bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medium-Term Outcomes Using Fresh Osteochondral Allograft Transplantation for Treatment of Large Osteochondral Lesion of the Talus
Authors: Rungprai Chamnanni , Hartog Taylor Den , Patterson Jason A. , Amendola Annunziato 
Published: October 2016

Category: Ankle Introduction/Purpose: Osteochondral allograft has been proven to be successful surgical option for treatment of large osteochondral defect of the talus. However, there are currently limited literatures reported outcomes of this technique. Methods: Retrospective Chart review with prospectively collected data of 26 patients with 26 ankles who had been diagnosed with large osteochondral lesion of the talus and underwent fresh osteochondral allograft transplantation 2004 and 2011 in single institution. All patients had failure of conservative treatment and minimum follow-up to be included in this study was 1 year (mean 40.9 months, range, 12 to 123 months). Pre- and post-operative pain (Visual Analog Scale (VAS)), SF-36 (PCS and MCS), and Foot Functional Index (FFI) were obtained and compared using Wilcoxon Singed-Ranks test. Results: Twenty-six patients (13 male and 13 female) with mean age of 31.7 years and an average of BMI of 29.0 were included in this study. Complete pre-operative and 1-year post-operative pain (VAS) (n=19/26) and functional outcome scores (SF-36 and FFI)(n=12/26) were collected. The mean pain (VAS) decrease from 6.9/10 to 4.8/10 post-operatively (p = 0.007). The mean SF-36 (PCS and MCS) were 41.3 and 54.7 pre-operatively which improved to 47.2 and 56.0 post-operatively, p = 0.084 and p = 0.875, respectively. The mean FFI (pain, disability, activity limitations, and total score) were 48.0, 48.8, 57.6, and 45.8 pre-operatively which changed to 53.4, 57.6, 68.5, and 54.6 post-operatively (p = 0.674, 0.575, 0.110, and 0.859, respectively). There were 61.8% patient satisfaction with this surgery and 82.7% of the patients will do the surgery again and they will recommend this type of surgery to their friends and family. There were 100% survival rate at 5-year (8 of 8) and 10-year (1 of 1). Conclusion: Osteochondral allograft demonstrated significant relief of pain in medium-term of follow-up as measured with VAS. This procedure was successful for treatment of large osteochondral lesion of the talus.
Modified Mitchell Osteotomy Alone Did Not Have Higher Rate Of Residual Metatarsalgia Than Combined First And Lesser Metatarsal Osteotomy
Authors: Chen Shu-Jung , Cheng Yuh-Min , Huang Peng-Ju 
Published: October 2016

Category: Bunion Introduction/Purpose: Transfer metatarsalgia (TM) is a common forefoot disorder secondary to hallux valgus (HV), and the best treatment for HV related TM remains controversy. Some authors suggested a combined lesser metarsal osteotomy while undergoing HV surgery, but some authors didn’t agree with it and concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of the retrospective study was to compare clinical outcomes in the patients with and without combined lesser metatarsal osteotomy while they received HV correction surgery. Methods: We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All the patients underwent HV correction with Modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) score and residual metatarsalgia were assessed, and hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsal shortening, and plantar shifting of metatarsal head were measured. Results: Sixty-five patients ( 83 feet ) meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were grouped as combined surgery group, and the others were grouped as control group ( 53 feet ). The overall rate of persistent symptomatic metatarsalgia was 19.28 % after operative treatment. There were 6 feet with residual metatarsalgia in combined surgery group, and 10 feet in control group. There was no significant difference in the rate of persistent symptoms between groups ( p=0.9). Conclusion: According to this result, modified Mitchell osteotomy alone didn’t have higher rate of residual metatarsalgia than combined surgery. Besides, we also found that the average recovery rate of transfer metatarsalgia was about 80.7% and the patients, whose preoperative hallux valgus angle was more than 30 degrees, had the higher risk of residual metatarsalgia after surgery.
Preoperative Patient and Institutional Factors Influence Anaesthetic Type in Foot and Ankle Surgery
Authors: Katchky Ryan , Rofaiel James R. , Rampersaud Yogi R. , Lau Johnny 
Published: October 2016

