bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective, Randomized, Controlled, Comparative Effectiveness Trial Examining Healing, of Acellular-Reticular Human-Dermis Versus Standard Care in Treatment of Diabetic Foot Ulcers
Authors: Zelen Charles M. , DiDomenico Lawrence , Serena Thomas , Li William W. , Kaufman Jarrod , Carter Marissa J. , Galiano Robert , Orgill Dennis P. 
Published: October 2016

Category: Diabetes Introduction/Purpose: One sequitur of prolonged diabetes is the development of diabetic foot ulcers (DFUs), which are often complicated by lower extremity amputation (LEA). The annual incidence of DFUs and LEAs calculated from the Medicare population is approximately 6% and 0.4% respectively. Many acellular dermal matrices have been shown to successfully heal these wounds. In this study, we examined a novel, human, acellular reticular dermis with an open, porous, uniform framework aseptically processed to retain endogenous matrix protein versus standard of care in non healing diabetic foot wounds. Methods: This study was a multicenter, randomized controlled trial in which diabetic patients having at least one non-healing neuropathic foot ulcer that failed at least 4 weeks of documented conservative care with adequate blood flow and a lack of renal failure were screened for a 2-week period. Those meeting inclusion and exclusion criteria, after 2-weeks of offloading and moist wound care if the diabetic foot ulcer (DFU) failed to reduce in area by 20% were randomized 1:1 to standard of care (SOC) or human acellular dermal tissue (HADT) applied weekly plus SOC for up to 12 weeks Results: At 6 weeks, 65% of the HADT–treated wounds had healed (13/20) compared to 5% (1/20) of the wounds that received SOC alone (adjusted p=.00028). At 12 weeks, 80% of the HADT–treated wounds (16/20) had healed compared to 20% (4/20) of the DFUs in the SOC group (adjusted p=.00036). Mean time to heal within 12 weeks was 39.6 days for the HADT group compared to 77.0 days for the SOC group (adjusted p=.00014). There was no incidence of increased adverse or serious adverse events between groups, nor adverse events related to the graft. The mean and median costs to closure in the HADT group were $1475.00 and $963.00, respectively, per healed wound Conclusion: These findings demonstrate that weekly application of acellular human reticular dermis is an effective treatment for non-healing diabetic foot wounds. Wound-size-specific pieces may allow for decreased cost to closure and wastage.
Relationship of Sesamoid Position and Other Radiographic Measurements in Hallux Valgus
Authors: Yeo Eui Dong , Oh Seong Rok , Lee Young Koo , Choi Young Suk , Kim Ki Chun 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Many radiographic measurements have been developed and used for evaluating hallux valgus, but their relationships have not been clearly established. The purpose of the present study was to investigate the relationship and reliability of sesamoid position and other radiographic measurements in hallux valgus. Methods: We included 180 patients(mean age 52 years; 18 males and 162 females) with weightbearing plain radiograph. In anteroposterior view, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, proximal phalangeal articular angle, hallux interphalangeal angle, sesamoid subluxation and metatarsophalangeal congruency were measured. In lateral view, Meary angle(tarso-1st metatarsal angle) was measured. 3 trained observers measured. Correlations among the radiographic measurements were analyzed. Relationship of sesamoid position and other radiographic measurements were evaluated using ANOVA or Fisher’s exact test. Results: The sesamoid subluxation had the correlation with the hallux valgus angle (p < 0.001), intermetatarsal angle (p < 0.001) and metatarso-phalangeal joint congruency (p < 0.001). As the sesamoid subluxation grade increased, the metatarso-phalangeal joint congruency was non-congruent joint. In intraobserver reliability, the hallux valgus angle showed the highest ICC value (0.989; 95% CI, 0.984–0.992) Conclusion: we suggest that the measurements of sesamoid subluxation in assessments of hallux valgus deformity may be helpful for operation and degree of metatarsophalangeal congruency.
