bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment of Acquired Flatfoot Deformity: What is the State of Practice among Academic Foot and Ankle Surgeons in 2002?
Authors: Hiller Luke , Pinney Stephen J. 
Published: January 2017

Purpose: This study was performed to review the present approach to the surgical treatment of acquired flatfoot deformity among a cross section of academic foot and ankle surgeons in the United States. Methods: A typical case of stage II posterior tibial tendon dysfunction was developed. The hypothetical patient was a healthy 62-year-old male with a symptomatic acquired flatfoot deformity with posterior tibial tendon dysfunction. Nonoperative management had failed. A series of academic foot ankle surgeons were surveyed to identify their proposed operative treatment. Each surgeon surveyed was affiliated with an orthopaedic residency program and was directly responsible for teaching orthopaedic residents. Each surgeon had foot and ankle patients as the major component of their practice. The overall response rate was 81% (104/128). Results: Ninety-seven percent (101/104) of respondents reported that they would employ some type of bony procedure in their surgical treatment. Eighty-eight percent (89/104) described techniques that would preserve the subtalar and talonavicular joints. These included a medializing calcaneal osteotomy in 73% (76/104), a lateral column lengthening in 41% (43/104), and a medial column stabilization (first tarsometatarsal and/or navicular cuneiform arthrodesis) in 15% (16/104). Twelve percent (12/104) reported that they would perform an arthrodesis of one or more of the hindfoot joints. Ninety-eight percent (102/104) of respondents reported that they would employ some type of soft-tissue procedure. Ninety-four percent (98/104) would augment the posterior tibial tendon, 53% (55/104) would formally repair the spring ligament, and 70% (73/104) would address a presumed equinus contracture. Conclusions: There is a wide variation in the approach to surgical treatment of stage II acquired adult flatfoot deformity among academic foot and ankle surgeons. Most surgeons employed a combination of bony and soft-tissue procedures that preserved the subtalar and talonavicular joints.
Navicular Stress Fractures: A Prospective Study on Athletes
Authors: Saxena Amol , Fullem Brian 
Published: January 2017

Background: Navicular stress fractures of the foot often are difficult to diagnose and treat. Methods: Nineteen athletic patients seen from 1999 to 2003, were compared to a previously treated group of 22 athletes with similar injuries treated from 1994 to 1998. Based on the frontal plane CT images, a previously described classification system was used to assess the injury: type I dorsal cortical break; type II fracture extending into the navicular body; and type III fracture breaches two cortices. Nonoperative treatment was recommended for patients with type I injuries and open reduction and internal fixation (ORIF) were recommended for those with type II and III injuries. The time to return to activity and ability to return to competition were assessed, along with differences between fracture type and gender. Results: Return to activity (RTA) was 4.0 months for the entire group. RTA for type I (four injuries), type II (eight injuries), and type III (seven injuries) was 3.8, 3.7, and 4.2 months, respectively. Fifteen of 16 competitive athletes returned to full competition, including all who had ORIF. Conclusions: Navicular stress fractures can take 4 months to heal with nonoperative or operative treatment. Surgery should be considered for more severe injuries, which can be assessed by CT scan.
Kinematic MRI of the Normal Ankle Ligaments Using a Specially Designed Passive Device
Authors: Tokuda Osamu , Awaya Hitomi , Taguchi Kotaro , Matsunga Naofumi 
Published: January 2017

