bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Calcaneus Osteotomy for Treatment of Symptomatic Muller Weiss Disease
Authors: Li ShuYuan , Myerson Mark S. , Monteagudo Manuel , Maceira Ernesto 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Muller Weiss disease (MWD) is characterized by lateral navicular necrosis which is associated with a varus alignment of the subtalar joint, a short 1st metatarsal, varying degrees of arthritis of the talonavicular-cuneiform joints and a paradoxical flatfoot deformity in advanced cases. The literature is replete with various methods of arthrodesis of the hindfoot for treatment of refractory painful deformity. We present the results of a unique, previously unreported, method of treatment using a calcaneus osteotomy incorporating a wedge and lateral translation. Methods: Fourteen patients with MWD who were treated with a calcaneus osteotomy were retrospectively reviewed. There were seven females and seven males with an average age of 56 years (range 33-79). Using Maceira’s grading we found the following: one grade 5, five grade 4, four grade 3 and four grade 2 patients. Patients had been symptomatic for an average of eleven years (range 1-14), and all underwent initial conservative treatment with an orthotic support that posted the heel into valgus. The primary indication for surgery was a limited but positive response to the use of the orthotic support, and a desire to avoid an arthrodesis of the hindfoot. Other than the described calcaneus osteotomy, no additional procedures were performed. Results: Patients were followed for an average of three years following the procedure (range 1 – 7 years). Patients rated their pain on a visual analogue pain scale as an average of 8 (range 6-9) prior to surgery and an average of 2 postoperatively (range 0-4). The AOFAS scores improved from a mean of 29 (range 25 – 35) preoperatively to a mean of 79 (range 75-88) postoperatively. Hindfoot range of motion remained unchanged, so too the extent of arthritis of the navicular complex. One patient experienced ipsilateral knee pain for 6 months postoperatively which resolved following physical therapy. One patient experienced intermittent midfoot pain and felt that the surgery was not successful. No patient has since required an arthrodesis. Conclusion: While the traditional treatment of Muller Weiss disease has been various types of hindfoot arthrodesis, it has been our experience that these procedures are not ideal unless the heel varus is simultaneously corrected. Since the majority of MWD patients respond to an orthotic support which changes the load of the hindfoot and forefoot, we believed that selected patients would respond positively to a calcaneal osteotomy as an alternative treatment. Although the follow up in this series is relatively short, the patients responded remarkably well to the use of a calcaneus osteotomy, however we cannot predict if an arthrodesis will be necessary in the future.
Bone Block Graft from Calcaneus for Foot and Ankle Reconstruction
Authors: Sanhudo Jose V. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: The correction of foot and ankle deformities often require the use of a bone block for proper reconstruction. The iliac graft is the most used, but the additional approach in the hip region increases the morbidity, the risk of complications and prevents the execution of the procedure through the peripheral anesthetic block. The objective of the study is to demonstrate the clinical and radiological results of using a bone block graft from calcaneus for reconstruction of the foot and ankle region as an alternative to procedures that require bone lengthening . Methods: Between September 2013 and November 2014 eight patients underwent surgery with the use of bone block graft from calcaneus for reconstruction of local bone defects . In four cases the bone graft was used for reconstruction of calcaneal fracture malunion, two cases for ankle fracture reconstruction with shortening of the fibula, one case for hallux arthrodesis after avascular necrosis of the head of the first metatarsal, and one case for lateral column lengthening in a patient with flexible flatfoot. Four patients were male and four were female. The average age of patients at the time of surgery was 44 years. Results: After minimum of 13 months and average of 20 months follow-up, patients showed improvement of the AOFAS score from an average of 42 points preoperatively to an average of 83 points after the procedure. Union of both sides of the graft was observed in all patients except one (arthrodesis of the hallux). Despite the radiological failure, this patient remains without pain and satisfied with the her result. All patients were satisfied with the results and would underwent the procedure again under the same circumstances. Conclusion: The bone block from the posterior superior calcaneal tuberosity presents the advantages of using highly cancellous autograft with great density; can be removed under sedation and ankle block; dispensing the preparation of the surgical field in another anatomical region and often dispenses additional incision. These preliminary results put this technique as a viable alternative for cases of foot and ankle reconstruction that require a bone block graft.
