bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ankle Arthrodesis with Structural Grafts Can Work for the Salvage of Failed Total Ankle Replacement
Authors: Halverson Adam , Berlet Gregory 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Surgical treatment options after failed total ankle replacement (TAR) are limited to revision total ankle replacements, revision bone block interposition arthrodesis, or amputation. In patients where revision TAR is not an option and limb salvage is desired, conversion to an ankle arthrodesis can provide a stable, plantigrade foot. Revision arthrodesis is challenged by significant bone loss with removal of the TAR implant. The purpose of this study was to report midterm outcomes and radiographic results in a single surgeon’s group of patients who have undergone revision ankle arthrodesis with intramedullary nail fixation and structural allograft augmentation following failed TAR. Methods: Institutional review board approval was obtained for this study. A retrospective chart and radiographic review was performed. Patients with a minimum follow-up of 1 year who underwent failed TAR revision with structural femoral head allograft and intramedullary tibiotalocalcaneal (TTC) nail fixation were included. Patients with less than 1-year follow-up and alternative fixation or graft constructs were excluded from the study. Data were collected upon enrollment visit and again at midterm follow-up ranging from 3-7 years post-operatively. Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) outcomes scores and radiographs were obtained at each visit. Primary outcomes of interest were the rate of limb salvage and patient reported outcome scores. Secondary outcomes include limb length correction and the fate of the structural allograft. Results: Five patients were available for enrollment. Average age at surgery was 63.2 (range 56-69) years. Enrollment visits averaged 1.68 years post-operative (range 0.95 - 3.78). Midterm follow-up was at an average of 5.2 years (range 4.7-5.6). Upon enrollment average FFI was 34.82 (range 8.82-75.88) and at midterm follow-up was 20.42 (range 0-35.38). AOFAS scores upon enrollment averaged 66.6 (range 61-77) and at midterm follow-up averaged 70.33 (range 54-88). Radiographic results show union in 4 of 5 patients at enrollment and in 2 of 3 patients upon midterm follow-up. Average limb length discrepancy at enrollment was 1.4 cm (range 0.5 - 2.0) and 1.6 cm (range 0.2 – 2.4) at midterm follow-up. Conclusion: Conversion of failed TAR to TTC fusion with femoral head allograft is a salvage technique that can lead to a functional arthrodesis and limb salvage in a situation where options are challenging. Our results show continued improvement in patient reported outcomes scores moving from short-term to midterm follow-up with preservation of limb length and no trend towards structural allograft resorption.
InternalBrace has Comparable Stiffness and Strength as Tightrope for Lisfranc Fixation
Authors: Hopkins Justin , Heyrani Nasser , Kreulen Christopher , Garcia Tanya , Christiansen Blaine , Giza Eric 
Published: September 2017

Category: Sports, Biomechanics Introduction/Purpose: Lisfranc injuries are characterized by disruption between the medial cuneiform and base of the second metatarsal. Conventional interfragmentary screws decreases the amount of diastasis, however is believed to decrease the natural physiological movement of the joint compared to suture button (Tightrope, Arthrex, Inc., Naples, FL). The InternalBrace (IB, Arthrex, Inc., Naples, FL) allows physiologic movement and collagen ingrowth, while also decreasing iatrogenic bone loss. It also prevents erosion of the suture button into the medial cuneiform and prevents irritation of the tibialis anterior tendon. We hypothesized that there was no significant difference in the mechanical properties of these three constructs. Methods: Three groups of 10 sawbone models were used in this study. Two fourth generation 20 mm cylinder sawbones with open cell foam were fixed together with either a 3.5 mm conventional screw, mini Tightrope or IB with a curved button and 4.75 mm biotenodesis screw. Sawbone constructs were held in a mechanical testing system (Model 809, MTS Systems Corp, Minneapolis MN) using custom fixtures. Constructs were loaded in axial tension at 0.5mm/sec until failure. Load-displacement data were plotted for each test. Yield, stiffness, ultimate strength (US), yield energy, post-yield energy and ultimate