bluuebunny/crossref_metadata_2025_split huggingface dataset:
First Tarsometatarsal Joint Mobility in Hallux Valgus
Authors: Kimura Tadashi , Kubota Makoto , Taguchi Tetsuya , Suzuki Naoki , Hattori Asaki , Marumo Keishi 
Published: October 2016

Category: Bunion Introduction/Purpose: Hypermobility of the tarsometatarsal (TMT) joint has been much debated, but is considered to be an important factor in hallux valgus. However to date, studies investigating such hypermobility have been limited to two-dimensional (2D) evaluations using plain X-ray images or to mobility in the sagittal plane. Three-dimensional evaluation should offer more accurate pathological information given that deformity of the hallux valgus occurs in three dimensions. This study evaluated mobility of the first TMT joint in 3D using weight-bearing computed tomography (CT) and an original weight-bearing device (Figure) and then examined its correlation with the hallux valgus angle and intermetatarsal angle in hallux valgus patients. Methods: Ten feet of 10 hallux valgus patients and 10 feet of 10 healthy volunteers without foot disease (control group)were examined. Mean age of the two groups was 58.2 years and 55.9 years, respectively. The hallux valgus angle was 43.2° and 14.1° and the intermetatarsal angle was 22.1° and 9.3°, respectively. CT was performed under two conditions: non-load with the ankle in a neutral position and full-body weight-bearing load. Three-dimensional models of each bone were reconstructed by segmentation, the positions of each bone were adjusted, and the extent of first metatarsal displacement relative to the medial cuneiform was measured in 3D. We defined orthogonal coordinate axes(X-axis, Y-axis, Z-axis), the motion around the X-axis, Y- axis, and Z-axis was defined as plantar flexion/dorsiflexion, inversion/eversion, and adduction/abduction respectively. Data were compared between the hallux valgus and healthy control groups using Student’s t-test. In hallux valgus patients, mobility of the first TMT joint was compared with the hallux valgus angle and intermetatarsal angle using Pearson’s correlation coefficient. Results: Dorsiflexion (X-axis), inversion (Y-axis), and adduction (Z-axis)were significantly different between the hallux valgus patients and control subjects (p < 0.05). In the hallux valgus patients, there was no large correlation between mobility of the first TMT joint and either hallux valgus angle (X-axis: г=0.21 p=0.55, Y-axis: г=0.11 p=0.75, Z-axis: г=0.10 p=0.78) or intermetatarsal angle (X-axis: г=0.40 p=0.25, Y-axis: г=0.10 p=0.78, Z-axis: г=0.53 p=0.11). Conclusion: We were able to analyze 3D changes in the load on the foot in detail. Hallux valgus patients showed hypermobility of the first TMT joint not only in dorsiflexion (sagittal motion), but also in inversion and adduction. However, larger hallux valgus and intermetatarsal angles did not affect mobility of the first TMT joint. Therefore, the magnitude of hallux valgus deformity may correlate with other joint mobility or complex mobility of first ray. Our technique and findings help to clarify the nature of the pathology of hallux valgus and should assist in the selection and development of treatment methods.
Gas Formation and Its Effect After Implantation of Bioabsorbable Metal Magnesium
Authors: Kim Jong-Kil , Jeong Seong-Yup , Lee Kwang-Bok 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Metallic biomaterials (stainless steel and titanium) are most commonly used for osteotomy and fusion surgery in foot and ankle. But it results in the physical and psychological burden to the patients owing to the second surgery (hardware removal). Bioabsorbable polymer has the disadvantages such as mechanically weak strength and osteolysis. To overcome these, bioabsorbable metal such as magnesium (Mg) implant have been developed recently and applied clinically, but it has also drawback such as gas formation by the biodegradation of magnesium alloys. However, there is no study on the characteristics of the gas formation and its effect on the surrounding tissue. The purpose of this study is to identify the characteristics of gas formation and histological reaction during the absorption of Mg on surrounding tissue using in vitro and in vivo rodent model. Methods: Pure Mg plate (15 × 15 × 2 mm) was immersed in EBSS (Earle’s balanced salt solution) for in vitro immersion test for 30 days. Intramuscular implantation of Mg plate (25×5×0.25 mm) was performed on twenty-four rat’s back muscle and divided as two groups: implantation and sham surgery. Gas volume and compositions, corrosion rate and surface morphology of Mg plate, and histological exam were evaluated at every 5 days for 30 days. Results: Gas is mainly composed of H2 (2.483 ×104± 0.028 μV), but a small amount of CO (93.428±0.14 μV) and CO2 (57.18±0.53 μV) was detected in in vitro immersion test. Gas volume shows significantly higher at 5 days (0.084 ml) than other times (0.005 mL for 30 days) after implantation, and is gradually decreased over time. Corrosion rate is also faster in at 5 days and decreased over time in both in vitro and in vivo study. Surface morphology shows a lot of cracks and the formation of apatite paticles on Mg plate. Histological examination shows that nuclei gathered densely around the small and multiple air bubble pocket at 5 days and the number of gas bubbles and their volumes were reduced over time in tissue surrounded implant, and there is no difference in kidney and liver tissue between implant and sham surgery. Conclusion: The immersion of Mg in EBSS generated H2 as the major forming gas, and CO and CO2. The in vivo implantation of Mg into rats’ back muscle generated gas pockets inside the tissues because the initial gas formation rate was faster than the gas- absorbing rate; however, gas volume decreased after 15 days as the gas formation and absorbing rates became similar. The amount of Mg ions inside the liver and kidneys changed as well, but it was within a normal range, such that inflammation and tissue deformation were not found.