Beaming in Charcot Arthropathy- Intramedullary Fixation for Complicated Reconstructions
Authors: Fidler Corey M. , Watson Benjamin C. , Reb Christopher W. , Hyer Christopher F. 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: In the modern treatment of Charcot neuroarthropathy, beam screw fixation is an attractive alternative to plate and screw fixation because it minimizes the required exposure for implantation and supports the longitudinal columns of the foot from the inside out as a rigid yet load-sharing construct. Oversized implants risk metatarsal fracture and undersized implants risk implant fracture or impaired healing from mechanical instability. Our review of the scientific literature identified a lack of evidence regarding the aspects of metatarsal intramedullary canal morphology relevant to beam screw fixation. The purpose of the present study was to qualitatively and quantitatively describe metatarsal diaphyseal morphology. Methods: Twenty fresh-frozen adult cadaveric below knee specimens were utilized to assess the size and shape of the diaphysis of metatarsals 1-4. There were 10 male and 10 female specimens with a mean age of 75.8 years. No limbs had outward signs of prior injury/surgery, radiographic signs of Charcot neuroarthropathy or previous fracture. Metatarsals 1-4 were excised, cleaned of all soft tissue and then axially transected at the point of most narrow external diameter. The diaphyseal canal shape was categorized as round, oval, triangular, or pear. The widest distance between two endosteal cortical surfaces was measured. Results: Triangular endosteal canals were only found in the 1st metatarsal whereas the remainder of metatarsals canals were largely round or oval. The mean diameter of the 1st metatarsal was 9.08 ± 1.26 mm. The mean diameter of the 2nd metatarsal was 4.72 ± 0.82 mm. The mean diameter of the 3rd metatarsal was 4.53 ± 0.88 mm. The mean diameter of the 4th metatarsal was 4.51 ± 1.10 mm. Conclusion: Intramedullary fixation by internal beaming of the columns of the foot can provide anatomical alignment with stabile fixation in cases of patients with Charcot arthropathy. Our study has given the smallest average diameter for metatarsals one through 4. This data is helpful when determining what size fixation to choose to achieve the maximum screw-endosteal purchase for column beaming in Charcot reconstructions.
Clinical and Radiographic Outcomes of the Infinity Total Ankle Arthroplasty System
Authors: Asaad Asaad , Kakwani Rajeshkumar , Murty Aradhyula N. , Townshend David 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: We report our early results of the Infinity Total Ankle Arthroplasty (TAA) system, a third generation, constrained implant, recently introduced to the UK market. Methods: All ankles were uncemented and standard instrumentation was used. Patients were reviewed at 3, 6 and 12 months for radiological and clinical assessment including Ankle Osteoarthritis Score (AOS), Visual Analogue Scale (VAS) and subjective component of AOFAS Ankle/Hindfoot score. Results: Mean age was 66 (range 42-88), 14 females and 21 males. The mean follow-up 12 months (range, 4-18 months), and no patients were lost to follow-up. The diagnosis was post-traumatic in 15 cases, primary osteoarthritis in 15 and inflammatory arthritis in 5 cases. Preoperative coronal alignment deformity was < 10 degrees in 54%, 10-20 degrees in 43% and >20 degrees in 3%. Mean AOS score improved from from 64 to 24, AOFAS score improved from 19/70 to 49/70 and VAS from 7.0 to 2.0. Tibial component subsidence was noted in 1 case (3%), and asymptomatic periprosthetic lucent lines in 6 cases (17%). No ankles were revised. Complications included intraoperative medial malleolar fracture (8.5%), delayed wound healing (14%), tibial osteotomy non-union (3%), and regional pain syndrome (3%). The mean radiographic coronal plane alignment of the tibial component was 1.9 degrees varus (range, 5.3 varus to 1.7 valgus) and its mean sagittal plane alignment 2.8 (range -1.7 to 8.5) degrees dorsiflexion. Conclusion: Our early experience has demonstrated good patient outcomes, low complication rate and reproducible alignment with the Infinity implant.