strength energy were calculated Additionally, the load and energy to 0.5 mm, 1.0 mm and 1.5 mm of displacement were captured to relate strength at clinically relevant displacements. The residuals of an ANOVA on all mechanical testing results were not normally distributed. Therefore non-parametric comparison was used to compare fixation types (Proc NPAR1WAY, SAS 9.4, SAS Institute). Results: Compared to IB, the screw demonstrated greater stiffness, yield load and energy, and ultimate load and energy, with smaller yield, ultimate and failure displacement. When comparing the Tightrope and IB, there was no difference in stiffness (p=0.82), although the Tightrope performed greater in terms of having a larger yield load, energy and displacement, a larger ultimate strength load, energy and displacement, and a larger failure load, energy and displacement. When assessing the load at various distances of displacement, there was no significant difference between the load at 0.5 mm displacement (p=0.5, Figure 1). At greater displacement, the load was greater in the Tightrope than the IB (Figure 1). Conclusion: In this study, IB has shown proper stiffness and strength for fixation of ligamentous lisfranc injury. However, if a diastasis of >0.5 mm is evident, concerns for a clinical failure should be examined. This is the first study examining the use of an IB for treatment of a ligamentous lisfranc injury. The data supports its current clinical indications and further studies in cadaveric models are recommended.
Fixation of calcaneal fractures through a mini-incision technique
Authors: Hudson Parke , Sahranavard Bahman , Johnson Michael , Watson Shawna , Terry Charles 
Published: September 2017

Category: Hindfoot, Trauma Introduction/Purpose: The management of calcaneal fractures is a source of debate among orthopaedic surgeons due to a high risk of complications. The goals of surgical fixation are to restore the alignment and articular surface of the calcaneus. A popular fixation technique is open fixation as it provides the best visualization of fracture fragments. However, the extensive soft tissue disruption often associated with a larger incision places patients at risk for wound healing complications and infection. Due to the high risk of complications, non-operative treatment is often recommended. However, malunion of calcaneus fracture with non- operative treatment leads to predictable complications as well. Due to wound concerns, fixation using a mini-incision technique has emerged as an option for restoring calcaneal anatomy while minimizing wound complications. Methods: From July 1, 2013 to December 31, 2015, 22 patients underwent surgical fixation of 25 displaced calcaneal fractures through a mini-incision technique. All patients were 18 years of age or older and had no history of prior fracture of the operative calcaneus. A chart review was performed to assess for complications defined as non-union, infection, or reoperation for any reason. To assess for restoration of calcaneal anatomy, preoperative and postoperative lateral radiographs were reviewed to assess the Angle of Gissane (normal: 130-145 degrees) and Bohler’s angle (normal: 20-40 degrees). Results: Of the 22 patients (25 fractures), 68.2% (15/22) were male and average age was 41.86 years old. History of tobacco use was present in 81.8% (18/22), alcohol use in 40.9% (9/22), and illicit drug use in 31.8% (7/22). Sixty-eight percent (17/25) of fractures were tongue type and 32% (8/25) were depression type. Average Bohler’s angle (BA) was 13.2 preoperatively and 26.4 degrees postoperatively. Of the 17 calcanei with an abnormal BA preoperatively, 14 (82.4%) had a normal BA restored by surgery. The average postoperative time at final radiograph was 3.9 months. Twelve percent (3/25) of fractures had complications. One reoperation for removal of painful hardware, one reoperation due to non-union and infection, and one reoperation due to infection only. Conclusion: Our results indicate the mini-incision technique is an effective option in restoring calcaneal anatomy while minimizing complications. The poor follow-up and multiple comorbidities present in patients in this study are likely common in the general calcaneal fracture population as well. These factors make techniques that reduce the risk for wound complications, such as the mini-incision, intriguing and potentially extremely useful. Further study comparing a mini-incision technique to more extensile approaches is needed.
Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy
Authors: Hull Michael , Campbell John T. , Cerrato Rebecca , Jeng Clifford , Henn R. Frank 
Published: September 2017

Category: Arthroscopy, Midfoot/Forefoot Introduction/Purpose: Arthroscopy has been increasingly utilized to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized. Methods: Ten (10) fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. Arthrosocopy was performed with gravity distraction utilizing a 1.9 mm 30° arthroscope and small joint instruments. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The percentage of cartilage visualized (visualized / total cartilage x 100%) was measured using ImageJ® software. Measurements include surface area visualized on axial imaging as well as arc visualized on lateral imaging Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (49.6 – 65.3) of the metatarsal head and 100% (100-100) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72° (65-80) was visualized out of an average total articular arc of 199° (192-206), for an average 36.5% (32.2 – 40.8) of the articular arc. Conclusion: The results suggest that hallux MTP arthroscopy visualizes a sizable portion of the joint surfaces. However, incomplete visualization could potentially miss a hallux metatarsophalangeal lesion. Further imaging preoperatively may improve diagnostic confidence.
The V Sign in Lateral Talar Process Fractures
Authors: Jentzsch Thorsten , Hasler Anita , Renner Niklas , Peterhans Manuel , Sutter Reto , Espinosa Norman , Wirth Stephan 
Published: September 2017

Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Lateral talar process fractures (LTPF) constitute 15% of ankle injuries in snowboarders. They are often misdiagnosed on conventional radiographs, which are also susceptible to rotational malpositioning due to pain. A positive V sign is an interruption of the contour of the lateral talar process. It has been suggested to be pathognomonic for LTPF. However, there are very few studies about this topic. The objectives were to study whether the V sign is useful in diagnosing LTPF. Methods: In an experimental study, two investigators evaluated lateral radiographs (n=108) of high resolution, solid foam, radiopaque distal foot and ankle models. Two other investigators, who obtained the radiographs, defined the gold standard. Four different models (no fracture, type A, B, or C fractures according to Hawkins) and three varying ankle joint positions (0°, 20°, and 40° of inversion, plantar flexion, and internal rotation) were the independent variables. The correct detection of a V sign on lateral radiographs (Figure 2 showing a positive V sign on a lateral radiograph in a type B LTPF) was the primary dependent variable and the detection of the fracture type and uncertainty in making this decision were the secondary dependent variables. The chosen study size surpassed the sample size calculation. The chi-squared test was used for categorical data. Results: There were fair interobserver agreements on the V sign and fracture types (kappa coefficient [k]=0.35, 95% confidence interval [CI] 0.18-0.53, p<0.001 and k=0.37, 95% CI 0.26-0.48, p<0.001). For the detection of the V sign, the mean sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio, and mean uncertainty were 77% (95% CI 67-86%), 59% (95% CI 39-78%), 85% (95% CI 75-92%), 46% (95% CI 29-63%), 2, and 38%. Increased inversion and type B fractures were associated with better detection of the V sign (p=0.035 and p=0.011 as well as p=0.001 and p=0.013, for each investigator). Plantar flexion and internal rotation were not associated with the V sign (p=0.31 and 0.33 as well as 0.35 and 0.53, for each investigator). Conclusion: It is not recommended to exclusively use the V sign for the evaluation of LTPF. If negative, LTPF cannot be excluded. However, if positive, it may be a helpful surrogate parameter for the presence of LTPF, especially type B fractures. Inversion may lead to better visualization of the V sign. This knowledge about the V sign is a valuable asset for the diagnostic skillset of an orthopaedic surgeon. Future clinical studies may focus on validating these experimental findings. [Notes: Level of evidence is not applicable to this study. This abstract has also been submitted to the swiss orthopaedics congress 2017.]
