups. However analysis of the time taken to perform the anaesthesia highlighted a mean addition of eleven minutes when an ultrasound guided ankle block was performed. Conclusion: This prospective randomised blinded study demonstrates that metatarsal blocks are just as effective in giving post- operative analgesia as ultrasound guided ankle blocks in patients undergoing first ray surgery under general anaesthetic.
A Prospective Cohort-Study on the Return to Work and Function Two Years After Surgical Treatment of Tibiotalar Arthritis
Authors: Younger Alastair S. , Veljkovic Andrea , Wing Kevin , Penner Murray J. , Gagné Oliver 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a debilitating condition. People who are affected by end stage ankle arthritis are as symptomatic as arthritis in other main articulations of the lower extremity, and often present with concurrent medical conditions and comorbidities. Once these patients cannot perform their job due to disabling arthritic ankle, they leave the workplace and require financial aid. The purpose of this study was to determine the work status before and after surgery for end stage ankle arthritis in the working age population. We hypothesized that middle-age patients at the time of surgery [55 years-old and younger] were able to go back to work within 2 years of their index ankle procedure and not depend on social / subsidized programs. Methods: Since 2001, patients treated for end-stage ankle arthritis in three Canadian centers were offered to partake in the Canadian Orthopedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database. The modalities of treatment included total ankle replacement and ankle arthrodesis (open and arthroscopic). A survey was given to patients at various points of the study, which included the MODEMS questionnaire from AAOS and SF-36. This study used the pre-operative survey, including the along with the same survey filled by patients 2 years post-operatively. Degenerative osteoarthritis, post-traumatic osteoarthritis and inflammatory arthritis requiring surgical intervention was the main inclusion criteria. Patients over 55 years- old at the time of surgery were excluded. Results: This group had 211 patients of age 47±8 and was balanced as far as sex (113 M) and side (102 L). The employment rate for this group should be 79.2 per Statistics Canada. The employment rate prior to surgery was 56% and increased to 63% two years later. The additional 7% were on leave of absence or disability prior to surgery. At the two-year follow-up, 92 patients reported less pain with work, 88 patients reported that the surgery met their expectations and 78 reported minimal interference with their work. With regards to WCB, Disability and Social Security, 115 (56%) were never on any of the above, 41 (20%) were no longer on any two years post-operative and 9 (4%) entered at least one program. Conclusion: The two-year follow-up after tibiotalar arthrodesis or arthroplasty in patients younger than 55 years-old shows that more people are able to get back to work than go off work. It also shows that more people are able to get off subsidized programs and that there is an overall satisfaction with regards to pain, inference with work and expectation. After surgery, this patient population still has a lower employment rate than the normal population. More research would be needed to better outline strategies that could reduce the disability within this group and maintain them in the workforce.
Adult Flexible Flatfoot Due to Insufficiency of Posterior Tibial Tendon
Authors: Ceccarini Paolo , Rinonapoli Giuseppe , Gambaracci Giulio , Bisaccia Michele , Ceccarini Alfredo , Caraffa Auro 
Published: October 2016

Category: Hindfoot Introduction/Purpose: We postulated that in a flexible adult flatfoot, calcaneo-stop procedure combined with medial tensioning of posterior tibial tendon allowed the resolution of symptoms by correcting the pattern of the gait and avoiding the evolution to a subsequent stage. The purpose of this study was to determine functional, biomechanic, and radiographic results in patients who underwent surgery for flexible flatfoot without osteotomies or arthrodesis. Methods: We evaluated clinically and radiographically 29 patients surgically treated for adult flatfoot grade IIa according to Myerson, with a mean age of 46.4 years. Mean follow-up was 34.15 months. For clinical evaluation the AOFAS hindfoot and VAS- FA scores were used. In 10 patients, pre and post-operatively gait analisys was performed. Results: Postoperative results showed a significant increase of AOFAS and VAS-FA scores, from 54.7 (range 34 to 78) to 83.1 (range 66-100) and 60.5 (range 35-86) 85 (range 64-100) points, respectively. For the X-ray parameters, in the AP projection, we observed a significant variation of Kite's angle, from 24.2° in the pre-op to 19.2° in the post-op. In lateral view Costa-Bertani angle showed changes from 146.8° to 140.5°. The Meary's angle, showed an average at the post-op of 4.3°. Postoperative satisfaction was excellent-good for 25 patients (86.2%). Postoperative gait analysis showed an improved pattern of the gait. Conclusion: The technique of arthroereisis with medial tensioning of PTT is a valid technique for the young adult, up to 50 years and with no signs of osteoarthritis of the midfoot and hindfoot.
Arthritis in the First Metatarsophalangeal Joint After Proximal Opening Wedge Osteotomy for Moderate to Severe Hallux Valgus Deformity
Authors: Park Yoo Jung , Park Kwang Hwan , Hwang Yeokgu , Shim Dong-Woo , Han Seung Hwan , Choi Woo Jin , Lee Jin Woo , Suh Jae Wan 
Published: October 2016

