bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation and Validation of Anatomic Triplane Hallux Abducto Valgus Classification
Authors: Santrock Robert , Smith W. Bret , Dayton Paul , Hatch Daniel 
Published: September 2017

Category: Bunion Introduction/Purpose: The most common classification system for HAV deformity is based on two-dimensional radiographs. This system relies upon measurements taken of the transverse plane. (IMA and HVA) to classify and deploy surgical options based on the severity of these angles [1]. Recently, the understanding of HAV deformity as a three-dimensional problem has been described. A study by Kim et al. [2] utilized WB-CT to describe a frontal plane rotational component in 87% HAV cases. To develop a better understanding of HAV, a unique anatomic classification system (see figure) was proposed. The aims of this study were: (1) To use traditional WB radiographs to confirm the findings of Kim’s WB-CT study. (2)To use inter-observer and intra-observer analysis to validate the classification of HAV into this new system. Methods: An Institutional Review Board approved multi-center retrospective study was performed utilizing four view WB radiographs (Anterior-Posterior, Oblique, Lateral and Axial Sesamoid) on patients presenting to the clinic for “bunion,” Hallux Valgus, HAV, Hallux Rigidus or “great toe pain.” The data were analyzed for the presence of frontal/coronal plane rotation of the first metatarsal, subluxation of the sesamoids, metatarsus adductus and degenerative joint disease of the first MTP (metatarsophalangeal) joint (Hallux Rigidus); these findings were compared to Kim’s study. Additionally, these data were used to categorize HAV deformities into a new 3D classification scheme and were tested for inter-observer and intra-observer reliability. Results: The results established the presence of frontal/coronal plane rotation and subluxation in similar ratios as reported by Kim et al. thus confirming the utility of a four-view WB radiograph series in recognition of 3D deformity of HAV. The results also confirmed good reliability of the classification from both the inter-observer and intra-observer standpoint. Conclusion: These data suggest that new protocols and tools are reliable in helping the surgeon recognize and better identify the three-dimensional components of HAV.
Primary Subtalar Arthrodesis for Acute Intra-articular Displaced Calcaneal Fractures
Authors: Schipper Oliver , Jones Carroll P. 
Published: September 2017

Category: Hindfoot, Trauma Introduction/Purpose: Many patients who sustain intra-articular calcaneus fractures have persistent pain and ultimately require subtalar fusion secondary to posttraumatic arthritis. Although often recommended for severe fractures, little evidence exists describing outcomes of primary subtalar arthrodesis for calcaneus fractures. The purpose of this study was to evaluate primary subtalar arthrodesis for the management of acute, displaced, intra-articular calcaneus fractures. Methods: A retrospective chart review was completed for all primary subtalar arthrodeses of acute displaced, intra-articular calcaneus fractures over a 6 year period. 25 patients were identified. Preoperative CT scans were reviewed for Sanders classification and CT scans obtained at a minimum of 3 months postoperatively were evaluated to quantitate the fusion mass by a blinded reviewer. Subtalar union was defined as greater than 50% bony bridging of the posterior facet based on CT sagittal and coronal views. Patients were contacted to complete the VR-12 mental and physical components, and the Foot and Ankle Ability Measurement (FAAM) score. Results: Median patient age at the time of surgery was 49.9 years (41.5-55.9). Mean follow up was 35 months (range 5-80). Four percent (1/25) of patients had a Sanders II calcaneus fracture, 40% had a Sanders III fracture, and 56% (14/25) had a Sanders IV fracture. Median VR-12 mental component was 66.9 (62.9-68.6), median VR-12 physical component was 41.44 (33.0-49.9), median FAAM ADL score was 66.7 (36.9-83.3), and median FAAM sports score was 58.9 (28.6-69.6). One patient had a nonunion of the subtalar joint (4%), 3 patients had 51-75% fusion of the posterior facet, and 21 patients (84%) had greater than 75% union of the posterior facet. One patient required hardware removal after fusion. Conclusion: Primary subtalar fusion for acute, displaced, intra-articular calcaneus fractures has a high rate of union and good pain and function outcomes. It should be considered for patients with significant cartilage injury and comminution of the posterior facet.
