bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteoarthritis of Lateral Lisfranc Joint After Lateral Column Lengthening in Flatfoot
Authors: Yoshida Yasuhisa , Matsubara Hidenori , Aikawa Takao , Ugaji Shuhei , Tsuchiya Hiroyuki 
Published: October 2016

Category: Lesser Toes Introduction/Purpose: Lateral column lengthening (LCL) procedure is commonly optional treatment as one of reconstruction surgery for the adult acquired flatfoot deformity (AAFD) due to posterior tibial tendon insufficiency in stage II. However, it had been confirmed that lateral forefoot pressures increase after LCL in previous studies. We may occasionally encounter some cases who have pain in the lateral aspect of the foot associated with osteoarthritis of Lisfranc joint after the surgery (Fig.). In this study, we retrospectively assessed lateral Lisfranc arthritis as postoperative complications after LCL. Methods: 17 feet in 15 patients who underwent operation including LCL for AAFD due to posterior tibial tendon insufficiency in stage II (two patients male and 13 were female). The mean age at the time of surgery was 64.2 years (52-80). All cases had LCL by calcaneocuboid distraction arthrodesis. The amounts of LCL achieved were 12.7 mm on average (8.0-15.0). The average duration of follow-up after the surgery was 21.8 months (4-97). We divided the subjects up into two groups: (1) pain group (n=7), were experiencing pain in the plantar-lateral aspect of the foot and/or tenderness at fourth and/or fifth tarsometatarsal (TMT) joint postoperatively; and (2) no-pain group (n=10), did not have that pain nor tenderness until the latest follow-up. Two groups were compared in age, body mass index (BMI), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the amounts of LCL and several parameters on the radiograph. Results: In the pain group, all cases had osteoarthritic changes of the lateral Lisfranc joint (41.2%) on radiographs (grade II or more on the Kellgren-Lawrence grading scale). In overall subjects, 11 feet (65%) were revealed lateral Lisfranc arthritis. There were no significant differences in age, BMI, AOFAS scale, the LCL amounts between both groups. The medial column height was lower than lateral preoperatively, it became higher postoperatively by the reconstruction. In the pain group, the postoperative differences between medial and lateral tend to be greater than in no-pain group (P = 0.17). Patients with pain had significantly lower postoperative first talometatarsal angle (p < 0.05). However, no significant differences were found in terms of the other radiographic parameters such as calcaneal pitch angle, talonavicular coverage angle and hindfoot alignment by Cobey’s view. Conclusion: This study indicated a high possibility of Lisfranc arthritis in patients who have pain of the lateral aspect of the foot after LCL. We suggest that this osteoarthritic change is one of the causes of such pain, and attribute the arthritis to increased lateral column pressures by excess calcaneocuboid distraction. As a preventive measure had reported previously, we may have to keep LCL within less than 10 mm, and may have to add the stabilization of medial column such as the first TMT fusion or Cotton osteotomy.
Collagen Dressing in the Treatment of Diabetic Foot Ulcer
Authors: Park Yoo Jung , Hwang Yeokgu , Park Kwang Hwan , Suh Jae Wan , Shim Dong-Woo , Han Seung Hwan , Lee Jin Woo , Choi Woo Jin 
Published: October 2016

Category: Diabetes Introduction/Purpose: Ulcer healing in the diabetic patients is challenging due to a prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence. Collagen components are fundamental to the process of wound healing and skin formation. Recently, collagen-containing wound dressings, which create a biological scaffold matrix, have been used in the treatment of diabetic foot ulcer (DFU). However, there is not enough evidence to support that 100% collagen dressing can replace the diabetic wound management. In this study, we examined the effectiveness and safety of a new collagen dressing material in the treatment of DFU. Methods: This study was a prospective, randomized, placebo-controlled, single-center study conducted between November 2011 and September 2014. The inclusion criteria were type 1 or 2 diabetes, a ulcer size ≥ 1.0 cm2 that did not exhibit signs of healing for 6 weeks, Wagner grade 1 or 2, and palpable pulses at the ankle. The assessments of DFU included size, microbial culture study, detailed description of DFU, and clinical photos. Patients in the study group were treated with a collagen dressing material (100% porcine type I collagen) and foam dressing, while patients in the control group were treated with only foam dressing. Dressing changes had been performed two or three times per week. Complete ulcer healing rate was evaluated as a primary endpoint and ulcer size were compared between the two groups as a secondary endpoint. Results: Thirty patients were included in the final analysis (study group: 17 patients, control group: 13 patients). There were no significant differences between two groups regarding demographic factors and baseline DFU characteristics. The study group presented a higher rate of complete healing as compared to that in the control group [82.4% (14/17), 38.5% (5/13), respectively, P = 0.022]. At the last follow-up, ulcer sizes of the study group were smaller than those of the control group (P = 0.048). The Kaplan-Meier analysis for the complete ulcer healing also showed a significantly higher rate of complete healing in the study group (Hazard ratio = 3.0, log-rank P = 0.025). There were no adverse events related to the dressing materials. Conclusion: This study supports that the wound dressing using 100% collagen materials may offer a safe and effective treatment for DFU.