Tibiotalocalcaneal Arthodesis via a Nitinol Containing Intramedullary Nail
Authors: Kadakia Rishin , Labib Sameh , Bariteau Jason 
Published: September 2017

Category: Ankle, Ankle Arthritis, Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a common procedure used in the management of foot and ankle pathologies. TTC fusions are frequently performed in patients with limited bone stock and poor vascular status. Adequate compression at the arthrodesis site is vital to successful fusion as even small amounts of bone resorption greatly increase nonunion risk. A recently designed hindfoot nail contains a built in nickel titanium alloy (nitinol) that has psuedoelastic properties which maintains compression across joint surfaces in the setting of bone resorption. The authors present a case series of patients who were managed with this nitinol containing intramedullary hindfoot nail system. Methods: Patients treated by one board certified orthopaedic foot and ankle surgeon who were managed with the nitinol containing hindfoot nailing system were retrospectively reviewed over a two year span. Electronic medical records were reviewed to collect demographic information and details regarding the patient’s procedure. Operative specifics collected included the data of the procedure and the preoperative diagnosis. Records were reviewed postoperatively as well to document the incidence of postoperative complications and functional outcomes. Proximal migration of the distal interlocking screw on lateral radiographs were measured in a standardized fashion at two, six, and twelve weeks to objectively assess additional compression obtained through the nitinol nailing system. Results: Eight patients were included in the case series with an average follow up time of 7 months postoperative (minimum of 4 months for one patient). The most common preoperative diagnosis was posttraumatic arthritis (n = 4). One patient suffered from wound dehiscence postoperatively that required operative intervention within the first three months – this patient’s wound healed by six months with no further complications. All patients were cleared for full weight bearing and activities as tolerated by six months, except only had four months of follow up available. The compression obtained through this nailing system increased at each follow up for all patients. The average compression obtained was 2.9 mm at two weeks, 3.8 mm at six weeks, and 4.4 mm at twelve weeks. Conclusion: Tibiotalocalcaneal arthrodesis can be an excellent procedure that provides significant pain relief and restores function. The patients in this case series all had excellent results with only one postoperative complication that ultimately did not result in any functional deficits. Furthermore, patients all demonstrated increased compression at each follow up radiographs which demonstrates the sustained compression obtained at the arthrodesis site through this hindfoot nail system. Further prospective work with a larger patient cohort is warranted to determine if this nailing system is superior to other TTC hindfoot nails.
Extended Distal Chevron Osteotomy
Authors: Kang Chan , Song Jaehwang , Kang Donghun , Noh Chang-Kyun , Jun Ahn Ki 
Published: September 2017

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Numerous corrective osteotomies have been performed for surgical treatment of hallux valgus(HV). One of these procedures is distal chevron osteotomy, traditionally indicated for correction of mild to moderate HV. We proposed a new modification of the chevron osteotomy, extended distal chevron osteotomy, to provide even greater stability by extend the contact surface, as well as more effective and accurate correction of the angulation and rotational profile than conventional osteotomy. Methods: Between July 2013 and June 2014, the extended distal chevron osteotomy (DCO) was performed for the treatment of mild-to-moderate hallux valgus deformity in 63 feet (Group A) by the same surgeon. For the extended chevron, the first osteotomy was performed to cut 5-10 mm from the head of metatarsal to the proximal upper 1/3 of the neck. The second osteotomy was performed to cut 2.5~3.0 cm from the upper 1/3 of the neck toward horizontal plane of the plantar surface with an angle of 45~50 degree. Standard foot radiographic measurements, hallux valgus angle(HVA) and intermetatarsal angle(IMA), were recorded to compare with the values of 37 patients (Group B) who were treated by the traditional DCO technique. Results: Mean patient age was 45.3 (range 15–78) years, and 54 patients were available for follow-up at both one and two years postoperatively. Mean follow-up duration was 13.7 (range 4–26) months. In group A, mean HVA decreased from 32.3° preoperatively to 8.4° at final follow-up, while the angle of group B decreased from 32.4° to 11.4°. Mean IMA decreased from 15.1° preoperatively to 7.3° at final follow-up in group A, while the IMA decreased from 15.1° to 8.9° in group B. That way we could verify that the extended chevron osteotomy is more effective for stability and correcting of the angulation and rotational profile than traditional DCO. Conclusion: The extended chevron osteotomy achieved even greater stability and accurate correction of the deformity. Furthermore, it was more effective than traditional chevron osteotomy in terms of correction of the angulation and rotational profile.