Results of Single incision Hallux Valgus Surgery
Authors: Qasim Sultan N. , Elzubeir Lee , Bhatia Maneesh 
Published: October 2016

Category: Bunion Introduction/Purpose: Soft tissue release is an integral part of Hallux Valgus surgery and is traditionally performed through an additional dorsal first web space incision. We performed a review of Hallux Valgus correction with Scarf +/- Akin osteotomy using single medial incision with lateral release performed through the same incision. Methods: The study included 202 feet operated by a single surgeon between July 2009 and July 2014. Average age of patients at the time of operation was 60 years +/- 14. Patient satisfaction survey was conducted at the time of study. Patients with minimum follow up of 12 months post surgery were included in this study. The average follow up at the time of study was 45+/- 18 months. Pre-operative and final post-operative radiographic data was collected for Hallux Valgus angle, Intermetatarsal angle, Distal Metatarsal Articular Angle and Medial Sesamoid Position. The average Mean radiological follow up duration was 6.7 months. Results: Mean Hallux Valgus Angle improved from 33.2 to 15.6 degrees, Intermetatarsal angle improved from 14.4 to 7.8 degrees, Distal Metatarsal Articular Angle improved from 17.6 to 9.8 and Medial Sesamoid Position improved from 3 to 1 [p < 0.05 for each variable]. Response rate was 78% (Very satisfied 69%, Satisfied 14%, Satisfied with reservation 11%, Dissatisfied 6%). There was no correlation of any preoperative or postoperative radiographic measure with satisfaction grade. Two patients had intraoperative fracture with no long term sequelae. No patient required revision procedure. Conclusion: Single medial incision surgery for Scarf +/- Akin Osteotomy for Hallux Valgus Correction is a simple, safe and effective technique with very high satisfaction. The results are comparable to, if not better that, traditional two-incision surgery thus questions requirement of a second dorsal first web space incision.
Retrospective Case Study of TTC Fusion Treated with Carbon Fiber Nail
Authors: Jones Caleb W. , O’Daly Andres , Smith Kenneth S. , Shah Ashish 
Published: October 2016

Category: Ankle Introduction/Purpose: Tibiotalocalcaneal arthrodesis is a salvage option reserved for severe ankle and hindfoot deformities, arthritis of the ankle and subtalar joints, avascular necrosis of the talus, failed total ankle arthroplasty, and Charcot arthropathy. Implants have long been made from various metals most commonly stainless steel or titanium alloys. Disadvantages of metal implants include limited fatigue life, mismatch of modulus of elasticity, potential for wear debris, corrosion, and radiodensity that can preclude accurate radiographic visualization. Carbon fiber implants have been available for years. The advantageous properties of carbon fiber for use as orthopaedic implants include a similar modulus of elasticity to bone to decrease stress shielding, biocompatilibity, with minimal cellular response when studied invitro and invivo, ability to withstand prolonged fatigue straining and radiolucency on XR. Methods: A Carbofix TM carbon fiber TTC fusion nail was used in 15 patients with for Tibiotalocalcaneal /TC fusion. All patients received preop, intra op xrays, and follow up xrays at weeks 2/6/12. After 12 weeks xrays were taken every 3 months until 1 year. All xrays were read by a radiology attending to assess for consolidation and maintenance of alignment. We also performed CT scan for the nonunion [clinical & Radiological] Results: We were able to find comparable results [patients operated with carbon fiber nail] to the historical data of the patients treated with different metal implants. We were also able to check the safety of using the implant [no tissue reaction or reactivity], easily able to see the fusion across the joints secondary to radioluceny and artifact free CT scan or MRI when required. There were no metal related complications noted. Conclusion: These studies have shown the usefulness of carbon fiber implants but there are no studies which explicitly review Tibiotalocalcaneal/Tibiocalcaneal fusion. We present a retrospective case series of 15 patients who were treated with carbon fiber tibiotalocalcaneal fusion nail.