A Novel Use of Arthroereisis in the Adult Flat Foot
Authors: Dega Raman , Peek Anna C. , Malagelada Francesc , Clark Callum I. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: The use of an arthroereisis screw is well described in the paediatric population for the correction of flexible flat feet. Here we present a case comparison series involving the use of an arthroereisis screw to augment reconstruction in adult patients with Tibialis Posterior Insufficiency. Methods: All patients (36 feet in 34 patients) underwent flexor digitorum longus transfer, reefing of the spring ligament and a translational medialising calcaneal osteotomy. In 23 cases the reconstruction was augmented with an arthroereisis screw (Kalix, Integra), which was removed 6 months later in all cases. The mean age was 58 years and most patients were female. Weight bearing radiographs were taken after removal of the implant and assessed using previously published parameters. Patients were evaluated at follow up using validated functional outcome questionnaires (MOXFQ, EQ-5D and a health VAS). Results: One patient in the group without augmentation went on to have a triple fusion 13 months after reconstruction. In both cohorts the calcaneal pitch was raised, Meary’s angle decreased, the medial cuneiform height increased and the talonavicular coverage angle improved post-operatively compared to pre-operative measurements (p < 0.05, Wilcoxon Signed Rank tests). There was a trend towards better radiographic correction in the augmented group and the difference in correction of the talonavicular coverage angle was statistically significant (p < 0.05, Students T test). There was however no difference between the MOXFQ, EQ-5D and heath VAS scores between the two groups at mean follow up of 4 years. Conclusion: We conclude that the use of an arthroereisis screw is a promising adjunct to conventional reconstruction in tibialis posterior insufficiency.
A Prospective Cohort Study of Symptomatic Venous Thromboembolic Events in Foot and Ankle Trauma
Authors: Blanco Jose A. , Brocklesby Gemma , Mangwani Jitendra 
Published: October 2016

Category: Trauma Introduction/Purpose: The incidence of Venous Thromboembolism (VTE) and the balance of risks and benefits associated with chemical thromboprophylaxis in foot and ankle trauma are controversial, and much less investigated than in hip and knee surgery. A recent systematic review showed a low VTE rate in foot and ankle surgery (0-0.55%), but with an increased incidence in foot and ankle trauma, the highest in TA rupture and surgery. This study compares the 90-day VTE rates of 3 cohorts of patients: Group 1: TA ruptures managed in a full weight bearing (FWB), functional, Vacoped™ protocol over an 8 week period; Group 2: Stable ankle fractures managed in NWB below knee casts for 6 weeks; Group 3: Unstable or displaced ankle fractures managed with surgery and NWB below knee casts for 6 weeks. Methods: The data was extracted from two prospectively collected databases, one for the acute TA ruptures between March 2010 and December 2014, and one for ankle fractures from October 2013 to April 2014. These datasets were cross validated with the hospital VTE database. All patients were risk assessed at the time of presentation to the hospital. Selective chemical thromboprophylaxis was prescribed for patients with the previous history of VTE and patients who were deemed high-risk on VTE assessment. 90-day incidence of symptomatic VTE was drawn from the hospital radiology database. Results: Group 1: Overall VTE rate of 4.9% at a mean of 16.1 days. 3 Pulmonary Embolism (PE) and 11 Deep Vein Thrombosis (DVT). Total number of 283 patients. Group 2: Overall VTE rate of 2.2% at a mean of 33.4 days. 5 DVT. Total number of 227 patients Group 3: Overall VTE rate of 3.0% at a mean of 37.2 days. 1 PE and 5 DVT. Total number of 199 patients. Symptomatic VTE presents significantly earlier in acute TA rupture than ankle fracture patients (p=0.002) Conclusion: Although the overall incidence of VTE in foot and ankle trauma is low., there is a relatively higher incidence of VTE in patients with acute TA ruptures. This is, in spite of recent early weight bearing regimens. This study also shows that occurrence of symptomatic VTE in patients with Acute TA rupture happens much sooner compared to the ankle fracture patients. Although the exact reason for this difference in time of presentation of VTE is unknown, it may be due to de-functioning of the calf muscle pump immediately after the acute TA rupture.