Figure 8 (Heel open) short leg cast
Authors: Kang Chan , Song Jaehwang , Kang Donghun , Noh Chang-Kyun , Ahn Ki-Jun , Lee Gi-Soo 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: To report the results of applying heel open (figure 8) short leg cast on foot & ankle trauma or disease patients requiring short leg casts. Methods: 380 patients who were confirmed and treated by diagnosed of foot & ankle trauma or diseases were included between November 2014 and July 2016. Comprised of 222 males and 158 females, their mean age was 46 years old. The bottom of the figure 8 cast covered the metatarsal head to half portion of the medial longitudinal arch, while leg portion covering consisted from the prominence of the both malleolus to halfway of the lower leg, resulting in complete exposure of the heel and distal portion of the achilles tendon. After application of the figure 8 cast, changes in the ROM in active ankle dorsiflexion & plantarflexion, passive foot inversion & eversion, and foot internal & external rotation were measured. Results: In all cases, measurements of active ankle dorsiflexion & plantarflexion was less than 5 degrees, measurements of passive foot inversion & eversion was less than 5 degrees, foot internal & external rotation was less than 0 degrees, and were stably held without skin or soft tissue injury until cast removal. Notable were 22 cases of foot & ankle fractures treated with conservative therapy with figure 8 short leg cast resulting in bone union and stabilization without surgery. VAS discomfort score was an average of 2.6 (0~5) and figure 8 short leg cast was selected in all cases requiring a short leg cast. Conclusion: The use of figure 8 short leg cast in patients of foot & ankle trauma and diseases requiring short leg cast provides safety and prevention of skin necrosis and pressure sores from open heels while providing high patient satisfaction in daily life, such as heel touch. We believe that figure 8 short leg cast could replace the traditional short leg cast, if the safety of the figure 8 cast could be proven through long-term follow up study with various patient and cases.
The Use of Weight-Bearing CT Scan in the Evaluation of Hindfoot Alignment
Authors: Kaplan Jonathan , Myerson Mark , Welck Matthew , Tracey Joseph , Avila Adriana , Li ShuYuan 
Published: September 2017

Category: Hindfoot, Diagnostic Imaging Introduction/Purpose: Multiple techniques have been described in determining the hindfoot alignment radiographically. While these studies have traditionally showed good reliability, the 2-dimensional nature of radiographs fails to consider the contribution of the remainder of the foot on the overall alignment. A new technique has been recently published in which the hindfoot alignment is calculated using the Ground Reaction Force Calcaneal Offset off radiographs. This technique accounts for the individual forefoot contributions on overall alignment, however is still limited by the 2-dimensional nature of plain radiographs. The purpose of this study is to compare two accepted radiographic measurements, the hindfoot moment arm (HMA) and the hindfoot alignment angle (HAA), with a novel technique determining the ground reaction force calcaneal offset (GRF-CT) using 3- dimensional weight bearing CT Scans. Methods: Retrospective chart review was performed over a two-year period from 2014-2016 to identify patients with weight bearing hindfoot alignment radiographs and PedCat (Curvebeam, Warrington, USA) 3-D weight bearing CT scans. The HMA, HAA, and GRF-CT were measured by three different investigators. Each of these measurements were calculated two times on separate occasions by each investigator to determine the intra- and inter-observer reliability with each of these techniques Results: One-hundred and four patients underwent weight bearing hindfoot alignment radiographs and 3-dimensional weight bearing CT scans. There were 33 patients with varus deformities and 71 patients with valgus deformities. There was excellent intra- and inter-observer reliability with all three measurement techniques, however the GRF-CT showed the best intra- and inter-observer reliability with the lowest standard deviation Conclusion: The GRF-CT technique is more reliable than traditional radiograph techniques for measuring the hindfoot alignment. While the intra- and inter-observer reliability is good for all three techniques, the GRF-CT technique resulted in the best intra- and inter-observer reliability with the lowest standard deviation. This technique provides the most accurate hindfoot alignment as it takes into account the effect of forefoot on overall alignment, preventing inaccuracies of projection and foot orientation in contrast to traditional radiographic techniques, which may be valuable in surgical decision making.