Category: Bunion Introduction/Purpose: Over recent years, a proximal opening wedge osteotomy (POWO) using a novel low-profile plate have gained in popularity for the correction of moderate to severe hallux valgus. However, the proximal opening wedge osteotomy was known to increase the length of the first metatarsal, resulting in tightening of the soft tissues around the first metatarsophalangeal (MTP) joint and predisposing to jamming of the joint and subsequent arthritis. The purpose of this study was to evaluate the arthritic change of first MTP joint after POWO using a low-profile plate for correction of moderate to severe hallux valgus. Methods: We retrospectively reviewed 100 consecutive POWOs using a low-profile plate performed in 87 patients with moderate to severe hallux valgus deformity. After excluding 17 cases, 83 cases in 73 patients were included. For clinical assessment, VAS, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and Foot and Ankle Outcome Score (FAOS) were obtained. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), the relative first metatarsal length which is the first metatarsal length divided by the second metatarsal length and the first MTP joint radiographic arthritic grade by Coughlin and Shurnas were assessed on standard weight bearing radiographs of the foot for radiographic evaluation. Results: Mean follow-up period was 16.1 (12-45) months. The mean VAS, AOFAS score and most of FAOS subscales improved significantly. Significant corrections in the HVA and IMA were obtained and the mean increase in the relative first metatarsal length was 3.8% at last follow-up (P < 0.001). There were 15 (18.1%, 15/83) cases of the first MTP joint arthritis at last follow-up (Radiographic grade I: 5, II: 8, III: 2). Of 62 cases using a large wedge plate (≥5.0 mm), 12 (19.4%, 12/62) cases showed poorer outcomes and a significant progression of the arthritic grade at last follow-up (Fisher's exact test, P=0.031) comparing to using a small wedge plate (< 5.0 mm) (Table 1). Conclusion: The POWO using a low-profile wedge plate is effective and reproducible technique for correction of moderate to severe hallux valgus deformity. However, the exacerbation of preexisting first MTP joint arthritis and the subsequent arthritis can occur after POWOs using a large wedge plate (≥5.0 mm) at short to mid-term follow-up. Therefore, POWOs with a low-profile wedge plate should be used judiciously for correction of moderate to severe hallux valgus.
Enhancing Osseointegration of Orthopaedic Implants with Titania Nanotube Surfaces
Authors: Vara Alexander , Baker Erin A. , Salisbury Meagan , Fleischer Mackenzie , Bhosle Sachin M. , Friedrich Craig , Fortin Paul 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Solid biologic fixation at the bone-implant interface provides long-term stability of orthopaedic implants. Historically, coatings and surface treatments on implant surfaces have been used to promote osseointegration of orthopaedic implants. The purpose of this research study is to evaluate two morphologies of titania nanotube (TiNT) surfaces via in vitro experiments as well as an in vivo model of femoral intramedullary fixation, in order to assess the influence of TiNT structure on de novo bone formation and bone-implant stability. Methods: TiNT structures were grown from Ti-6Al-4 V materials via an established electrochemical anodization process. Samples were either sonicated then annealed (Aligned TiNT) or annealed without prior sonication (Trabecular TiNT), to produce different morphologies. As-received titanium alloy was the control. Marrow-derived stem cells were isolated from long bones of Sprague Dawley rats and cultured on samples. Alkaline phosphatase (ALP) and osteocalcin (OC) expression by stem cells were assessed via ELISA. Cells were lysed and subjected to quantitative polymerase chain reaction (qPCR) to assess Col1a1, osteonectin, and IGF- 1 expression. An in vivo study evaluated bone formation at 4- and 12-week endpoints. Eight female Sprague Dawley rats per group per endpoint received bilateral Ti-6Al-4 V K-wires as femoral implants. Left femur received control, while right femur received Aligned/Trabecular TiNT K-wire. Bone formation was assessed via microCT, backscatter electron imaging (BEI), and non- decalcified histologic analyses. Results: Aligned and Trabecular TiNT groups demonstrated higher ALP activity than control at 2 and 3 weeks. The in vivo study demonstrated increased bone volume fractions (BV/TV) and total bone volume (TBV) for TiNT surfaces (microCT). The ratio of both BV/TV and TBV in the distal VOI were nearly equivalent for both TiNT surfaces, indicating similar bone formation between both TiNT surfaces and control. In the midshaft VOI, the ratios between TiNT surfaces and control were 1.5 or greater, indicating increased bone formation. At 12 weeks, the bone-implant contact fraction ratio (BEI) showed Aligned TiNT and Trabecular TiNT were 1.3 and 1.4 times greater than control, respectively. Histologic analysis showed both TiNT surfaces had 1.5 times the bone-implant contact as control. Conclusion: In vitro studies demonstrated improved support for osteogenic functions of cultured marrow-derived stem cells on TiNT surfaces compared to controls. μCT, BEI, and histologic analyses associated with the in vivo study demonstrated increased bone formation in the TiNT femora, at specific timepoints and VOIs.
First Metatarsophalangeal Arthrodesis for Treatment of Hallux Valgus with Severe Metatarsus Adductus Deformity
Authors: Zhu Yuan 
Published: October 2016