A Prospective Study
Authors: Shah Ashish , Araoye Ibukunoluwa , Johannesmeyer David , de Cesar Netto Cesar , Jones Caleb , Stavrinos Despina 
Published: September 2017

Category: Post-surgical Lifestyle Introduction/Purpose: Gastrocnemius recession is the most common surgical procedure in the foot and ankle orthopaedic community. After surgery, patients ask their surgeons when they can safely resume day-to-day activities such as driving. Most times, the surgeon responds with generalized instructions using pain and patient comfort level as benchmarks for when the patient can return to driving. Several studies have identified safe return times for driving after traumatic injuries. However, a safe return time for gastrocnemius recession patients has never been studied. Given the safety concerns and risk associated with driving after surgery, it is important to have evidence-based advice for patients. The purpose of this study is to determine when a patient can safely return to driving after gastrocnemius recession. Methods: IRB approval has already been obtained for this study. 20 patients undergoing right-sided gastrocnemius recession will be identified in the Foot and Ankle clinic. Inclusion criteria will include first time isolated gastrocnemius recession surgery, licensed driver, and age between 18 and 65. Exclusion criteria will include failure to meet inclusion criteria, inability to return for follow-up testing, non-active driver status, medical contraindication to driving, history of any prior foot and ankle surgeries, and performance of any concurrent foot and ankle surgical procedures alongside gastrocnemius recession. Study participants will attend a driving simulator session prior to undergoing their procedure and will follow-up with repeat simulations at 1, 2, and 4 weeks postoperatively. Collected data will include braking reaction time, total braking time, speed stability, and number of traffic violations. A matched healthy control dataset will be used for comparison. Results: There was no detailed data available at the time of writing this abstract. We anticipate data availability over the next couple of months. Conclusion: We anticipate conclusions on the safe time to resume driving in gastrocnemius recession patients after gathering and processing detailed data. This is the first prospective study to guide counseling for patients undergoing gastrocnemius recession regarding a safe time to resume driving.
Timing of arthroscopy does not impact recurrence rate of ankle instability in patients undergoing lateral ligament repair surgery
Authors: Shah Ashish , Cone Brent , de Cesar Netto Cesar , Hudson Parke , Araoye Ibukunoluwa , Sahranavard Bahman , Pinter Zachariah , Lee Sung , Jones Caleb , Bergstresser Shelby 
Published: September 2017

Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Although the initial treatment is conservative, some patients may develop chronic instability requiring surgical repair. Arthroscopy is often performed prior to ligament reconstruction to evaluate concomitant intraarticular and cartilage injuries. Arthroscopic treatment may be performed immediately prior to ligament repair (single stage), or it may be scheduled days/weeks prior to ligament repair (double stage). Concerns of single stage arthroscopic treatment are related to the increased difficulty in dealing with ligaments and soft-tissue injuries hindered by fluid extravasation. Our study compares outcomes between single and double stage arthroscopy in patients undergoing lateral ligament repair surgery. Methods: In this retrospective study we reviewed charts of patients with chronic lateral ankle instability who underwent ankle arthroscopy followed by lateral ligament repair from 2011 to through 2015. A total of 102 patients were included in the study, 65 patients in the single stage group, and 37 in the double stage group. Surgical failure was defined as recurrence of ankle instability at any point in the follow up period after the procedure. Demographic data and recurrence rate of instability were compared between the groups using chi-squared test. Results: Women comprised 72% (73/102) percent of the total patient population. No significant differences in demographic data were found between the two groups. There was no difference in the recurrence rate of lateral ankle instability between patients who underwent 1-stage versus 2-stage arthroscopic treatment. The rate was similar between the groups: 10.8% (7/65) of patients with the single stage technique and 8.1% (3/37) of patients in the double stage group (p=0.6208). Conclusion: In the treatment of chronic lateral ankle instability, the use of single-stage arthroscopy and lateral ligament repair showed similar rates of surgical failure when compared to the double-stage procedure. A single stage approach may be a more efficient use of time and hospital resources, and avoids the need to place the patient under anesthesia multiple times. Arthroscopy may be performed immediately prior to lateral ligament repair without concern for increased risk of recurrence of instability.