Secondary Procedures in Third Generation Total Ankle Arthroplasties
Authors: Gross Christopher E. , Huh Jeannie , Shi Glenn G. , Lampley Alexander J. , Green Cynthia , Nunley James A. , DeOrio James K. , Adams Samuel B. , Easley Mark E. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: As surgeons have become more comfortable with performing more complex total ankle replacements (TAR) with larger amounts of deformity, it is unclear whether or not to address additional pathology at the time of surgery. Currently, we address all foot and ankle pathology at time of the index arthroplasty. It is unclear however, how often and for what reasons secondary surgery is performed after TAR. We hypothesize that there were no differences in the type or rate of secondary surgeries performed. Methods: We identified a consecutive series of 761 primary TARs performed between January 1998 and December 2014. We identified patients who required a secondary surgery to treat foot and ankle pathology following a STAR, INBONE I/II, or Salto- Talaris. We then analyzed if there were differences between the implants in terms of time to secondary surgery or types of procedures performed. Results: 193 patients (25.3%) required a secondary procedure with an average time to a secondary procedure of 24.5 months. The rate of second surgery in both the Salto (25/113, HR=0.64 with 95%CI=0.408-0.996; p=0.048) and STAR (81/333, HR=0.694 with 95%CI=0.507-0.949; p=0.022) is less when compared to the INBONE group (87/315). The STAR had a significantly longer time to secondary procedure (33.8 months) versus a Salto-Talaris (12.8 months) or an INBONE (19.2 months, p=001). The number of secondary procedures (p< .001), polyethylene exchanges (p< .001), cyst grafting (p=.036) were similar in INBONE and STAR, but significantly more than the Salto. The INBONE prosthesis had a significantly higher talar component failure rate (p=.038), but similar rate of subtalar, ankle, and TTC fusion. Conclusion: Knowledge of the rates and types of secondary surgeries is useful information on the natural history of third generation ankle implants. While there are differences in the rate of failure or revisions between implants, no implant has proven superior to one another.
Surgical Repair of Symptomatic Chronic Achilles Tendon Rupture Using Synthetic Graft Augmentation
Authors: Shoaib Ahmed , Mishra Viren 
Published: October 2016

Category: Other Introduction/Purpose: Surgical repair of symptomatic chronic Achilles tendon (TA) rupture is a challenging problem due to the presence of large defect between tendon edges. We report the results of surgical repair of symptomatic chronic TA rupture by synthetic graft augmentation. Methods: Seven consecutive patients with a symptomatic chronic TA rupture underwent surgical repair by VY plasty and augmentation with bio-absorbable synthetic graft (Artelon®). In all patients, the intraoperative tendon gap after debridement was more than 5 cm (Myerson Grade 3). Postoperatively, weight bearing on plantigrade foot was allowed at 4 weeks in a plaster cast. The total duration of plaster immobilization was 10 weeks. The complications were recorded prospectively and functional outcome was assessed by AOFAS score and Achilles tendon Total Rupture Score (ATRS). Results: At a mean follow up of 29 months there was no re-rupture or deep infection. All patients reported good functional outcome as shown by AOFAS and ATRS scores. There were no graft related complications. One patient had an early superficial infection which was treated by a course of oral antibiotic. Two patients reported numbness in the sural nerve territory after surgery,of which one patient developed scar sensitivity and paraesthesia. At final follow up, six patients were able to do single stance heel raise however, calf wasting was noted in all patients. Conclusion: Symptomatic chronic TA repair augmented by synthetic graft is a safe and effective technique in Myerson Grade 3 chronic TA ruptures where gap between two tendon edges is more than 5 cm.
Swelling Results in Poor Outcome After Ankle Arthritis Surgery
Authors: Younger Alastair S. , Daniels Timothy R. , Wing Kevin , Penner Murray J. , Glazebrook Mark A. , Veljkovic Andrea , Wong Hubert , Dryden Peter 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Patients often comment on swelling after foot and ankle surgery. However the relationship between swelling and outcome has not been defined. Pinsker and Daniels demonstrated that swelling was an important aspect of outcome. The purpose of this paper was to determine the relationship between swelling score and outcome after ankle fusion and replacement. A secondary purpose was to determine how this relationship changed in time, how swelling score changed before and after surgery, and determine differences in swelling score between total ankle replacement (TAR), open ankle arthrodesis (OAA) and arthroscopic ankle arthrodesis (AAA). Methods: The MODEMS outcomes package from AAOS was used, with the validated ankle osteoarthritis score (AOS) score being used to assess outcomes in the pain and disability domains. The swelling score was indexed from 1 to 5, 1 being no swelling and five being severe swelling. Outcomes were recorded pre-operatively and annually up to 2010. Statistical analysis was performed using 95% confidence intervals and correlations being determined using Pearson’s correlation and r 2 values. Results: The swelling score was correlated with AOS score preoperatively. Postoperatively patients with a swelling score of 1 had an average AOS score of 15.1 (CI 13.3 to 16.9), a swelling score of 2 had an AOS score of 23 (CI 21.7 to 24.9), 3 an AOS of 31 (CI 29.6 to 33.1), 4 an AOS of 33.6 (CI 34.9 to 38.8), and 5 an AOS of 39 (CI 35.3 to 43.0). There was therefore a difference in outcome score for all groups of swelling score (i.e. 1 scored better than 2, 2 better than 3, 3 better than 4 and 4 better than 5). Swelling scores were the same for TAR, OAA and AAA preoperatively. Postoperatively swelling scores were lower for AAA (2.1, CI 1.9 to 2.2) compared to TAA (2.5, CI 2.4 to 2.6) and OAA (2.5, CI 2.4 t0 2.6). Conclusion: Swelling has a relationship with outcome. Swelling after surgery may result in poorer outcomes. Strategies to reduce swelling such as patient education about elevation, surgical technique and the use of compression stockings may improve outcomes. Arthroscopic surgery may have better outcomes because of the reduction in postoperative swelling.