Category: Bunion Introduction/Purpose: The surgical treatment of hallux valgus with severe metatarsus adductus deformity can be challenging. This study aims to investigate the clinical and radiologic outcomes of first metatarsophalangeal arthrodesis in treating this complex deformity. Methods: Between Jun 2009 and Jun 2013, 15 consecutive cases of hallux valgus with severe metatarsus adductus [metatarsus adductus angle, MAA>25°(modified Sgarlato method)] received first metatarsophalangeal arthrodesis for correction with a dorsal plate and a lag screw. The clinical outcome of these patients (average age of 63.1 years) was evaluated by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux MTP-IP Scale and ankle pain on the visual analogue scale (VAS). Radiological imaging included hallux valgus angle (HVA) and 1st intermetatarsal angle (IMA). Results: All these 15 patients were available for follow-up at a mean of 12.7 months. The average postoperative AOFAS Hallux MTP-IP Scale 12 months after surgery was 88.6 (compare with 60.8 preoperatively). The mean visual analog scale score decreased from 5.51 ± 1.53 preoperatively to 0.98 ± 0.98 at the latest follow-up. All the metatarsophalangeal joints got complete fused without delayed fusion. The HVA improved from 45.2°preoperatively in average to 17.3°postoperatively. No deformity recurrence was observed by the time of the latest follow-up. Conclusion: first metatarsophalangeal arthrodesis is a simple, reasonable and reliable option for the treatment of hallux valgus with severe metatarsus adductus deformity, especially for elderly patients with degenerated symptomatic metatarsophalangeal joint.
Outcomes and Complication Following Endoscopically-Assisted Percutaneous Achilles Tendon Repair
Authors: Rungprai Chamnanni , Phisitkul Phinit 
Published: October 2016

Category: Arthroscopy Introduction/Purpose: Open repair of acute Achilles tendon rupture is considered as a standard surgical treatment while percutaneous technique has gained increasing popularity especially under endoscopic control. However, there is a lack of currently research reporting outcomes and complications following this technique. Methods: The retrospective chart reviews with prospectively collecting data were performed in 32 patients with 32 legs who underwent endoscopically-assisted percutaneous Achilles tendon repair using 6-portal technique between 2008 and 2015. The minimum follow-up to be included in the study was 6 months (mean, 49.3 months; range, 6 to 76 months). The primary outcome was Foot and Ankle Ability Measure (FAAM); Activity and Sport, Short Form-36 (SF-36); physical and mental component scores, and Visual Analogue Scale (VAS). The secondary outcomes included tourniquet time, recovery time, and complications. Pre- and post-operative FAAM, SF-36, and Visual Analog Scale were obtained and compared using pair t-test. Results: There were 32 patients (26 male and 6 female) with a mean age of 36.7 years. An average of tourniquet time was 39.6 minutes (range, 23-67 minutes). There was significant improvement of VAS (7.1/10 to 0.1/10), SF-36 (PCS (38.8 to 49.9) and MCS (49.0 to 51.8)), FAAM (Activity, 19.0 to 88.4 and Sport, 0 to 65.6). An average time to return to activity of daily living, works, and sports were 6 weeks, 7 weeks, 3.6 months respectively. The complications included hypertrophic scar without pain (6.7%), superficial wound infection (3%). There was no re-rupture, deep vein thrombosis, sural nerve injury, and painful scar in this study. Conclusion: Endoscopically assisted percutaneous Achilles tendon repair demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS. acute rupture of Achilles tendon. This technique is safe and feasible for treatment patients with acute rupture of Achilles tendon.
Treatment Outcomes of Chronic Lateral Ankle Instability Associated with Mild Cavovarus Deformity
Authors: Park Yoo Jung , Park Kwang Hwan , Hwang Yeokgu , Shim Dong-Woo , Han Seung Hwan , Choi Woo Jin , Lee Jin Woo , Suh Jae Wan 
Published: October 2016