Clinical Comparison of the Two-Stranded Single Krackow and Four-Stranded Double Krackow Techniques for Acute Achilles Tendon Ruptures
Authors: Kim Hak Jun , Lee Tae Hoon , Park Young Hwan , Choi Gi Won 
Published: October 2016

Category: Sports Introduction/Purpose: Introduction: Several different configurations of the Krackow stitch have been used for acute achilles tendon rupture repair. Despite there are a few biomechanical studies comparing different Krackow stitch configurations, we could find no studies that have compared the clinical outcome of these different suture methods. This study aims to compare the clinical outcomes and complications of the two-stranded single Krackow and four-stranded double Krackow techniques. Methods: Materials and methods: We retrospectively reviewed 48 consecutive patients who underwent an open repair using the two-stranded single Krackow (17 pateints) or four-stranded double Krackow techniques (31 patients) between September 2011 and August 2014. Isokinetic strength of plantar-flexion and dorsiflexion of both ankles was assessed on a Cybex dynamometer at 6 months after surgery. Clinical outcomes were evaluated at 12 months postoperativly. Results: Results: There were no significant differences between groups with regard to patient demographics or activity levels prior to treatment. At the time of follow-up at one year, there were no significant differences in the American Orthopaedic Foot and Ankle Society ankle–hindfoot score and four-point Boyden scale. One case of rerupture and one case of superficial wound dehiscence occurred in the double Krackow group, but there was no complication in the single Krackow group. The mean peak torque deficits and work deficits in both plantar flexion and dorsiflexion showed no differences between the groups with any angular velocity. Conclusion: Conclusion: The two-stranded single Krackow and four-stranded double Krackow techniques for acute achilles tendon ruptures resulted in similar clinical outcomes and isokinetic strengths. The overall complication rates were low in both suture techniques.
Comparison of MRI and Operative Findings in Peroneal Tendon Disorders in a Military Population
Authors: Boomsma Shawn E. 
Published: October 2016

Category: Sports Introduction/Purpose: Peroneal tendon pathology is an overlooked cause of lateral ankle pain and a significant amount of patients are misdiagnosed at their initial visit. Previous studies have compared the magnetic resonance imaging (MRI) findings of peroneal tendon disorders to intraoperative findings with mixed results. The purpose of this study was to compare MRI findings of peroneal tendon pathology to intraoperative findings in an active duty military population. Methods: Active duty military servicemembers who underwent peroneal tendon exploration between 2009-2014 with a preoperative MRI were retrospectively reviewed. Studies were reviewed by a board certified radiologist who was blinded to the purpose of the study. MRI findings were then compared to surgical findings from operative reports. The following peroneal tendon pathologies were identified: peroneus brevis tears, peroneus longus tears, tendinopathy of either tendon, tenosynovitis, presence of peroneus brevis low lying muscle belly or peroneus quartus muscle and injury to the superior peroneal retinaculum. Concomitant procedures such as lateral ankle reconstruction, ankle arthroscopy, or osteotomies were also recorded. Comparative statistics were performed to correlate imaging and surgical findings. Results: Of 32 patients included, peroneus brevis and longus tears were the most common MRI finding while peroneus brevis tears and tenosynovitis were the most common surgical finding. Peroneus longus tears were found in 4 patients during surgery but seen in 12 patients on MRI. The sensitivity/specificity of MRI for peroneus brevis tears were 69% and 74% compared to 75% and 68% for peroneus longus tears. Tenosynovitis had a sensitivity of 9% and specificity of 95%. Twenty two patients (69%) had a low lying peroneus brevis muscle belly with 9 of those patients having a peroneus brevis tear. Of the 7 patients with peroneus quartus muscles identified in surgery, only 1 was seen on MRI and three had a tear of the peroneus brevis. Conclusion: In this study of active duty military personnel, we found similar results to previous published studies. MRI had a slightly lower sensitivity and specificity for diagnosing peroneus brevis tears while being slightly better for peroneus longus tears compared to previously published studies. We found significantly higher percentage of patients with a low lying peroneus brevis muscle belly than previous reported, with a 40% correlation to peroneus brevis tears. In patients with an identified low lying peroneus brevis or peroneus quartus on preoperative imaging, we recommend evaluation for associated tendon tears in active duty military servicemembers presenting with lateral ankle pain.
Gravity Stress Radiographs and Effect of Ankle Position on Deltoid Ligament Integrity & Medial Clear Space
Authors: Grimes J. Speight , Ashraf Mohammed A. 