Background: Knowledge of the normal MRI appearances of the ankle ligaments and tendons is particularly important in the diagnosis of ankle sprains. In most clinical practices, the ankle is imaged in a neutral position with standard imaging planes and sequences. The purpose of our study was to investigate whether passive positioning influences the MRI appearances of the ligaments of the ankle. Methods: The axial and coronal T1- weighted MR images obtained from 10 subjects were reviewed by two musculoskeletal radiologists. The following imaging planes were used: dorsiflexion with inversion, dorsiflexion with neutral, dorsiflexion with eversion, neutral with inversion, neutral, neutral with eversion, plantarflexion with inversion, plantarflexion with neutral, and plantarflexion with eversion. A subjective rating system was used to determine the optimal imaging plane and position for individual ligaments in each volunteer. Each ligament was rated on a scale (of 1 to 6). Results: There were significant differences in the appearances of the anterior talofibular ( p = 0.0002), calcaneofibular ( p < 0.0001), and posterior talofibular ( p 0.0001) ligaments between the optimal and least optimal ankle positions in the axial plane, and in those of the (plantar calcaneonavicular) spring ( p 0.0001), tibiocalcaneal ( p 0.0001), posterior tibiotalar ( p = 0.0087) and posterior talofibular ( p = 0.0213) ligaments in the coronal plane. Conclusions: Kinematic MRI of the ankle is feasible and appears to improve visualization of ankle ligaments compared to MRI.
Antibiotic-Coated Nail for Fusion of Infected Charcot Ankles
Authors: Pawar Abhijit , Dikmen Goksel , Fragomen Austin , Rozbruch S. Robert 
Published: January 2017

Background: Treating infected ankles in patients with neuropathy is difficult, and complications are frequently encountered. Eradication of infection and effective arthrodesis are required for a successful outcome. The purpose of this study was to evaluate the outcomes of patients with Charcot neuropathy whose infected ankles were treated with a retrograde, antibiotic-coated, locked intramedullary nail. Methods: We analyzed 5 patients with infected neuroarthropathy of the ankle joint. Three patients had failed treatment with the circular external fixator for infected neuroarthropathy of the ankle. The other 2 were treated primarily by this technique. All patients were treated with surgical nonunion repair, arthrodesis, and insertion of an antibiotic-coated, locked intramedullary nail. The average age was 59 years (range, 46 to 82 years). The average follow up period was 18 months (range, 12-24 months). Results: The average time taken for radiological healing was 4.1 months (range, 4-4.5 months). In all patients, bony union was achieved and infection was eradicated. There were no cases of hardware failure. Conclusion: Antibiotic-coated nails were used to treat infected ankle nonunions and infected distal tibial fractures in Charcot patients with successful bony union, fusion, and eradication of infection. Level of Evidence: Level IV, therapeutic study.
The Intraosseous and Extraosseous Vascular Supply of the Fifth Metatarsal
Authors: McKeon Kathleen E. , Johnson Jeffrey E. , McCormick Jeremy J. , Klein Sandra E. 
Published: January 2017

Background: Osteotomies of the fifth metatarsal may disrupt the nutrient artery and result in nonunion. The location of the nutrient artery foramen relative to the location of common osteotomies has not been described. The goal of this study was to describe the vascular supply of the proximal fifth metatarsal, including the artery of origin of the nutrient artery and the location of the nutrient artery foramen. Methods: Fifty-six adult cadaver specimens were amputated below the knee. The anterior tibial, posterior tibial, and peroneal arteries were injected with India ink and Ward’s Blue Latex. The specimens were frozen for 48 hours and then thawed to room temperature. The soft tissues were débrided with sodium hypochlorite, and the extraosseous vascularity was recorded. The fifth metatarsal was then removed and the intraosseous vascular anatomy elucidated using a modified Spälteholz technique. Results: The dorsalis pedis, posterior tibial, and peroneal arteries branch in predictable patterns to supply the fifth metatarsal. The nutrient artery arose from the fourth plantar metatarsal artery in 100% of specimens and inserted into the plantar medial diaphysis in 83% of specimens. The nutrient artery foramen was an average of 26.8 mm (range, 19-40) from the medial aspect of the base of the fifth metatarsal. Conclusions: When an operative approach to the fifth metatarsal is planned, care should be taken to avoid stripping the bone on the plantar and medial aspects. Clinical Relevance: Osteotomies placed within the proximal 40 mm of the bone carry a risk of disrupting the nutrient artery, resulting in possible nonunion.
The Ability of Outcome Questionnaires to Capture Patient Concerns Following Ankle Reconstruction
Authors: Pinsker Ellie , Daniels Timothy R. , Inrig Taucha , Warmington Kelly , Beaton Dorcas E. 
Published: January 2017