Category: Other Introduction/Purpose: Lower-extremity orthopaedic procedures may be performed under regional or general anaesthesia, or a combination of techniques. There is a growing body of evidence outlining benefits of regional anaesthesia, with meta-analyses of randomized controlled trials and registry data suggesting decreases in surgical site infections, thromboembolism, cardiopulmonary complications and length of stay associated with regional anaesthesia. In patients undergoing foot and ankle surgery specifically, the literature demonstrates decreased pain, nausea, vomiting, opioid use and unplanned hospital admission. This supports increased use of regional anaesthesia in patients undergoing foot and ankle surgery. However, the type of anaesthetic used is dependent on surgeon, patient, anaesthesiologist and institutional factors. The purpose of this study is to investigate pre-operative factors that predict anaesthetic type in patients undergoing foot and ankle surgery. Methods: Data was collected prospectively on 888 patients undergoing foot or ankle surgery at a single institution. The primary method of anaesthesia for each procedure was recorded. Ten additional variables were recorded and analyzed: age, BMI, gender, diabetes, ASA status, procedure length, procedure start time, elective vs. trauma procedure, primary vs. revision procedure and preoperative anticoagulation. Logistic regression modelling was performed to identify factors that independently predict the type of anaesthetic used. Results: General anaesthetic was employed in 280 patients (32%), and regional anaesthesia was the primary anaesthetic type used in 608 (68%). Logistic regression modelling demonstrated that factors that independently predict use of general anaesthetic include younger age (p < 0.0001; Odds Ratio 0.97/year), male sex (0.0033; 1.618), procedure start time (0.0319; 1.066/hour) and length of procedure ( < 0.0001; 1.520/hour). Patients who underwent general anaesthetic had a mean length of procedure of 108 ± 77 minutes, whereas patient provided with regional anaesthesia had a mean length of procedure 83 ± 64 minutes. Conclusion: With increasing evidence supporting use of regional anaesthesia, it is important to identify modifiable factors that contribute to patients receiving alternative treatments. Since later procedure start time was identified as an independent predictor of general anaesthetic use, there may be a role for identifying patients at increased risk of complications associated with general anaesthesia and scheduling earlier start times. Furthermore, while it is logical that extended length of procedure is a contraindication to regional anaesthesia, the mean procedure time of 108 minutes in the general anaesthesia group indicates that many of these patients should still be candidates for regional anaesthesia.
Return to Active Duty Lifestyle After Modified Brostrom
Authors: Melton Thomas J. , Dannenbaum Joseph H. , Ryan Paul M. , Robbins Justin 
Published: October 2016

Category: Ankle Introduction/Purpose: Ankle sprains are a common sports related injury and typically treated conservatively. Chronic ankle instability, however, may require surgical management when non-operative measures fail. The Brostrom procedure with Gould modification is the most frequently employed operation for chronic ankle instability with a record of good to excellent treatment outcomes. The purpose of our study was to evaluate the clinical outcomes of this procedure in an active duty population. Methods: A retrospective review of our electronic surgery records for a cohort of active duty patients aged 18-45 who were indicated for operative treatment of chronic ankle instability and who underwent surgical repair consisting of a standard Brostrom procedure with Gould modification at Madigan Army Medical Center between January 1,2010 through April 30, 2014 was performed. All patients were treated by a single surgeon and had a minimum of one year follow-up. The electronic medical record was reviewed for each patient to determine their ability to remain on active duty status as well as their permanent lower extremity activity restrictions. Results: 127 total patients who met the inclusion criteria underwent Brostrom procedures with Gould modification during the study period. 23 out of 127 (18.1%) underwent Medical Evaluation Board (MEB) and separation from active duty for reasons related to their ankle. Another 11 patients underwent military separation for reasons unrelated to their ankle. 67 patients (52.7%) currently have permanent lower extremity profiles in the electronic record. 38 patients with permanent profiles have been able to meet retention standards and remain on active duty status. Of the 93 patients who were able to remain on active duty status, only 2 individuals changed their military occupational specialty (MOS). The remainder of patients remain on active duty status in their current MOS, completed their active duty obligation or reached planned retirement. Conclusion: Chronic ankle instability in active duty service members can be severely limiting. Brostrom procedure with Gould modification can provide significant improvement in symptoms and allow patients to remain on active duty status. However, in our high demand population approximately 50% of patients required some form of permanent activity restriction with nearly 20% requiring military separation. This is important information when counseling an active patient population about the expectations from surgical intervention for chronic ankle instability.
Suture-Tape Augmentation for Chronic Ankle Instability
Authors: Gwak Heui-Chul , Kim Jeon-Gyo , Roh Sang-Myung 
Published: October 2016