Published: October 2016

Category: Trauma Introduction/Purpose: External rotation and gravity stress radiographs have been described to distinguish stable Supination External Rotation-II (SER-II) ankle fractures from unstable SER-IV fractures. It has been previously shown both external rotation and gravity stress views are equivalent in their ability to diagnose deltoid ligament injury. It has also been shown that the position of the ankle influences the external rotation stress radiograph. However, no data of ankle position exists for gravity stress radiographs. Methods: 8 fresh-frozen cadaveric ankles were dissected and destabilized sequentially according to the SER mechanism of ankle fractures, starting with the anterior inferior tibiofibular ligament, distal fibula osteotomy at the level of the syndesmosis, posterior inferior tibiofibular ligament, superficial deltoid ligament, and finally the deep deltoid ligament. Fluoroscopic radiographs were taken with gravity stress views in both neutral and plantarflexion. Measurements of both dorsal and the medial clear space were taken for each stage. The difference between the dorsal and medial clear space was measured. Results: Positive predictive value (PPV) with a medial clear space cut off of 5 mm was 80% in plantar flexion and 72.72% in neutral with a negative predictive value (NPV) of 100% in both positions. Using 6 mm cutoff the PPV improved to 100% and NPV remained 100% for both neutral and plantar flexion. When the difference measurement is used a 1.0 mm difference yielded a PPV of 72% and a NPV of 100% in both neutral and plantarflexion. With a 1.5 mm cutoff the PPV and NPV was 100% for both positions Conclusion: The position of the ankle during gravity stress radiographs does not influence the clinical effectiveness of the images. By using larger references for stability, the PPV can be improved.
Intermediate Outcomes of Hydrogel Implant for Hallux Rigidus
Authors: Miniaci-Coxhead Sara Lyn , Glazebrook Mark A. , Younger Alastair S. , Penner Murray J. , Wing Kevin , Pinsker Ellie , Baumhauer Judith F. , Daniels Timothy R. 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is the most common arthritic condition of the foot. Although a variety of great toe implants have been tried in an attempt to maintain toe motion, the majority have failed. In these cases, salvage to arthrodesis is more complicated and with a prolonged recovery. This prospective study assesses the intermediate efficacy and safety of a small (8/10 mm) hydrogel implant requiring minimal bone resection for moderate to severe hallux rigidus. Methods: Patients who underwent 1st MTP hemiarthroplasty with an organic polymer-based biomaterial implant (Cartiva), with at least five-year follow-up were contacted. Patients underwent a physical exam, and completed a pain visual analog scale (VAS) scale, SF-36, patient satisfaction questions, and the Foot and Ankle Ability Measure (FAAM). Results: Twenty-nine patients were available, with two lost to follow-up. The average time of follow-up was 5.3±0.5 years. The average age was 55.6±8.4, with 24(80%) females. The average VAS for pain improved from 64.6(±11.8) to 5.2(± 9.4) (p < 0.001). The average FAAM scores were: ADL subscale: 62.1(±16.4) to 95.8%(± 7.2) (p < 0.001); and Sports subscale: 40.2(±15.1) to 91.3%(±11.2) (p < 0.001); The average FAAM scores at follow-up for: Level of function during sports: 91.9%(±10.7); and Current level of function: 92.5%(±10.6). 69.2% of patients reported their level of function as normal, 26.9% nearly normal, and 3.8% abnormal function. Patients had 17.7 degrees of dorsiflexion, with a range of 12.7 to 22.7 degrees. Average peak dorsiflexion was 28.2°(±8.8). 92.3% stated they would undergo the procedure again. Conclusion: This study reports the mid-term results of an organic polymer-based biomaterial hemiarthroplasty implant for the management of hallux rigidus. Overall patients were very satisfied with the procedure. At an average of five years, patients are functioning very well, with limited pain and maintained motion of the 1st MTP joint. These results are promising as a viable alternative to fusion of the 1st MTP joint for management of moderate to severe hallux rigidus.