Background: The objective of this study was to compare questions from outcome questionnaires with items generated by preoperative and postoperative ankle reconstruction patients (using the open-ended questions of self-reported Patient-Specific Index [PASI]) to determine whether existing questionnaires address patients’ concerns. Methods: Patients (n = 142) completed the PASI. Questions from 6 standardized questionnaires (American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire [AAOS], patient-reported portion of the American Orthopaedic Foot and Ankle Society Clinical Rating System Ankle-Hindfoot Scale [AOFAS], Foot Function Index [FFI], Lower Extremity Functional Scale [LEFS], Short Musculoskeletal Function Assessment [SMFA], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and PASI were matched by 3 reviewers to corresponding categories in the International Classification of Functioning, Disability and Health (ICF). Standardized questionnaires were then compared with the patient responses produced by the PASI. Results: Patients identified 690 items corresponding to 45 ICF categories. Most PASI concepts fell into Activities and Participation (60.3%) and Body Functions (29.0%) components, including the categories “walking” (19.1%), “pain” (16.5%), and “recreation and leisure” (15.4%); 237 items were identified in questionnaires and linked to 39 ICF categories. Core issues in questionnaires (“pain,” “walking,” “stairs”) were important concerns for patients, but other key patient concerns (“swelling,” “recreation and leisure,” “sports”) were seldom included in questionnaires. Conclusion: No single questionnaire captured all patient concerns, and standardized questionnaires differed largely in content. This analysis may help guide development of a more comprehensive instrument for evaluating outcomes following ankle reconstruction. Clinical Relevance: When choosing an outcome questionnaire, clinicians and researchers should consider the targeted outcome because no one questionnaire captures the full patient experience.
Case Series of Topical and Orally Administered β-Glucan for the Treatment of Diabetic Wounds: Clinical Study
Authors: Karaaslan Onder , Kankaya Yuksel , Sungur Nezih , Kocer Ugur , Cuzdart Suat Sedat , Sahin Belma , Uysal Afsin 
Published: January 2017

Background: Chronic, nonhealing wounds, foot ulcers, and lower extremity amputations are among the most problematic complications associated with diabetes mellitus. Standard care for diabetes-related chronic ulcers has included treatment of infection, weight off-loading, aggressive surgical débridement, and maintenance of a moist wound environment with frequent dressing changes. Objective: Yeast glucan is a particular high-molecular-weight polymer of β-(1,3)-glycosidic linkages of glycopyranose. We report our observations about the effectiveness of topically and orally administrated β-(1,3)-glucan for the treatment of chronic diabetic wounds and compare them to the literature results previously reported for similar wounds. Materials and Methods: Twenty-two patients with nonhealing ulcers associated with diabetes were included in this study. β-Glucan was given both orally and topically for the treatment of nonhealing ulcers. Macroscopic changes and surface areas of diabetic ulcers were recorded, and complete healing times were noted for each patient. Results: A rapid decrease in size and healthy granulation were significantly observed in most patients. The duration of complete healing averaged 10.8 weeks (range 6–20 weeks). No adverse events were observed in the treatment period. The complete healing time was shorter than the results previously reported in the literature. Conclusions: Our observations support the view that application of glucan hastens epithelialization and wound closure, so topically and orally administered β-(1,3)-glucan therapy can help reverse some of the deficits in impaired healing diseases such as diabetes mellitus.
Topical 5% Imiquimod in the Treatment of Lentigo Maligna
Authors: Wong Jessica G. , Toole Jack W.P. , Demers Alain A. , Musto Grace , Wiseman Marni C. 
Published: January 2017