Category: Ankle Introduction/Purpose: This retrospective study was performed to evaluate the clinical outcomes of internal brace technique using suture tape for chronic ankle instability. Methods: twenty-three patients were followed for more than 2 years after suture tape augmentation for lateral ankle instability. Twenty five patients were followed for more than 2 years after modified Brostrom procedure. The clinical results after using two techniques were evaluated and compared using Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) score, Olarud and Molander score, Hamilton score and Visual Analogue Scale (VAS). Anterior talar translation and talar tilt angle were obtained from stress radiographs to evaluate the mechanical ankle stability. Results: There was no significant difference in VAS at final follow-up (P < .325). There was no significant difference in FAOS at final follow-up (P < .242). There was no significant difference in AOFAS score at final follow-up (P < .418). There was no significant difference in Olarud and Molander score at final follow-up (P < .244). According to the Hamilton score, 14 cases (93%) in internal brace group and 23 cases (92%) achieved satisfactory functional results. Talar tilt angle and anterior talar translation had improved to an average of 2.2 degrees and 4.4 mm in internal brace group and 2.7 degrees and 5.4 mm in modified Brostrom group, respectively, at final follow-up, and there was no significant difference (P < .128, < .226, respectively). There were no complications such as skin irritation and wound infection. Conclusion: Suture tape augmentation has shown the potential for stabilizing the lateral ankle ligmament complex as an alternative to direct repair. Functional, objective, and subjective outcomes were excellent in all cases and no complications were seen postoperatively. To confirm the above further, it is appropriate to conduct a larger study.
The Use of a Fibular Nail to Treat Ankle Fractures in Patients With Diabetes
Authors: Younger Alastair S. , Veljkovic Andrea , Penner Murray J. , Wing Kevin 
Published: October 2016

Category: Trauma Introduction/Purpose: Patients with diabetes have difficulty healing skin and bone after ankle fractures. A paper published previously demonstrated a much higher rate of wound complications and amputation in patients with diabetes compared to those without diabetes. The purpose of this study was to analyze the outcome of patients with diabetes and ankle fractures prospectively followed using a fibular nail. The primary outcome was bone healing as assessed by CT scan at 12 weeks, and secondary outcomes were outcome scores, reoperation rates, mortality and wound complications. Methods: 10 patients with diabetes and ankle fractures (Weber b and c, isolated fibula, bi-maleolar and tri-maleolar fractures) were treated with a fibular nail for the fibular fracture, and percutaneous screw fixation for the posterior or medial maleolar fractures. Patients included were those with diabetes with an HBA1c of over 7 or other systemic complications of diabetes. Patients had to survive for 12 weeks after the procedure for inclusion. Excluded were fractures outside the ankle, concomitant injuries, patients unable to follow the study protocol and those with open injuries. The CT scans were assessed on both the Sagittal and Coronal views for bone healing at the fracture site. Each slice was measured for the percent of bone bridging. Results: One patient was excluded because of mortality before the 12 week visit. A second patient survived the 12 week follow up and died before 24 weeks. Successful bone bridging was seen in all patients by 12 weeks. The bone bridging was estimated to be 70 +/- 16% (SD) on the sagittal view and 75 +/- 10% on the coronal view at 12 weeks and was on the 82% sagittal view and 80% on the coronal view at 24 weeks. No hardware failure was seen. No fracture failed to unite. There were no mal-unions or non-unions either clinically or radiographically. There was one proximal locking screw wound treated with debridement and antibiotics with successful outcome. This patient developed a charcot arthropathy and underwent ankle fusion. Conclusion: This prospective case series demonstrates that the fibular nail can generate successful bone healing and excellent alignment after ankle fractures in patients with diabetes. A further comparative study with plate fixation is merited.
Treatment of Acute Achilles Tendon Rupture with a Standardized Protocol in Normal Clinical Setting
Authors: Haapasalo Heidi , Peltoniemi Ulla , Laine Heikki-Jussi , Mattila Ville M. 
Published: October 2016