How Reliable is Clinical Evaluation in Hindfoot Coronal Alignment?
Authors: Slullitel Gaston , Alvarez Victoria , Calvi Juan P. , Calvo Ana B. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Hindfoot alignment in the coronal plane is an extremely important aspect to consider in order to make a comprehensive evaluation of different foot and ankle disorders. To the authors knowledge the evidence concerning the precision of clinical hindfoot alignment assessment is scarce. The aim of this study is to evaluate correlation and reproducibility between clinical and radiographical hindfoot alignment. Methods: Intra and interobserver reliability of clinical and radiographical hindfoot assessment was performed in 85 patients. Clinical alignment was evaluated on photographs taken at the time of presentation and hindfoot alignment was quantified on long axial view radiographs in neutral rotation position. Photographs were classified into three categories (valgus, neutral and varus) and radiographs were measured taking standardized parameters. Each observer made measurements independently and was blinded to both patient identification and the others’ measurements. All measurements were made on two separate occasions with the order of images randomized. Results: We did not observe a significant correlation between clinical and radiographical assessment (k1a 0,072 - p=0,24; k1b 0,167 - p=0,029; k2a 0,23 - p< 0,001; k2b 0,137 - p=0,021). We did find a good clinical and radiographical intraobserver agreement (K1= 0,789; K2=0,783; Pearson1= 0,956; Pearson2= 0,990). Clinical interobserver agreement was moderate (K1= 0,584; K2=0,566) while radiographical interobserver agreement was statical significant (Pearson1= 0,926; Pearson2= 0,953). Conclusion: Due to a poor clinical-radiographical correlation we should not rely on clinical evaluation to guide the decision making in different foot and ankle conditions. We strongly recommend the use of the long axial view in order to assess the magnitude of the hindfoot deformity.
Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation
Authors: Gross Christopher E. , Erickson Brandon J. , Fillingham Yale A. , Hellman Michael D. , Adams Samuel B. , Parekh Selene G. 
Published: October 2016

Category: Arthroscopy Introduction/Purpose: Osteochondral lesions of the talus (OLT) are frequent occurrences when patients sustain both traumatic and atraumatic ankle injuries with a report rate of up to 70% OLT in patients who sustain an ankle sprain or fracture. Surgical treatment options for OLT is either reparative or replacement and are dictated by characteristics of the lesion, including size and presence or absence of cysts. Periosteal-autologous chondrocyte implantation (P-ACI) or MACI (matrix-induced autologous chondrocyte implantation) is useful for lesions with or without cysts under 2.5cm2. We hypothesize that MACI will have the lowest reoperation rate and highest patient satisfaction rate in treating OLT. Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available free databases. Therapeutic clinical outcome investigations reporting OLT outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student’s t-tests, one-way ANOVA, chi-squared, and two-proportion Z-tests. Results: Nineteen articles met our inclusion criteria, which resulted in a total of 343 patients. Six studies pertained to arthroscopic MACI, 8 to open MACI, and 5 studies to open PACI. All studies were Level IV evidence. Due to study quality, imprecise and sparse data, and potential for reporting bias, the quality of evidence is low. In comparison of open and arthroscopic MACI, we found both advantages favoring open MACI (AOFAS and MOCART score). However, open MACI had higher complication rates versus arthroscopic (18.18% vs 0.78%, p = 0.002). In addition, the rate of impingement was noted to be significantly higher for the open technique of MACI with a rate of 10.61% as opposed to 0.78% for the arthroscopic technique (p = 0.01). Conclusion: No procedure demonstrates superiority or inferiority between the combination of open or arthroscopic MACI and PACI in the management of OLT less than 2.5 cm2. Ultimately well-designed randomized trials are needed to address the limitation of the available literature and further our understanding of the optimal treatment options.