An Algorithm to Assist the Surgical Decision Making in the Operative Management of the Cavovarus Foot
Authors: Grice John E. , Willmott Henry , Taylor Heath P. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: The cavovarus foot is a complex deformity caused by muscle imbalance, soft-tissue contracture and secondary bony abnormality. It is a combination of hindfoot, midfoot and forefoot deformity and the decision making process for surgical management can be difficult. The process of deciding which combination of procedures is required is often poorly understood. We present an algorithm to assist with this decision making. Methods: We have analyzed a single surgeon's experience of cavovarus foot correction, from a consecutive series of 60 patients over 6 years, to develop an algorithm to guide operative decision making. Cases included cavovarus deformity secondary to cerebral palsy, Frie-dreich's ataxia, Charcot Marie Tooth disease, post-traumatic contracture, post-cerebrovascular accident, iatrogenic post-surgery and physiological cavus. We have taken a systematic appr oach to each component of the deformity in order to generate the algorithm. Results: To assist in rationalizing the traditional ‘a-la-carte’ approach, our algorithm describes what we believe are the indications for a variety of surgical interventions, including soft tissue contracture release, osteotomies of the hindfoot, midfoot and forefoot, tendon transfer and soft tissue balancing, and arthrodesis. We detail the decision making process for each surgical option and give the reasons for each decision. We have also reviewed the available literature on this topic, to produce an evidence-based and useable means of surgical planning. Conclusion: The surgical decision making process in the management of the cavovarus foot is complex. We believe that this algorithm, based on extensive personal experience and up-to-date published evidence, provides a clear and proven framework on which surgical decision making can be guided and justified.
Bone Reconstitution With Synthetic Bone Graft Material for Osseous Defects in Revision Total Ankle Arthroplasty
Authors: Beuchel Matthew W. , Brage Michael 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Various treatments have been suggested for the treatment of periarticular cysts in revision total ankle arthroplasty including autograft and allograft bone grafting, polymethylmethacrylate cement, and revision to ankle or tibiotalocalcaneal arthrodesis. This study investigated the rate of osseous reconstitution following treatment with a unique calcium phosphate-calcium sulfate blend. Methods: A retrospective review of all revision total ankle arthroplasty procedures over a 3 year period was performed. 37 patients were identified that had utilized the calcium phosphate-calcium sulfate blend for the treatment of osseous defects. Data on graft location, volume, infection rate, bone reconstitution rate, and further revision procedures were collected. Plain radiographs were used to determine osseous reconstitution, qualified as bony trabeculae present with no lytic area remaining. Patient's average age was 66 years old, revision performed an average of 9.5 years after primary arthroplasty, with an average of 503 (range 99-1333) days of follow up. Results: Grafting of 23 tibial, 23 talar, 7 fibular, and 5 calcaneal bone defects were undertaken. All patients had Agility implants at time of primary arthroplasty. 16 patients had retention of Agility components, with 21 being revised to Inbone 2 implants. An average of 8.25 ml of material was used. Complete bone reconstitution was noted in 24 patients (65%). Incomplete or no bony healing was noted in 9 talus, 2 tibias, and 2 fibulas. Further revision was performed or offered to 7 patients for continued symptoms(19%). No seromas or excessive wound drainage was noted. Conclusion: Grafting of osseous defects for total ankle arthroplasty with a fully synthetic calcium sulfate and calcium phosphate mixture is an effective technique. Caution should be used in its use for patients with talar subsidence, as these have higher rates of failure likely due to its diminished blood supply and smaller surrounding structural support. provide significant long-term structural support. It should not be depended to