Tarsal Tunnel Release
Authors: Rungprai Chamnanni , Phisitkul Phinit , Femino John , Amendola Annunziato , Sittapairoj Tinnart 
Published: October 2016

Category: Ankle Introduction/Purpose: Tarsal tunnel release is a standard surgical treatment for patients who have tarsal tunnel syndrome and failure of conservative treatment. However, there remains little evidence demonstrating the medium-term of functional outcomes and complications of tarsal tunnel release. The purpose of this study was to report functional outcomes and complications of tarsal tunnel release. Methods: Retrospective chart review with prospectively collected data of 79 consecutive patients with 87 feet (primary surgery = 74/80 and revision surgery = 5/5) who were diagnosed with tarsal tunnel syndrome and underwent tarsal tunnel release between 2008 and 2014. Diagnosis bases on history and physical examination. All patients were failure of conservative treatment at least 6 weeks and the minimum follow up to be included in the study was 12 months (mean, 32.2 months; range, 12 to 80 months). The primary outcome was visual analogue scale (VAS), Short Form-36 (SF-36); physical and mental component scores, and Foot Function Index (FFI); pain, disability, activity limitation, and total score. Pre- and post-operative SF-36, and Foot Functional Index (FFI), pain (Visual Analog Scale) were obtained and compared using pair t-test. The secondary outcomes were operative time, time to return to activity of daily living and work, and complications. Mann-Whitney U-test was used to compare non-parametric data and Wilcoxon signed ranks test was used to compare parametric data. Results: The VAS was significantly decrease from 7.6 to 2.0(p = 0.001) and SF-36 was significantly improved from 33.2 to 40.2, for PCS (p= 0.001) and 47.7 to 49.7 for MCS (p = 0.005). The FFI was significantly decreased from 63.0 to 36.0, 61.9 to 35, 72.5 to 34.9, and 65.8 to 35.3 for pain, disability, activity limitations, and total scores(p=0.001, all). Mean operative time was 36.1 minutes for primary surgery and 54.8 minutes for the revision surgery. There 45 of 87 feet (51.7%) had positive Tinel test pre-operatively and 9 of 87 feet (10.3%) post-operatively. Revision surgery demonstrated significantly worse outcomes (VAS,SF-36,and FFI) compared to primary surgery(p < 0.05) but duration >12 months and Tinel sign did not affect the outcomes compared to duration >12 months and Tinel sign negative (p>0.05 all). An average time to return to activity of daily living and work was 8.1 and 9.5 weeks. Complications were painful scar(14.9%), wound infection(6.9%), CRPS(2.3%), and paresthesia on the foot(20.7%). Conclusion: Tarsal tunnel release demonstrated significant improvement of functional outcomes and pain relief in medium-term follow-up as measured with SF-36, FFI, and VAS. Revision surgery demonstrated less favorable outcomes while pre-operative Tinel test and duration of symptom more than 12 months did not affect the outcome. This procedure was effective and feasible for tarsal tunnel syndrome with minor complications.
