bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Outcomes After Midfoot Bone Block Arthrodesis
Authors: Aiyer Amiethab , Shariff Raheel , Tracey Joseph A. , Myerson Mark S. 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Midfoot arthrodesis requires a structural graft where bone loss from AVN, osteomyelitis and erosive arthritis is present in the navicular, cuneiform or 1st metatarsal. The goal of this study was to evaluate radiographic outcomes of midfoot bone block arthrodesis. Methods: A retrospective, IRB approved study was completed evaluating midfoot arthrodesis between 2002 and 2014. where structural bone graft was used as part of an arthrodesis of the tarsometatarsal (TMT) joints or the naviculocuneiform (NC) joints or both. Demographic characteristics were obtained including age, body mass index (BMI), diagnosis, diabetes or tobacco use, indication for use of bone block, location of the bone block, and type of graft used. Radiographic data collected included time to union, the number of patients in which union was obtained, and graft length Results: Over a 12-year period, there were a total of 33 with an average age of 57.9 years, and included 20 females and 13 males with an average BMI of 29. The average length of follow up was 24 months. The most common diagnoses was erosive midfoot arthritis (11) and prior navicular fracture associated with AVN (9). Structural allograft was used in all patients. (first TMT (10), talocuneiform (9), other combinations (14)). Various types of biologic agents were used in 20 of 33 arthrodeses. Radiographic evidence of union was found in 21/33 patients (63.6%) at an average of 4.7 months after surgery. Twelve patients developed a nonunion. The risk factors for nonunion include age > 50, the presence of erosive osteoarthritis, AVN of the navicular and lack of use of biologic stimulation. There was no correlation between the presence of diabetes, a prior history of infection or prior history of trauma and development of nonunion. Conclusion: The radiographic fusion rate of patients undergoing large structural midfoot bone graft arthrodesis was 63.6% with radiographic evidence of healing present in this group at 4.77 months after surgery. This is the first known study reporting on radiographic outcomes of structural bone graft arthrodesis of the midfoot. The rate of fusion seen here is slightly better compared with recent studies evaluating healing of large defects using femoral head structural allografts. Nonetheless, the risk of non-union remains far greater than when an in situ arthrodesis of these same joints are performed.
Accurate Measurement of First Metatarsophalangeal Range of Motion in Patients with Hallux Rigidus
Authors: Vulcano Ettore , Tracey Joseph A. , Myerson Mark S. 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: The reliability of range of motion (ROM) measurements has not been established for the hallux metatarsophalangeal (MTP) joint in patients with hallux rigidus. The aim of the present study was to prospectively assess the clinical versus radiographic difference in ROM of the arthritic hallux MTP joint. Methods: One-hundred consecutive patients who presented with any grade of hallux rigidus were included in this prospective study to determine the hallux MTP dorsiflexion. Clinical range of motion using a goniometer and radiographic range of motion on dynamic xrays was recorded. Inter and intra-rater reliability were calculated. Results: The mean difference between clinical and radiographic dorsiflexion was 13°. This difference was statistically significant. For all measurements clinical dorsiflexion was equal or less than radiographically-measured dorsiflexion. The difference was significantly greater in patients with a clinical dorsiflexion of less than 30° than in patients with 30° or more. Radiographic measurement of hallux dorsiflexion had an excellent intra- and inter-observer reliability. Conclusion: This study describes a reliable, reproducible, and straightforward method of measuring hallux MTP ROM that eliminates the “human” component of measuring clinical ROM and all the variables that are encountered when making said measurement.
Angular Correction with Chevron-Akin Double Osteotomy in Mild, Moderate, and Severe Hallux Valgus
Authors: Panchbhavi Vinod K. , Lindeman Robert W. 