Category: Ankle Introduction/Purpose: Chronic lateral ankle instability (CLAI) has shown significant relationship with cavovarus deformity in prior studies. Isolated lateral ankle ligament reconstruction in patients who have CLAI with cavovarus deformity has been shown poor outcome if the deformity had not been corrected. Traditionally, cavovarus foot has been associated with neuromuscular conditions, however, nowadays it occurs in a less severe form even in the normal population. Mild cavovarus deformity is thought to be an anatomical risk factor for CLAI, but there are still debates on the correction of the mild deformity. The purpose of the current study was to evaluate clinical and radiographic outcomes of the modified Broström operation (MBO)s with additional procedures for the CLAI with mild cavovarus deformity. Methods: We reviewed total 12 patients who underwent MBOs with additional procedures for CLAI with mild cavovarus deformity between August 2009 and September 2013. Patients were evaluated by visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Karlsson-Peterson (KP) ankle score. The talar tilt angle and the anterior displacement of the talus on ankle stress radiographs and the first metatarsal- talus angle, the arch height between cuneiform and fifth metatarsal base and the calcaneal pitch angle on foot lateral standing radiographs were examined. Results: The mean follow-up period was 31.5 months. Calcaneal lateral closing wedge osteotomy was performed in 6 patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy in 9 patients to correct remnant plantarflexion of the first ray. Three of 12 patients underwent both calcaneal and first metatarsal osteotomies. The mean VAS score decreased from 5.5 to 1.7 at last follow-up (p=0.002). The mean AOFAS score and the mean KP ankle score were significantly improved (61.0 to 85.3 (p< 0.001), 56.8 to 83.1 (p < 0.001)) and there was no recurrence of instability. Radiographically, the mean talar tilt angle and the anterior displacement of the talus were decreased (p=0.001, p=0.007), and the first metatarsal- talus angle and the arch height were decreased at last follow-up (p=0.001, p=0.003). Conclusion: Concomitant correction of mild cavovarus deformity with MBO for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for deformity should be followed when treating patients with chronic ankle instability.
Inverse agonism at the P2Y12 receptor and ENT1 transporter blockade contribute to platelet inhibition by ticagrelor
Authors: Aungraheeta Riyaad , Conibear Alexandra , Butler Mark , Kelly Eamonn , Nylander Sven , Mumford Andrew , Mundell Stuart J. 
Published: October 2016

Key PointsTicagrelor acts as an inverse agonist at the P2Y12R, inhibiting basal agonist-independent signaling. Ticagrelor inhibits the adenosine transporter ENT1 not only on erythrocytes, but on platelets too.
Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer
Authors: Wallner Lauren P. , Abrahamse Paul , Uppal Jaspreet K. , Friese Christopher R. , Hamilton Ann S. , Ward Kevin C. , Katz Steven J. , Hawley Sarah T. 
Published: October 2016

Purpose Collaborative care between cancer specialists and primary care providers (PCPs) may improve the delivery of high-quality cancer care. Yet, patient perspectives about how involved the PCPs were in their breast cancer care and treatment decisions remain unknown. Patients and Methods A weighted random sample of women newly diagnosed with breast cancer in 2013 to 2014, as reported to the SEER registries in Los Angeles, California, and Georgia, were sent a survey approximately 6 months after diagnosis (N = 2,279, 71% response rate). The distributions of patient-perceived PCP quality (six questions about PCP access and awareness of values) and the following three measures of patient-reported PCP involvement were assessed: how informed the respondent felt her PCP was about her breast cancer (engagement); how often the respondent talked with her PCP (communication); and how often the respondent felt the PCP participated in treatment decisions (participation). Adjusted mean scores of patient-reported satisfaction with and deliberation about the surgical treatment decision were then compared across levels of PCP engagement, communication, and participation using multivariable linear regression. Results The majority of women in this sample perceived high PCP quality (63.6%), high PCP breast cancer engagement (66.2%), and high PCP communication (69.1%). More than a third of women (35.4%) reported that their PCP participated in their treatment decisions. Higher PCP engagement was associated with higher decision satisfaction when compared with low PCP engagement (adjusted P = .003). Conclusion Patient perceptions of PCP quality and PCP involvement in breast cancer care during treatment are high for most women, and PCPs often participate in breast cancer treatment decisions. However, PCP involvement did not lead to meaningful improvements in patients’ appraisals of their decision making.