Measurement Properties of Total Ankle Replacement Outcome Measures
Authors: Pinsker Ellie , Inrig Taucha M. , Daniels Timothy R. , Beaton Dorcas 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Researchers and clinicians measuring outcomes following total ankle replacement (TAR) are challenged by the wide range of outcome measures used in the literature without consensus as to which are valid, reliable, and responsive in this population. This review identifies region- or joint-specific outcome measures used for evaluating TAR outcomes and synthesizes evidence for their measurement properties. Methods: A standard search strategy was conducted of electronic databases MEDLINE, EMBASE and CINAHL (to June 2015) to identify foot/ankle measures in use. A best evidence synthesis approach was taken to critically appraise measurement properties [COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)] of identified measures. The review was restricted to English publications and excluded cross-cultural adaptations. Measurement properties collected from each article were coded for validity, reliability, responsiveness, or interpretability. Psychometric evidence exists for identified measures tested in non-TAR populations, but were not the focus of this review. Results: The search identified five measures to include in the best evidence synthesis, which have undergone psychometric testing in a TAR population (Foot Function Index, Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society Ankle- Hindfoot Scale, Foot and Ankle Outcome Score, Self-Reported Foot and Ankle Score). Methodological quality of the studies providing psychometric evidence was assessed: (1) Validity—Two good quality studies examining different measures provide moderate evidence supporting construct validity (SEFAS; FFI, AOS, AOFAS *subjective items); (2) Reliability—two good quality studies examining different measures provide moderate evidence supporting internal consistency and test-retest reliability (FFI, AOS, AOFAS*; FAOS, SEFAS); (3) Responsiveness—one fair quality study provides limited evidence for AOFAS*, AOS, FFI; (4) Interpretability—two studies provided interpretability values (AOS, FFI, AOFAS*). Conclusion: This review offers a basis for choosing the most appropriate instrument for evaluating TAR outcomes. Numerous outcome measures were identified with evidence supporting their use in populations with various foot/ankle conditions, but none have strong evidence supporting usage in a TAR population. Outcome measures must have adequate psychometric properties in all patient groups in which they are applied. Evidence supporting or critiquing an instrument should not be based on studies with poor quality methodology, as identified by this review. Further testing in a TAR population would benefit identified measures with emphasis on adequate sample sizes, testing a priori hypotheses, and evaluating their content validity for a TAR population.
Modified Broström Procedure for Chronic Ankle Instability with Generalized Joint Hypermobility
Authors: Park Jae Yong , Kim Hyong Nyun , Park Yong Wook 
Published: October 2016

Category: Sports Introduction/Purpose: Chronic ankle instability with generalized joint hypermobility (GJH) is considered a contraindication for the modified Broström procedure. The most widely accepted definition of GJH is a Beighton-Horan score of ≥4 on a 9-point scale. However, it is not clear if this criterion can be applied to determine the GJH that would lead to a poor outcome after the modified Broström procedure. Methods: The modified Broström procedure was performed in 32 patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varus talar tilt and anterior talar translation during the stress tests. We hypothesized that when the contralateral uninjured ankle shows a normal varus talar tilt and anterior talar translation during stress tests in patients with GJH, GJH may have a smaller effect on the ankle ligaments, and the modified Broström procedure in these cases may have satisfactory outcomes. The mean patient age at surgery was 21.7 years. The mean follow-up duration was 27.4 months. Results: The Karlsson-Peterson ankle score significantly improved from 63.6 ± 7.1 points (p< 0.001; 95% CI, 22.1 – 29.7) preoperatively to 90.4 ± 6.7 points at the final postoperative follow-up. Sixteen patients were very satisfied with the results, 10 patients were satisfied, 3 patients rated their satisfaction as fair, and 1 patient was dissatisfied with the results. We stratified the clinical outcomes according to the Beighton scores. There was no correlation between the Beighton scores and the Karlsson- Peterson ankle scores at the last follow-up (Spearman’s correlation coefficient, -0.11; p= 0.591). However, 1 patient with a Beighton score of 8 points and 1 patient with a score of 9 points had lower Karlsson-Peterson ankle scores (82 and 85, respectively) compared to the average scores at the last follow-up. Conclusion: The modified Broström procedure was successful in patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varustalar tilt and anterior talar translation during the stress tests. The repaired ligaments may eventually stretch out in patients with GJH secondary to connective tissue disorders such as Marfan syndrome as these patients have been found to have inherent connective tissue extensibility. However, GJH includes mild joint hypermobility without any symptoms or problems except increased joint range of motion. When the contralateral normal ankle shows negative stress tests that the modified Broström procedure may be successful.