Published: October 2016

Category: Bunion Introduction/Purpose: Hallux valgus affects a substantial number of patients requiring foot and ankle orthopaedic surgery. Chevron osteotomy is commonly used in mild hallux valgus for angular correction, and the chevron-Akin double osteotomy is a more powerful tool, with presumed usefulness in moderate and severe deformity. The objective of this study was to use radiographic analysis to determine the average and maximum corrections achievable with the chevron-Akin double osteotomy. Methods: This retrospective study included a total of 30 patients and a total of 33 feet. Pre- and postoperative hallux valgus angles (HVA) and intermetatarsal angles (IMA) were evaluated using standard weight-bearing AP plain x-rays and the differences pre- to post- were calculated. Patients were grouped based on the severity of preoperative hallux valgus into mild, moderate, and severe pathology. The pre- to post- changes of HVA and IMA, and the postoperative values of each angle, were compared between severity groups by using ANOVA, and means and standard deviation were reported at each level of severity. The rate of correction to normal was noted in each severity group. The study was approved by our institutional review board. Results: Of the 33 feet, 3 were categorized as mild, 19 as moderate, and 11 as severe. In the mild group, average improvement was 13 in HVA and 6 in IMA; maximum correction achieved was 14 in HVA and 9 in IMA; and 3 of 3 (100%) were corrected to the normal range. In the moderate group, average improvement was 16.5 in HVA and 5.2 in IMA; maximum correction achieved was 29 in HVA and 9 in IMA; and 18 of 19 (95%) were corrected to the normal range. In the severe group, average improvement was 28.5 in HVA and 8.8 in IMA; maximum correction achieved was 43 in HVA and 20 in IMA; and 9 of 11 (82%) were corrected to the normal range. Conclusion: This study demonstrates that the combined chevron-Akin double osteotomy is capable of both small and large degrees of angular correction in hallux valgus. It shows that the use of the chevron-Akin double osteotomy can be expanded to cases of moderate to severe angular deformity.
Does Post-Traumatic Arthritis Produce Poorer 5 Year Patient Outcomes Following Mobile-Bearing Total Ankle Replacement?
Authors: Johnson-Lynn Sarah E. , Ramaskandhan Jayasree R. , Siddique Malik S. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Little long term data is available on patient-reported outcome measures (PROMs) following total ankle replacement in patients with posttraumatic osteoarthritis (PTOA), osteoarthritis (OA) and rheumatoid arthritis (RA). Patients with post-traumatic osteoarthritis have previously been felt to have poorer short and long term results following total ankle replacement, due to younger age, higher activity levels and greater patient expectations. We report the 3 and 5 year outcomes for patients who underwent total ankle replacement with a mobile bearing prosthesis, comparing prospectively collected PROMs data for PTOA patients with those with OA and RA. Methods: We analysed patient demographic data, American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Scores (FAOS), the SF-36 Health Survey, and patient satisfaction scores, collected preoperatively and up to five years postoperatively. Results: The study included 109 consecutive patients with total ankle replacement (58 OA, 21 RA, 30 PTOA). At one and two years postoperatively, the PTOA group reported significantly better scores on the general health domain of the SF-36. At three and five years postoperatively, there was a trend for better scores in the PTOA group for all domains of the SF36, however none of these reached significance (P>0.05). At one year postoperatively, the PTOA group and the RA group had better FAOS results for pain than the OA group. There were no significant differences in FAOS scores between groups at three or five years. There were no significant differences in AOFAS scores or in patient reported satisfaction at any measured time point. Conclusion: Our findings suggest that patients with posttraumatic osteoarthritis of the ankle can expect comparable five year outcomes after total ankle replacement with a mobile bearing prosthesis as patients with osteoarthritis and rheumatoid arthritis.
Does Smoking Affect Outcome in Surgical Management of Ankle Arthritis? A COFAS Multicentre Study
Authors: Mehta Kinjal , Penner Murray J. , Daniels Timothy R. , Younger Alastair S. , Wong Hubert , Dryden Peter , Wing Kevin , Glazebrook Mark A. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Smoking has been shown to increase complication rates after ankle surgery. The aim of this study was to compare complication rates between smokers and non smokers undergoing surgery for ankle arthritis. Methods: Smokers (n=88) and non smokers (n=565) with ankle arthritis who had undergone ankle arthrodesis or ankle arthroplasty were included in the study. Multicentre, prospective data was used from the COFAS ankle arthritis database. Patients with information available on smoking habits and 2 year follow up were included Results: There was no significant difference in the overall re operation rates between smokers and non smokers. However, the amputation rate was higher in smokers (3.4%) as compared to non smokers (0.7%). AOS scores and SF 36 scores were similar in the 2 groups. A higher proportion of smokers underwent fusion (46.5%) as compared to non smokers (28.8%). Amputation rate after ankle arthrodesis was higher in smokers (4.9%) as compared to non smokers (0.6%). Conclusion: Smokers have a higher amputation rate after ankle arthrodesis or ankle arthroplasty as compared to non smokers. Information from this study can be used during counselling of surgical patients
Effect of Diabetes Mellitus, Peripheral Neuropathy, or Charcot Arthropathy on Workers Compensation Claims
Authors: Grimes J. Speight , Murphree Jefferson J. 