Background: Standard treatment for lentigo maligna (LM) is surgical excision with 5 to 10 mm margins. This can be cosmetically disfiguring. Imiquimod locally induces Toll-like receptors to release cytokines that destroy neoplastic melanocytes. Objective: The off-label use of topical 5% imiquimod cream may provide an alternative to surgery. This study reviews the use of imiquimod to treat LM. Methods: A 5-year retrospective and prospective chart analysis was conducted. Pretreatment biopsies confirmed the diagnosis. Treatment was individualized for each patient. Posttreatment biopsies and dermoscopy determined clearance of LM. Results: Twenty-seven patients were reviewed. There were 20 responders (74.1%) and 7 failures. The mean tumor size (area of an ellipse) was 6.69 cm2, and the mean treatment duration was 17.68 weeks. Neither the size of the tumor ( p = .86) nor treatment duration ( p = .18) was related to resolution of the lesion. Conclusion: Imiquimod is an effective treatment for LM that provides patients with a cosmetically favorable outcome when standard surgery is not an option.
Successful Treatment of Plantar Warts with Very Diluted Bleomycin Using a Translesional Multipuncture Technique: Pilot Prospective Study
Authors: Alghamdi Khalid M. , Khurram Huma 
Published: January 2017

Background: Plantar warts are common and often painful. Treatment of plantar warts is difficult and requires multiple treatments. Several clinical trials have proven the efficacy of bleomycin, but relatively high concentrations have been required and considerable side effects have been experienced. Objective: To evaluate the efficacy and safety of low-concentration (0.1 U/mL) bleomycin using a translesional injection technique for the treatment of plantar warts. Methods: The study included 23 patients with single or multiple plantar warts. Very low-concentration bleomycin was injected into a single wart or the largest plantar wart in the case of multiple lesions. Injections were performed at 4-week intervals until resolution of the warts or development of side effects. The translesional multipuncture technique was used. Results: Thirteen patients were male (56.5%), and the mean age was 27.7 years. The results revealed complete clearance of warts in 17 of 23 (74%) patients, partial response in 1 (4.3%) patient, and no response in 3 (13%) patients. Recurrence was observed in 2 patients at 3 months of follow-up. Among those two, one patient showed complete clearance after the second injection at 6 months of follow-up. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only three patients (13%) had localized moderate pain for 2 to 3 days after the injection. Conclusion: Translesional injection by very low-concentration (0.1 U/mL) bleomycin appears to be a simple, effective, and safe treatment modality for plantar warts.
Sample Size Calculations for Cluster Randomised Trials
Authors: Campbell Marion , Grimshaw Jeremy , Steen Nick ,   Changing Professional Practice in Europe Group (EU BIOMED II Concerted Action)
Published: January 2017

Objectives: Cluster randomised trials, in which groups of individuals are randomised, are increasingly being used in the health field. Adopting a clustered approach has implications for the design of such trials, and sample size calculations need to be inflated to accommodate for the clustering effect. Reliable estimates of intracluster correlation coefficients (ICCs) are required for robust sample size calculations to be made; however, little empirical evidence is available on their likely size, and on factors which influence their magnitude. The aim of this study was to generate empirical estimates of ICCs and to explore factors which may affect their magnitude. Methods: Empirical estimates of ICCs were calculated for both process variables and patient outcomes from a number of datasets of primary and secondary care implementation studies. Results: Estimates of ICCs varied according to setting and type of outcome. Estimates of ICCs for process variables were higher than those for patient outcomes, and estimates derived from secondary care were higher than those from primary care. ICCs for process variables in primary care were of the order of 0.05–0.15, whilst those in secondary care were of the order of 0.3. Estimates for patient outcomes in primary care were generally lower than 0.05. Conclusions: Adopting cluster randomisation has implications for the design, size and analysis of clinical trials. This study gives an insight into the potential size of ICCs in primary and secondary care, and provides a practical guide to researchers to aid the planning of future studies in this area.
Near-Patient Tests in Primary Care: Setting the Standards for Evaluation
Authors: Delaney Brendan , Wilson Sue , Fitzmaurice David , Hydel Chris , Hobbs Richard 
Published: January 2017