Category: Trauma Introduction/Purpose: Achilles tendon rupture (ATR) is a common trauma among active people. Recent high-quality randomized studies, have shown that using a standardized treatment protocol with early weight-bearing and controlled early range-of-motion exercises provides similar clinical outcome than operative treatment without surgery-related complications. The purpose of this study was to find out whether the clinical results and complication rates of standardized treatment protocol in normal clinical setting with non-selected population correspond to those achieved in RCT studies. Methods: A treatment protocol modified from RCT studies of acute ATR was implemented in standard clinical care of Tampere University Hospital in 2008. Both conservative protocol and postoperative care protocol were based on early weight bearing and early range-of motion exercises. All patients treated due to acute ATR in our hospital during 2008 – 2014 (n=514) were included in the study. The patient records were retrospectively evaluated. Results: 514 acute ATRs were treated. 407 (79.2%) of the patients were men and 107 (20,8%) women. The mean age of all patients was 47.2 years. In female patients the mean age was 47.0 years, in males 47.9 years. 239 (46%) of the ATRs were treated operatively and 275 (54%) non-operatively. The proportion of operatively treated patients declined from 70% (2008) to 21% (2014). The mean age of patients in the operative group was 39.7 years and 53.7 years in the non-operative group. The rerupture rate was 4.6% in operative and 5.8% in the non-operative group. 10,4% of patients in operative group had wound problems. Unsatisfactory clinical outcome was reported in 5,0% of the patients in the operative group and in 6,9% of the non-operative group. Conclusion: Our results show that the treatment of acute ATR in our clinic has changed remarkably during the years 2008 to 2014. In 2008 70% of acute ATRs were treated operatively whereas in 2014 only 21%. Our study shows that it is possible to implement a similar treatment protocol than used in the controlled study setting as a part of the daily clincal care. The most important finding, however, is that the clinical outcome of the patients seems to be fully comparable to the clinical results achieved in RCT-study settings despite the heterogenity of the treated patients and medical staff.
Treatment of Children and Adolescents With Metastatic Medulloblastoma and Prognostic Relevance of Clinical and Biologic Parameters
Authors: von Bueren André O. , Kortmann Rolf-Dieter , von Hoff Katja , Friedrich Carsten , Mynarek Martin , Müller Klaus , Goschzik Tobias , zur Mühlen Anja , Gerber Nicolas , Warmuth-Metz Monika , Soerensen Niels , Deinlein Frank , Benesch Martin , Zwiener Isabella , Kwiecien Robert , Faldum Andreas , Bode Udo , Fleischhack Gudrun , Hovestadt Volker , Kool Marcel , Jones David , Northcott Paul , Kuehl Joachim , Pfister Stefan , Pietsch Torsten , Rutkowski Stefan 
Published: October 2016

Purpose To assess an intensified treatment in the context of clinical and biologic risk factors in metastatic medulloblastoma. Patients and Methods Patients (4 to 21 years old, diagnosed between 2001 and 2007) received induction chemotherapy, dose-escalated hyperfractionated craniospinal radiotherapy, and maintenance chemotherapy. Subgroup status and other biologic parameters were assessed. Results In 123 eligible patients (median age, 8.2 years old; median follow-up, 5.38 years), 5-year event-free survival (EFS) and overall survival (OS) were 62% (95% CI, 52 to 72) and 74% (95% CI, 66 to 82), respectively. OS was superior compared with the precedent HIT ’91 trial. The 5-year EFS and OS were both 89% (95% CI, 67 to 100) for desmoplastic/nodular (n = 11), 61% (95% CI, 51 to 71) and 75% (95% CI, 65 to 85) for classic (n = 107), and 20% (95% CI, 0 to 55) and 40% (95% CI, 0 to 83) for large-cell/anaplastic (n = 5) medulloblastoma ( P < .001 for EFS; P = .001 for OS). Histology (hazard ratio, 0.19 for desmoplastic/nodular and 45.97 for large-cell/anaplastic medulloblastoma) and nonresponse to the first chemotherapy cycle (hazard ratio, 1.97) were independent risk factors (EFS). Among 81 (66%) patients with tumor material, 5-year EFS and OS differed between low-risk (wingless [WNT], n = 4; both 100%), high-risk ( MYCC/ MYCN amplification; n = 5, both 20%), and intermediate-risk patients (neither; n = 72, 63% and 73%, respectively). Survival rates were different between molecular subgroups (WNT, n = 4; sonic hedgehog [SHH; n = 4]; group 4 [n = 41]; group 3 with [n = 3] or without [n = 17] MYCC/MYCN amplification; P < .001). All cases showed p53 immuno-negativity. There was no association between patients with nonresponding tumors to induction chemotherapy and WNT ( P = .143) or MYCC/MYCN status ( P = .075), histologic subtype ( P = .814), or molecular subtype ( P = .383), as assessed by Fisher’s exact test. Conclusion This regimen was feasible and conferred overall favorable survival. Our data confirm the relevance of subgroup status and biologic parameters (WNT/ MYCC/ MYCN status) in a homogeneous prospective trial population, and show that metastatic group 3 patients do not uniformly have poor outcomes. Biologic subgroup, MYCC/ MYCN status, response to induction chemotherapy, and histologic subtype may serve for improved treatment stratification.
Optimizing Pain and Rehabilitation After Knee Arthroplasty: A Two-Center, Randomized Trial
Authors: Choi Stephen , O’Hare Turlough , Gollish Jeffrey , Paul James E. , Kreder Hans , Thorpe Kevin E. , Katz Joel D. , Mamdani Muhammad , Moisiuk Peter , McCartney Colin J. 
Published: October 2016