A Comparative Study of the Saltzman and the Modified Long-leg Radiograph for Assessing Hindfoot Alignment
Authors: Shah Kalpesh , Dash Kumar Kaushik 
Published: September 2017

Category: Radiology Introduction/Purpose: There is growing evidence suggesting that the alignment of the leg (hip-knee-ankle or HKA axis) should be considered when planning an ankle replacement and alignment of the hindfoot (tibio-calcaneal or TC axis) should be considered when planning a knee replacement. The alignment of the HKA axis is assessed from standard long-leg radiographs, while the hindfoot alignment requires special views like Saltzman’s or Coetzee’s or similar. However we have discovered that by making minor adjustments to the way a standard long-leg radiograph is taken, it is possible to measure both the HKA as well as the TC axis from the same radiograph. The aim of our study was to compare the hindfoot alignment between a Saltzman’s view and the modified long-leg view. Methods: Approval was obtained for a prospective observational study on 65 consecutive patients referred to our hospital for a knee replacement. Patients with multiple joint arthritis, previous lower-limb surgery, or limb length discrepancy requiring shoe- raise were excluded. All patients had a preoperative modified long-leg view as part of our routine for radiographic assessment of a knee replacement; as well as a Saltzman’s view which served as a standard for hindfoot alignment. The long-leg alignment was measured using the standard HKA (hip-knee-ankle) axis, and the alignment of the hindfoot (tibio-calcaneal angle) was measured using the method described by Van Dijk et all. A difference of 3 degrees between the two observations was agreed to be considered as significant. Results were recorded by two Surgeons independently and analysed using the Bland-Altman Plot. The Intraclass Correlation Coefficient was used for inter-observer variation. Results: 48 patients were eligible for the study. The hindfoot angle measured in the modified long-leg view (mean 9.29 degrees, SD 4.26 degrees) was similar to that in the Saltzman’s view (mean 8.99 degrees, SD 4.16 degrees). The Scatter Plot showed a linear distribution, with Spearmann Correlation Coefficient of 0.892. Bland Altman Plot showed the differences in the measurements residing within the agreed difference of 3 degrees. Intraclass Correlation Coefficient was 0.94 for the modified long-leg view and 0.87 for the Saltzman’s view, suggesting excellent interobserver agreement. Conclusion: Our study shows that the position of the hindfoot can be reliably measured from the modified long-leg view, and this removes the need for additional radiographs for hindfoot alignment. As the entire femur, tibia and the hindfoot is accessible in the same long-leg view, this creates a platform for further research in to the mechanical axis of the entire lower limb as opposed to the HKA axis, and the effects of malalignment of the lower extremity in patients undergoing knee or ankle replacements.
The importance of medial wall stabilization in sinus-tarsi approach to treat Sanders type II and III calcaneus fractures
Authors: Shi Zhongmin 
Published: September 2017

Category: Trauma Introduction/Purpose: The aim of this study was to assess the clinical outcomes of medial wall stabilization in sinus-tarsi approach to treat Sanders type II and III calcaneus fractures. Methods: In this retrospective study, a total of 38 patients (32 men and 6 women) with 38 displaced intra-articular calcaneal fractures were included. A modified sinus tarsi approach was used to reduce and stabilize the posterior facet using rafting technique with mini-fragment locking plate and multiple sagittal screws were added percutaneously to stabilize the calcaneal body and to control rotation. Preoperative and postoperative Böhler’s and Gissane angle were compared, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and SF-36 scores were used to evaluate the final outcomes, and the complications were also recorded. Results: The mean duration of follow-up was 17.4 months. The mean preoperative Böhler’s angle (13.4 ± 3.4°), Gissane angle (88.1 ± 7.6°) were significantly increased (P < 0.05) at final follow-up (25.5 ± 5.6°, 116.2 ± 7.5°, respectively). Complications included 9 cases of moderate subtalar joint stiffness. There were 2 cases with wound edge necrosis, but there was no superficial or deep infection, or nerve injury was observed in these patients. Conclusion: The application of minimally invasive rafting technique with medial wall stabilization is an effective option for displaced intra-articular calcaneal fractures.