Obesity Predicts Lower Risk of Wound Complications following Open Reduction and Internal Fixation of Ankle Fractures
Authors: Matson Andrew P. , Morwood Michael P. , Peres-Da-Silva Ashwin B. , Cone Eugene B. , Hurwitz Shepard R. , Zura Robert D. 
Published: October 2016

Category: Trauma Introduction/Purpose: Ankle fractures are among the most common injuries treated by Orthopaedic Surgeons. Complications following surgical treatment of ankle fractures have been well described, however less is known about the risk factors for postoperative wound complications specifically. The purpose of the present study was to evaluate the incidence of wound complications following open reduction and internal fixation of ankle fractures in obese and non-obese patients. Methods: We retrospectively identified 127 consecutive patients who underwent open reduction and internal fixation for an isolated, closed ankle fracture from 2008-2012. The age, sex, height, weight, diabetes status, and tobacco use of each patient were recorded. Time from injury to surgical fixation, use of external fixation, presence of initial dislocation, energy of mechanism, and injury pattern were also recorded. Patients’ records were reviewed to identify any postoperative wound complications. Complications were categorized as major or minor based on need for subsequent surgical intervention. Complication rates were compared between groups using the chi square test, and significant results were followed up with calculation of odds ratios and 95% confidence intervals using multivariate logistic regression. Results: The overall rate of wound complication was 18.9% (24/127), consisting of 6 major and 18 minor complications. The rate of wound complication of any type was significantly lower in obese patients at 11.7% (7/60) compared to 25.4% (17/67) in non- obese patients (P = 0.049). Obesity was associated with a significantly lower risk of developing a wound complication (OR 0.267, 95% CI 0.087 - 0.822), even when controlling for age, sex, diabetes status, tobacco use, surgical delay, external fixation, and injury pattern. No other covariates were associated with an increased risk of a wound infection. Conclusion: In the present study obese patients were less likely than non-obese patients to have a postoperative wound complication following internal fixation of an ankle fracture. Obesity may be protective against wound complications following surgical treatment of ankle fractures given the additional soft-tissue overlying the ankle.
Resource Utilization After Ankle Arthritis Surgery
Authors: Ngai Jacqueline T. , Younger Alastair S. , Veljkovic Andrea , Wing Kevin , Penner Murray J. , Wong Hubert 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: As an alternative to ankle replacement, ankle arthrodesis remains a mainstay in the treatment of end- stage arthritis. Arthroscopic techniques for ankle arthrodesis have more recently been developed, although there has been limited research exploring the cost of arthroscopic (AAA) versus open ankle arthrodesis (OAA), and comparing ankle fusions to replacement (TAA). We hypothesize that resource use after AAA will be lower than that after OAA, and both will be lower than TAA. Methods: We performed a retrospective review of a prospectively collected database. The COFAS database was used to identify patients with >2 years of follow up who have undergone AAA, OAA or Hintegra TAA at St Paul’s Hospital between 2003-2010. Ninety patients with TAA, 52 with AAA and 56 with OAA met our inclusion criteria. The following data were documented: patient demographics (age, gender, presence of diabetes, inflammatory arthritis or any smoking history), factors related to the index surgery (type of surgery, OR time, length of stay) and factors relating to the post-operative course (number of unplanned post-operative clinic visits, OR time for re-operations, length of stay for additional hospital admissions). For all significant comparisons, p < 0.05. Results: AAA required less primary surgery OR time and shorter primary hospital stay vs. TAA and OAA. Patients required more additional follow-up visits for TAA and OAA vs. AAA. TAA required more additional days in hospital compared to OAA or AAA. For each primary TAA, on average an additional seven clinic visits, 60 minutes of revision surgery, three days in hospital were required on top of the cost assigned for the primary arthroplasty. For each primary AAA, an additional four clinic visits, 23 minutes of revision surgery and one day in hospital were required. For each primary OAA, an average additional five clinic visits, three minutes of revision OR time, and 0.2 days of additional hospital stay were required. Conclusion: Using several measures of resource use, we find that arthroscopic ankle fusions compare favourably to both ankle replacements and open ankle fusions. We also show that resource utilization measurements can be a useful surrogate for complications, and that resource utilization can demonstrate the practical implications of complications for patients, surgeons and health care providers or payers.