The Evaluation of SPECT-CT in the Early Management of Acute Charcot Osteoarthropathy (CN)
Authors: Ahluwalia Raju S. , Ahmed Bilal , Mullhollad Nicola , Vivian Jill , Kavarthapu Venu , Edmonds Michael 
Published: October 2016

Category: Diabetes Introduction/Purpose: Charcot osteooarthropathy (CN) is a debilitating condition afflicting the bone, soft tissue and joints of foot and ankle and is related to pain insensitivity. Its pathogenesis and natural progression is poorly understood. In patients with high clinical suspicion, treatment with immediate off-loading and immobilisation may halt and (help to) reverse or prevent deformity. We aim to establish the role of SPECT CT in the diagnosis of acute charcot osteoarthropathy of the red swollen foot prior to radiographic changes and assess its reliability in diagnostic accuracy and guiding treatment. Methods: A prospective, observational review of all patients presenting to the multidisciplinary diabetic foot clinic from 1st Jan 2009 to 1st Jan 2013 with clinically suspected acute active charcot arthropathy was performed. All patients with a high clinical suspicion of acute CN and normal radiographs, underwent SPECT-CT within 10 days of the assessment after emergency off-loading in a TCC. A positive SPECT CT scan for new onset acute CN was diagnosed if radioisotope uptake was seen in all 3 phases of scanning. Further CT fusion images provided localization of ongoing activity. All patients were followed up for 1-year or until treatment ceased and treated in concordance with clinical symptoms and SPECT CT imaging. Results: In total 137 patients were referred or self referred with a high suspicion of new onset acute CN. The majority being diabetic (98%), including 116 unilaterally symptomatic feet with normal radiographs; 86 were consequently positively confirmed on SPECT-CT CN; 15 new ‘diabetic’ fractures were diagnosed on the CT component. At 1 year – only 5 patients went on to develop radiological changes consistent with charcot arthropathy even with accepted off loading in TCC. Thirty negative scans were recorded where no triple phase trace response & localisation was uni-focal or not associated with skeletal structures. Differential diagnosis included cellulitis, degenerative changes, old fractures, and planter fasciitis were made. At 1-year none of the patients were found to have developed CN in neither in the form of foot deformity nor radiological evidence of fragmentation or loss of normal bone anatomy. Conclusion: A combination of symptoms including swelling, pain and/or heat, positive three phase tracer uptake and localisation on SPECT CT can identify and aid the management of acute active CN in radiographically normal feet. Positive scans seem to identify an intermediate grade of charcot arthropathy where cortical fractures have occurred with significant subchondral bone turnover. A negative scan excludes high-risk feet for CN confidently and thus can direct treatment. We find SPECT CT a valuable addition to the armamentarium of the treating physician in instituting off loading to prevent the possible progression and onset of deformity and avoiding unnecessary treatment.
The Natural History of Charcot Neuroarthropathy
Authors: Kane Justin M. , Brodsky James W. , Daoud Yahya , Rabinovich Alexander 
Published: October 2016

Category: Diabetes Introduction/Purpose: There are limited data in the literature regarding natural history of Charcot Neuroarthropathy (CN) of the foot and ankle. The utility of a classification system should be threefold: accurately describe the disease process, guide the appropriate treatment, and predict the long-term prognosis. This study investigates the natural history of CN of foot and ankle, and whether the Anatomic Classification is predictive of outcome and prognosis. Methods: A retrospective review of 334 patients treated at a single institution by a single surgeon from January 1986 to June 2010 was conducted. Clinical records, imaging studies, and operative reports were reviewed to tabulate the Anatomic Classification type, patient demographics (age, gender, BMI, diabetes, RA), number and types of surgeries performed, location of surgery, initial and final job status, ulcer status, ambulatory status and shoe wear type. ANOVA and Pearson Chi square were utilized to assess whether the classification was predictive of variables. P-values of < 0.05 were considered statistically significant. Results: Outcomes/p-values are listed in table 1. 35.3% of patients presented with a unilateral Type 1 Charcot foot(n=118), 17.1% presented with a unilateral Type 2(n=57), 13.8% presented with a unilateral Type 3(n=46), and 33.8% presented with bilateral disease(n=113). CN due to RA had increased bilateral involvement(12.4%; 14/113) compared to unilateral involvement(5%,11/221)(p=0.026). Comparing bilateral versus unilateral Types 1,2,or 3, a similar trend was noted(p=0.0939). The Anatomic classification predicted location/need for surgical intervention(p < 0.00001). The classification predicted distal disease was associated with increased likelihood to require shoe-wear modifications(p=0.0001). While a statistically significant difference was not detected, a trend for the classification to predict persistent ulceration at final follow-up was noted. Patients with bilateral involvement and more distal disease were more likely to have ulceration(p=0.0968). Conclusion: While the Anatomic classification did not predict ambulatory status, and only trended towards statistical significance for ulceration at the time of final follow-up, there is utility in the classification system for predicting location of surgery as well as shoe-wear at final follow-up. Additionally, patients with CN due to RA had an increased likelihood of having bilateral foot involvement. The Anatomic Classification has clinical utility when counseling patients on the overall course of their disease process.