Can Generalized Ligamentous Laxity be an Obstacle to Perform Minimally Invasive Surgery for Moderate Hallux Valgus?
Authors: Shim Dong-Woo , Hwang Yeokgu , Parsk Yoo Jung , Lee Jin Woo 
Published: September 2017

Category: Bunion Introduction/Purpose: Minimally invasive surgical techniques have challenged objectives in hallux valgus surgery, attempting to obtain good clinical outcomes with the least damage to anatomic structures, low complication rates, short time of surgery, cosmetic advantages and an earlier recovery. However, because patients with generalized ligamentous laxity have a major risk for recurrence, arthrodesis of the first tarsometatarsal (TMT) joint is an established method for the surgical treatment of the patients with generalized ligamentous laxity. This study aims to investigate the clinical and radiographic outcomes of joint-preserving minimally invasive distal metatarsal osteotomy in moderate hallux valgus patients with generalized ligamentous laxity. Methods: Thirty-two feet from 29 patients were involved prospectively with mean follow-up of 16.8 (range, 10 – 26) months. Generalized ligamentous laxity was assessed in all patients and the patients were divided into two groups (16: 16) with the result. Clinical outcomes were assessed using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Outcome Score (FAOS). Radiographic parameters were evaluated by preoperative and postoperative weight bearing radiographs. Results: Mean tourniquet time was 30.4 (range, 19 – 44) minute and additional procedures were required in 6 cases in each group. The mean VAS (p<0.001), AOFAS score (p<0.001) and three FAOS subscales (Pain, Symptoms and Quality-of-Life) (p=0.003, p=0.002 and p<0.001) improved significantly at the last follow-up. Significant corrections in the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and sesamoid reduction were obtained at the last follow-up (p<0.001). Relative first metatarsal length was decreased 2.8% from preoperative length (p<0.001). No other radiographic outcomes showed significant difference between the 2 groups but the mean relative first metatarsal length was shorter in the group without generalized ligamentous laxity (p=0.014, respectively) at the last follow-up. Conclusion: Despite the patients without generalized ligamentous laxity tended to have shorter first metatarsal bone postoperatively, minimally invasive distal metatarsal osteotomy yielded substantial clinical and radiological results without any recurrence or fixation failure. This procedure can be a reasonable alternative to first TMT arthrodesis in patients with moderate hallux valgus even with generalized ligamentous laxity.
Mid-term (5-10 year) Results of the Salto Talaris Total Ankle Arthroplasty
Authors: Stewart Matthew , DeOrio James , Adams Samuel , Easley Mark , Nunley James 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: The Salto Talaris total ankle replacement is a modern fixed-bearing implant used to treat symptomatic ankle arthritis with the goals of providing pain relief, restoring mechanical alignment, and allowing motion of the ankle joint. This prosthesis has been used in the United States increasingly over the last 10 years, primarily for older patients with end-stage ankle arthritis but indications are expanding to younger and more active patients. The goal of this study is to report the midterm clinical results of one of the largest cohort of patients in the United States who underwent ankle replacement with this prosthesis. Methods: This is a review of patients with a minimum of 5-year up to 10-year follow-up who were prospectively registered within our institutional database prior to proceeding with total ankle arthroplasty using the Salto Talaris prosthesis. Follow-up examinations were scheduled annually after the one-year postoperative mark to evaluate patients both clinically and radiographically. At each annual assessment, patients rated their current level of pain using the visual analog score (VAS) and reported their functional level using the American Orthopaedic Foot and Ankle (AOFAS) ankle-hindfoot scores, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health survey. These scores were analyzed to assess differences between their levels preoperatively, one year postoperatively and at their most recent follow-up. Preoperative and postoperative radiographs were reviewed for component loosening. Criteria for failure was defined as undergoing revision requiring exchange or removal of the metallic components for any reason. Results: We identified 106 patients who had a Salto Talaris total ankle replacement between March 2007 and February 2012. Of these, 72 patients (mean age, 61.9 years) met the requirement for a minimum follow-up of 5 years (range 60 to 115 months, mean 81.1 months). Average outcome in the VAS was 7.1 at one year post-op and 11.7 at last follow-up (preop: 70.0). Significant improvements were seen in the SMFA, AOFAS ankle-hindfoot score, and the SF-36 from preoperatively to their final follow-up. Survivorship was 97.2% with two patients undergoing revision arthroplasty for aseptic loosening and a third patient scheduled for revision for a chronic wound infection. 14 patients (19%) with midterm follow-up required a total of 17 additional surgical procedures on the ipsilateral ankle or hindfoot. Conclusion: Patients who underwent total ankle arthroplasty with the Salto Talaris prosthesis have continued to show significant improvements in pain and functional outcomes at mid-term follow-up. This has shown to be an effective treatment option with durable results for patients with end-stage ankle arthritis.