Buttress Plating versus Anterior-to-Posterior Lag Screws for Fixation of the Posterior Malleolus
Authors: Bennett Chase , Behn Anthony , Daoud Adam I. , Dikos Gregory , Bishop Julius , Sangeorzan Bruce 
Published: October 2016

Category: Trauma Introduction/Purpose: The preferred method of fixation for posterior malleolus fractures remains controversial, and practices vary widely among surgeons. The purpose of this study was to compare anterior-to-posterior lag screws to posterior buttress plating for fixation of posterior malleolus fractures in a cadaveric model. Methods: Posterior malleolus fractures were created in seven pairs of fresh frozen cadaveric ankles. One specimen in each pair was randomly assigned to fixation with either two anterior-to-posterior lag screws or a one-third tubular buttress plate without supplemental lag screws. Each specimen was then subjected to cyclic loading from 0% to 50% of body weight for 5,000 cycles followed by loading to failure. Failure was defined as 1 mm of axial displacement. Results: The buttress plate group showed significantly less peak axial displacement at all time points during cyclic loading. Permanent axial displacement was significantly less in the buttress plate group beginning at cycle 200 (figure). There were no significant differences between the two groups during load to failure testing. Conclusion: Posterior malleolus fractures treated with posterior buttress plating showed significantly less displacement during cyclical loading compared to fractures fixed with anterior-to-posterior lag screws. Surgeons should consider these findings when selecting a fixation strategy for these common fractures. these biomechanical findings. Further research is warranted to investigate the clinical implications of
Comparison of Fixed and Unmounted Digital Radiography System in Foot and Ankle Practice
Authors: Grimes J. Speight , Ackerman Mitchell 
Published: October 2016

Category: Other Introduction/Purpose: Digital radiography (DR) is rapidly replacing conventional and computer radiography. The configuration of DR can vary widely. Two common types of DR seen in outpatient settings are the fixed mounted systems with a motorized arm that contains the imaging plate or a unmounted imaging plate with either a tether or wireless connection to the main console. This study compared the efficiency of the two systems in a foot and practice. Methods: Two practices that routinely obtain weight bearing foot and ankle radiographs were identified. One used a fixed mounted DR system and the other a unmounted tethered DR system. An observer timed 50 sequential weight bearing radiographs of the foot or ankle at each facility. The time began when the patient was ready for the examination until the final image had been obtained. Results: The mean time for a foot or ankle image was 224 seconds (SD 93 seconds) for the fixed mounted system and 122 seconds (SD 29 seconds) for the unmounted system. The time difference was statistically significant (P < 0.001). Conclusion: The use of unmounted imaging plates more closely follows traditional techniques for weight bearing radiographs of the foot and ankle. Fixed mounted systems require special equipment and techniques to accommodate the mounting arm. These special needs almost double the time required to obtain the weight bearing radiographs. It is more efficient for foot and ankle practices to use systems with an unmounted imaging plate.