BACKGROUND:
This randomized trial compared (1) continuous femoral nerve block (cFNB), (2) single femoral nerve block (sFNB), and (3) local infiltration analgesia (LIA) with respect to analgesic and functional outcomes after primary tricompartmental knee arthroplasty (TKA).

METHODS:
One hundred twenty patients undergoing primary tricompartmental knee arthroplasty were randomly assigned to 1 of 3 interventions for postoperative analgesia: (1) cFNB—preoperative bolus of ropivacaine 0.5% 20 mL followed by ropivacaine 0.2% 5 mL per hour for 48 hours; (2) sFNB—preoperative bolus of ropivacaine 0.5% 20 mL with placebo 0.9% saline 5 mL per hour for 48 hours; or (3) LIA—intraoperative tricompartmental injection of ropivacaine 0.2% (150 mL) with epinephrine (10 µg/mL) and ketorolac 30 mg with femoral placebo 0.9% saline 20 mL preoperative bolus and 0.9% saline placebo 5 mL per hour for 48 hours. All participants received an identical, standardized, postoperative multimodal analgesic regimen. Participants, health care providers, data collectors, and analysts were blinded. All participants received identical perineural catheters and perineural/LIA solution (depending on randomized intervention) to maintain blinding. The primary outcome measure was numeric rating scale for pain (NRS) during physiotherapy on postoperative day (POD) 2 at 9:00 am. Secondary outcomes included opioid consumption, NRS on POD 1 (rest/physiotherapy/worst), functional outcomes, and block complications.

RESULTS:
For the primary outcome, pain during physiotherapy on POD 2 at 9:00 am, the overall analysis of covariance (ANCOVA) was significant (P = .049), but pairwise comparisons did not demonstrate any significant differences between treatment arms. NRS was 4.6 (95% confidence interval [CI], 3.3–6.0) for the cFNB group, 4.6 (95% CI, 3.3–6.0) for the sFNB group, and 3.4 (95% CI, 2.2–4.8) for the LIA group. The following is the mean difference in NRS on POD 2 at 9:00 am among groups: cFNB−LIA (1.2, 95% CI, −0.1 to 2.5; P = .073); sFNB−LIA (1.2, 95% CI, −0.2 to 2.5; P = .097); cFNB−sFNB (0.0, 95% CI, −1.3 to 1.4; P = .996). There were no statistically significant differences between groups in cumulative 48-hour opioid consumption or functional outcomes. cFNB and LIA were superior to sFNB for NRS on POD 1 for worst pain experienced and pain during physiotherapy, respectively. There were no adverse events associated with study procedures reported among participants in the 3 groups.

CONCLUSIONS:
Our findings suggest no clinically significant differences between cFNB, LIA, and sFNB for pain during physiotherapy on POD 2 after TKA. Secondary analyses suggest that cFNB and LIA are superior to sFNB for early analgesic outcomes (NRS on POD 1) after TKA.