Effects of wearing shoes on the feet
Authors: Suh Jin Soo , Choi Jun Young 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: Maasai tribe members either walk barefoot or wearing traditional shoes made from recycled car tires. Despite walking long distances (up to 60 km) daily, they do not generally experience foot ailments. We compared parameters associated with the feet, ankles, and gait of middle-aged partially and regularly shod Maasai women and Koreans. Methods: Foot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were compared among 20 middle-aged bush-living partially shod (PS) Maasai women, urban-living regularly shod (RS) Maasai women and Korean. Static and dynamic Harris mat footprints were taken to determine forefoot pressure distribution during walking. We also compared standing foot and ankle radiographic parameters. Results: The mean ratios of foot length to the width were not significantly different among three groups. Claw toe deformity was showed highly in PS (80%) and RS (95%) Maasai women. There were no significant differences in walking velocity and Harris mat findings among the three groups. On comparing PS and RS Maasai groups radiographically, talonavicular coverage angle, talo-first metatarsal angle and naviculo-cuboidal overlap were significantly greater in the PS Maasai group, whereas hallux valgus angle, the first and second intermetatarsal angle Meary angle and the medial cuneiform height were greater in the RS Maasai group. Conclusion: Regularly wearing shoes can protect the feet from fallen medial longitudinal arches with everted hindfeet and abducted midfeet. It could also cause hallux valgus deformity. Claw toe deformity was seen frequently in the Maasai tribe regardless of shoe wearing habits.
Arthroscopic autologous-matrix induced chondrogenesis in association with microfractures and autologous bone graft for the treatment of osteochondral talar lesions in young patients
Authors: Usuelli Federico Giuseppe , Maccario Camilla , D’Ambrosi Riccardo 
Published: September 2017

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: The purpose is to evaluate the clinical and radiological outcomes of patients younger than 20 years, treated with the arthroscopic-talus autogolous matrix-induced chondrogenesis (AT-AMIC®) technique and autologous bone graft for osteochondral lesion of the talus (OLT) at a follow-up of 24 months. Methods: 13 patients under 20 years (range 13.2 – 19.85) underwent the AT-AMIC® procedure and autologous bone graft for OLTs. Patients were evaluated pre-operatively (T0) and at 6 (T1), 12 (T2) and 24 (T3) months postoperatively, using the AOFAS score, the VAS and the SF-12 respectively in its Mental (MCS) and Physical component (PCS). Radiological assessment included CT-scan, MRI and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean size lesion measured during surgery was 1.1102 cm3 ± 0.518 cm3. We found a significant difference in clinical and radiological parameters with ANOVA for repeated measures (p<0.001). All clinical scores significantly improved (p<0.05) from T0 to T3. Lesion area significantly reduced from 120.12 ± 29.58 mm2 pre-operatively to 75.78 ± 15.00 mm2 (p<0.05) at final follow- up as assessed by CT, and from 133.32 ± 32.42 mm2 to 83.45 ± 15.54 mm2 (p<0.05) as assessed by MRI. Moreover we noted an important correlation between intra-operative size measurement of the lesion and BMI (p=0.0114). Conclusion: The technique can be considered safe and effective, reporting early good results in young patients. Moreover we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life.