Comparison of Fusion and Complication Rates in Patients with Primary Open Ankle Arthrodesis
Authors: Barg Alexej , Lyman Mikayla , Morris S. Craig , Saltzman Charles L. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: In the last decades, different surgical techniques with various approaches and fixation methods have been described for ankle arthrodesis. Tibiotalar arthrodesis can be performed with or without distal tibiofibular fusion. The objectives of this retrospective study were to compare (1) demographics, (2) surgical techniques, (3) postoperative fusion rates, and (4) postoperative complication rates in patients with primary open tibiotalar arthrodesis with vs. without distal tibiofibular fusion. Methods: Between March 2002 and November 2014, 322 primary open ankle arthrodeses were performed at our institution. There were 183 male and 139 female patients with a mean age of 56.0 ± 14.0 years (18.0-88.8). The mean weight, height, and body mass index (BMI) were 90.0 ± 20.4 kg (46-168), 172.9 ± 11.4 cm (147-208), and 30.0 ± 5.7 kg/m2 (18.9-54.9), respectively. Both patient groups were compared with regard to demographics including gender, weight, height, BMI, ASA classification, smoking, alcohol use, and comorbidities. The surgical technique has been analyzed in both groups including surgical approach, main fixation type, and allograft/autograft use. Finally, fusion rate and time to complete osseous fusion were analyzed. Complication rates including wound complications, deep vein thrombosis/pulmonary embolism, and any secondary procedures were described in both groups. The mean time to final follow-up was 36.7 ± 26.7 months (12.0-150.4). Results: 214 had a combined distal tibiofibular fusion, while 108 did not. The most common surgical approach was lateral and anterior in patients with and without distal tibiofibular fusion, respectively (P < 0.001). The main fixation type was different between groups, with the most common technique being screws for patients with tibiofibular fusion, and plates in those without (P < 0.001). Autograft and allograft were used significantly less frequently in patients without distal tibiofibular fusion. The rate of osseous union was comparable in both groups with 92.2% and 93.0% in patients with and without distal tibiofibular fusion, respectively (P = 0.675). The incidence of wound and thrombembolic complications was similar in both groups. Conclusion: The osseous union rates and complication rates were comparable in both patient groups, with and without distal tibiofibular fusion.
Effect of Blood Flow of the Metatarsal Head with Hallux Valgas after Minimally Invasive Distal Linear Metatarsal Osteotomy
Authors: Minokawa So , Yoshimura Ichiro , Naito Masatoshi , Kanazawa Kazuki , Hagio Tomonobu 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Distal first metatarsal osteotomies are recommended for surgical treatment of mild to severe hallux valgus (HV) deformities. Angthong et al. reported that minimally invasive distal linear metatarsal osteotomy (DLMO) exhibited good outcomes, with no major complications. However, avascular necrosis of the metatarsal head following a distal osteotomy has been reported, because an aggressive plantar cut can disrupt the soft tissue plantarly, thereby disrupting the blood supply of digital arteries. The purpose of this study was to evaluate the in vivo blood flow of the pre- and post-osterotomy metatarsal head in patients with HV using laser Doppler flowmetry (LDF). Methods: Between April and November 2015, DLMO was performed on seven patients with HV. The patients comprised one male and four females, with a mean age at surgery of 43.4 (21–62) years. The primary surgical indications for DLMO were all levels of severity of possible manual correction in patients with foot pain. The patients were placed in the supine position, and without a tourniquet, a 1.5-cm skin incision was centered over the medial aspect of the first metatarsal neck. A 2.0-mm Kirschner wire was inserted manually from the wound to the medial side of the hallux using a retrograde technique. Under direct vision, the Kirschner wire was introduced into the medullary canal of the first metatarsal shaft. Blood flow measurements of the pre- and post-osteotomy first metatarsal head in the seven patients were performed by LDF (ALF21 N; ADVANCE Co., Tokyo, Japan). The probe was touched to the first metatarsal head. The blood flow measurements were repeated three times, and the mean values were calculated. Results: On preoperative plain radiographs, the mean hallux valgus angle was 38.0° (range: 22.4–45.8°), and the mean intermetatarsal angle was 17.0° (range: 10.4–21.9°). The mean pre- and post-DLMO systolic blood pressure at the time of the measurements was 87.3±7.76 and 88.1±8.25 mmHg, respectively (P=0.85). The mean pre- and post-DLMO blood flow rate was 1.71±0.68 and 1.66±0.49 ml/min/100 g, respectively (P=0.90). Conclusion: Steven et al. reported that a distal osteotomy can lead to avascular necrosis of the metatarsal head, because an aggressive plantar cut can disrupt the soft tissue plantarly, thereby disrupting the blood supply of digital arteries. However, we found that blood flow of the pre- and post-osteotomy metatarsal head was present in all patients examined, with no significant difference in the blood flow rates of the metatarsal head before and after DLMO. Based on the present results, it is possible to avoid major complications, such as avascular necrosis of the metatarsal head, because DLMO is minimally invasive and involves less release of the soft tissue.