Near-patient tests (NPT) are an area of rapid technological advance that may enhance the quality of care given by primary care physicians by enabling more accurate diagnosis or more reliable monitoring of therapy. Unfortunately, many new diagnostic technologies prove disappointing in practice, either because of limitations of the technology or because of a failure to address setting-specific issues that were not apparent during their evaluation. A recent systematic review of NPT in primary care has highlighted the methodological weaknesses of most published evaluations. There is a need for a formal statement of the criteria by which to judge the quality of evaluations in this field. In a similar fashion to Wilson and Junger's criteria for screening, seven questions need to be addressed. These cover the performance, reliability and acceptability of the test, its impact on decision-making, comparison with existing practice, cost-effectiveness of the test and integration with the practitioner's knowledge base. Evaluations of NPTs should therefore address the following methodological issues: demonstration of the need for the NPT, definition of the appropriate reference standard, calculation of sample size based on modelling of the decision problem and defining acceptable limits to the likelihood ratio, avoidance of verification bias, selection bias and treatment paradox, testing for the presence of spectrum bias, reporting the sensitivity of the results to changes in setting or prevalence or disease and calculating cost-effectiveness.
Predicting Place of Discharge from Hospital for Patients with a Stroke or Hip Fracture on Admission
Authors: Bond John , Gregson Barbara , Lecouturier Monica Smith Jan , Rousseau Nikki , Rodgers Helen 
Published: January 2017

Objectives: To determine the predictive power of patient and service characteristics on place of discharge following hospital admission for an acute stroke and for hip fracture. Methods: Prospective cohort of 440 acute stroke and 572 hip fracture patients aged 65 years or over admitted from home to six district general hospitals and associated community hospitals, three in the North and three in the South of England. Results: Age, marital status, living arrangements, mental health status at admission, pre-admission self-rated disability, pre-admission use of home-care services, post-admission staff assessments of functional dependency as measured by Barthel Index and of confusion as measured by the modified Crichton Royal Behavioural Rating Scale and nursing staffs' expectation of place of discharge are all significantly related to place of discharge for stroke and hip fracture participants. Logistic regression correctly predicted discharge destination for 87% of stroke patients from data available at time of admission and 83% of hip fracture patients. Of the 30% of stroke patients discharged to an institution, the model correctly predicted 73%. However, of the 19% of hip fracture patients discharged to an institution, only 28% were correctly predicted. Conclusions: Data about older patients admitted to hospital with an acute condition should be routinely collected by hospital staff to inform clinical management and to permit risk-adjusted audit.
Evaluation of the Impact of a Technology Appraisal Process in England: The South and West Development and Evaluation Committee
Authors: Dixon Simon , Coleman Pat , Nicholl Jon , Brennan Alan , Touch Sandra 
Published: January 2017

Objectives: To examine the influence of the English National Health Service (NHS) South and West (S&W) region Development and Evaluation Committee (DEC) technology appraisal reports on purchasing and clinical decisions in the S&W and elsewhere in the NHS, and to estimate the cost of the DEC process. Methods: Two postal questionnaires examining issues of awareness, influence and quality of the DEC reports were sent to samples of clinical and managerial health service staff in S&W NHS region, the North West NHS region, and three other randomly selected health authorities elsewhere. Supplementary telephone interviews were undertaken with a subsample of staff. Trends in utilisation before and after the publication of four S&W DEC reports were examined using routine health service data. Results: Survey response rates ranged between 73% and 85%. Within health authorities in the S&W, agreement about the impact of the DEC in informing policy and purchasing decisions was consistently high, although responses from clinicians were more equivocal. In the topic areas examined, the impact of the DEC reports could not be separated from wider influences on practice. The cost of each DEC report is estimated to have been £24 659. Conclusions: Health service staff perceived that the S&W DEC process had had an impact on policy decisions and clinical practice locally; however, any actual impact on practice could not be identified with routine data. The approach used in this study would be valuable in evaluating the impact of the English NHS National Institute for Clinical Excellence.