Intra-Osseous Arthrodesis Techniques in the Foot and Ankle
Authors: Haydel Christopher , Eremus Joseph , Lachman James R. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Arthrodesis is considered the standard operative treatment for end-stage arthritis in the foot and ankle. The long-term effects of implant choices for fusions are largely unexplored in the literature. Many companies advertise implants as being "lower profile" and "less painful." The purpose of this study was to perform a clinical and radiographic review to determine outcomes, specifically rates of symptomatic hardware, using four major arthrodesis techniques in joints in the foot and ankle. Methods: A retrospective study was conducted including one-hundred and twenty-three patients (a total of 197 joints) who underwent arthrodesis of the ankle, or joints in the midfoot or hindfoot. A total of 197 joints underwent arthrodesis in this patient group. Four groups were created based on fixation methods; standard screw fixation, plate and screw fixation, screw-in- post fixation(so-called "intra-osseous" fixation), and a group using a combination of fixation methods. Through chart review and radiographic analysis, outcomes including fusion rate, pain at specific follow-up intervals(6-weeks, 3-months, 6-months, and 1-year), and symptomatic hardware requiring hardware removal were compared across groups. Results: No differences were found in fusion rates between the four groups. Non-union rates, hardware loosening, infection, and wound breakdown rates were all comparable across the cohort. Rates of reported pain at 6-weeks and 3-months were similar for all groups but the "plate and screw fixation" group reported significantly more pain at 6 months(p=0.035) and 1 year(p=0.022) than the other three groups and, subsequently, rates of symptomatic hardware requiring removal were significantly higher in this group as well. The patient population had higher rates of diabetes mellitus, human-immunodeficiency virus (HIV) and hepatitis C virus (HCV) than reported in recent studies of comparable design. Conclusion: In this high risk patient population, implant choice in arthrodesis of the midfoot, hidfoot or ankle has a significant effect on patient-reported pain during follow-up. In this cohort, the group fused with intra-osseous fixation methods did not demonstrate superiority with regards to rates of patient-reported post-operative pain related to hardware. Clinicians should expect significantly increased rates of symptomatic hardware when using plate fixation in fusions of the ankle, midfoot and hindfoot.
Is There a Role for Preoperative CT Scans in Evaluating the Posterior Malleolus in Ankle Fracture- Dislocations?
Authors: Ketz John , Maceroli Michael , McVicker Zachary 
Published: October 2016

Category: Trauma Introduction/Purpose: Ankle fractures are common injuries and have a wide variety of fracture patterns. There is a high incidence of posterior malleolar fragments with ankle fracture-dislocations. There has been increasing interest in the role of the posterior malleolus in the treatment of ankle fractures. Controversies still exist on the operative indications and best method of fixation for these injuries. The current study evaluates the role of preoperative CT scans in evaluating and treating posterior malleolar fractures in this injury pattern. Methods: At our institution we initiated a protocol of obtaining post reduction computed tomography (CT) scans for all ankle fracture-dislocations with an associated posterior malleolus (PM) fractures to evaluate the fracture pattern and its role in determining operative treatment. The CT scans were evaluated for number of fragments, loose intra-articular fragments or impacted fragments, and displacement. Displacement was measured as the maximum distance noted on axial, sagittal, or coronal images. Information obtained from the CT scans was compared to the preoperative plain radiographs. Also, the authors evaluated the use of CT scans in preoperative planning with respect to positioning and surgical incisions. Results: A total of 51 ankle fracture dislocations with posterior malleolar fractures were evaluated. The size of the PM fracture measured on lateral radiographs was 24.19% compared 25.19%(p=0.75) based on the CT scan. Preoperative CT scans were able to identify loose or impacted intra-articular fragments in 19/51 cases (37%) that were not seen on plain radiographs. Multifragmentary (>2 fragments) PM fractures not appreciated on plain radiographs were found in 18 patients (35%). A total of 20 (39%) fractures were approached using direct posterior surgical exposures. The surgical plan was altered in 31% of patients based on the CT scan. Overall, PM fractures treated with direct reduction had significantly less residual displacement than those treated through indirect reduction techniques (0.4mm v 1.13mm; p=0.04). Conclusion: Posterior malleolar fractures in the setting of ankle fracture-dislocations can have complex patterns. While the overall size of posterior fragment was similar on plain radiographs and CT scan, the CT offered improved evaluation of the pattern in terms of multiple or loose intra-articular fragments. This had a direct impact on the surgical technique and approach. Improved reductions were also seen with direct posterior approaches.