Published: October 2016

Category: Diabetes Introduction/Purpose: Charcot neuroarthropathy is a complication of peripheral neuropathy commonly resulting from diabetes mellitus. The actual trigger for a Charcot neuroarthropathy episode is unknown. Due to the chronic nature and multifactorial causality of the disease, affected patients frequently have difficulty with workers’ compensation claims resulting in appeals or even outright denials. This study retrospectively reviewed patient’s charts with workers’ compensation claims in a foot and ankle practice to determine the incidence of diabetes mellitus, peripheral neuropathy, and Charcot neuroarthropathy. The study will then review each affected patient to determine if there is a correlation between his or her health status and claim status. Methods: From January 2011 to January of 2015, 331 patients were seen in a tertiary foot and ankle clinic with a worker’s compensation claim. A chart review identified patients with diabetes mellitus, peripheral neuropathy, or Charcot neuroarthropathy. The claims database was reviewed to determine the number of claim appeals submitted for each patient. Results: There were 43 patients (13% of workers compensation patients) with diabetes, 12 (4% of workers compensation patients) with peripheral neuropathy, and 3 (7% of diabetics, 1% of workers compensation patients) with Charcot. There were a total of 115 appeals in patients without Diabetes Mellitus, peripheral neuropathy, or Charcot arthropathy, 23 appeals in patient with Diabetes, 8 appeals in patients with peripheral neuropathy, and 6 appeals in the patients with Charcot. Conclusion: Diabetes alone did not increase the number of appeals. Patients with peripheral neuropathy, however, were two- times more likely to have an appeal than a patient without peripheral neuropathy. Patients with Charcot had eight times more appeals than patients without Charcot. Thus, Charcot arthropathy and peripheral neuropathy are strong indicators an increased claim appeals in the Worker’s Compensation system. This data only reflects appeals of claims for services provided and does not reflect difficulty with obtaining approvals for planned procedures.
Foot and Ankle Fellowship Websites
Authors: Danna Natalie R. , Hinds Richard M. , Capo John T. , Mroczek Kenneth J. 
Published: October 2016

Category: Other Introduction/Purpose: The Internet has been reported to be the first informational resource for many fellowship applicants. Despite being a popular resource, no accessibility or quality standards exist for fellowship websites. The objective of this study was to assess the accessibility of orthopaedic foot and ankle fellowship websites and to evaluate the quality of information provided via program websites. Methods: The American Orthopaedic Foot and Ankle Society (AOFAS) and the Fellowship and Residency Electronic Interactive Database (FREIDA) fellowship databases were accessed to generate a comprehensive list of orthopaedic foot and ankle fellowship programs. The databases were reviewed for links to fellowship program websites and compared with program websites accessed from a Google search. Accessible fellowship websites were then analyzed for the quality of recruitment and educational content pertinent to fellowship applicants. Results: Forty-seven orthopaedic foot and ankle fellowship programs were identified. The AOFAS database featured direct links to 7 (15%) fellowship websites with the independent Google search yielding direct links to 29 (62%) websites. No direct website links were provided in the FREIDA database. Thirty-six accessible websites were analyzed for content. Program websites featured a mean 44% (range, 5-75%) of the total assessed content. The most commonly presented recruitment content was a program description featured on 94% of fellowship websites. The most commonly presented educational content was a description of fellow operative experience featured on 83% of websites. Conclusion: There is substantial variability in the accessibility and quality of orthopaedic foot and ankle fellowship websites. Comparison of the results of our study with those of similar investigations indicates a paucity of fellowship websites presenting comprehensive program information to applicants. Recognition of deficits in accessibility and content quality may assist foot and ankle fellowships in improving program information online.
Frontal Plane Rotation of the 1st Metatarsal in Relation to Arch Height
Authors: Smith W Bret 
Published: October 2016

Category: Bunion Introduction/Purpose: There is a question as to the relationship of the effect of the arch height on the frontal plane rotation of the 1st metatarsal, and its impact on hallux valgus deformities. We attempt to evaluate this question and offer an answer for discussion. Methods: A series of patients who presented to a single orthopedic foot and ankle clinic with a compliant of hallux valgus deformity received a standardized 4 view standing radiograph series. These included the standard weight-bearing anterior- posterior, oblique, and lateral images. The fourth view was an axial sesamoid view to evaluate the frontal plane rotation. The first 50 patients that met our inclusion criteria were used. Inclusion criteria were skeletal maturity, non-traumatic issue, and primary bunion complaint with no complaint related to the arch. Any patients with prior surgery on the 1st metatarsal or arch structure were excluded. The radiographs where then evaluated by 2 fellowship trained foot and ankle specialist with predetermined radiographic parameters. The included measurements regarding the HAV deformity were IM angle, HAV angle, sesamoid position, DMAA, and axial sesamoid rotation. The measurements captured in relation to arch height included Meary’s angle, talonavicular coverage angle, medial cuneiform arch height, navicular height, and lateral talocalcaneal angle. Results: The collected information was then initially checked for inter-observer reliability and found to be consistent between the two observers. Collected values allowed the subjects to be placed into 3 initial categories labeled as planus, normal, and cavus based on the arch measurements. The imaging studies related to the HAV deformity was then classed initially as mild, moderate and severe. The HAV deformities were then further classified based on frontal plane rotation deformity and categorized as rotated, rotated and subluxed, subluxed, or no rotation. All of the individual group measurements were determined and quantified using the same radiographic software and uniform points of measurement. The information was then feed into algorithms that included direct comparisons as well as regression analysis of the defined subsets. Conclusion: After review of the data it was noted that there was no significant correlation between arch height measurements, HAV deformity and frontal plane rotation of the 1st metatarsal.
Long-Term Results Of Low Tibial Osteotomy For Ankle Osteoarthritis
Authors: Hio Naohiro , Hasegawa Atsushi , Monden Satoshi , Noguchi Hideo , Taki Masanori , Tsunoda Kazuhiko 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: There are not many reports about long-term results of low tibial osteotomy (LTO) for ankle osteoarthritis. We mention treatment results for cases in which, among the cases where LTO was performed for ankle osteoarthritis caused by malalignment, tracking was possible for 10 years or more. Methods: The study evaluated 11 ankles of 11 patients. Among these were 1 male and 10 females, with a mean age of 57 years, and a mean observation period of 11 years, 5 months. There were 10 joints of 10 patients with varus type osteoarthritis, and 1 joint of 1 patient with valgus type osteoarthritis. For varus type osteoarthritis, in the Tanaka’s X-ray classification, there were 3 joints at stage 2, 2 joints at stage 3a, and 5 joints at stage 3b. As surgical procedures, LTO was performed for 3 joints, LTO with medial malleolar osteotomy was performed for 6 joints, LTO with reconstruction of collateral ligament was performed for 1 joint, and LTO with subtalar arthrodesis was performed for 1 joint. In the clinical evaluation, we used the score of Takakura et al, and in the postoperative radiographic evaluation, we used Tanaka’s X-ray classification. Results: Clinical results improved from a preoperative mean of 68.7 points to a one-year postoperative score of 77.2 points, with a score at final observation of 76.3 points. The postoperative radiographic evaluation one year after surgery was Stage 1 in 5 joints, and Stage 2 in 5 joints, but at the time of final observation, the results were Stage 1 in 3 joints, Stage 2 in 4 joints, Stage 3a in 1 joint and Stage 4 in 2 joints. The talar tilting angle had improved, from 9.6° preoperatively to 3.9° at the time of final observation. A strongly positive correlativity was seen between preoperative X-ray classification, arthroscopic classification and X- ray classification at the time of final observation. Conclusion: There are no doubt cases where the preoperative severity of the condition has an effect postoperatively, and in the long term, narrowing of the joint space progresses, with clinical results gradually falling, but that progression is gradual, so by performing LTO, it is believed to be possible to maintain functions that adequately tolerate the activities of daily living for that age.
Management of Talar Nonunion With Extensive AVN of the Talar Dome by Resection of Talar Dome, Autograft and Hindfoot Nail
Authors: Abd-Ella Mohamed M. , Farouk Amr 
Published: October 2016

Category: Ankle Introduction/Purpose: Extensive avascular necrosis (AVN) and non union are common complications after talar neck fractures especially Hawkin’s grades 3 and 4 and cases associated with comminution of the talar body. When both complications occur together, there is instability due to non union and talar collapse, arthritis of both ankle and subtalar joints, and hindfoot deformity in some cases in the form of varus or equines. The aim in these cases is to get a plantigrade stable painless foot, which requires ankle and subtalar fusion as well as union between the anterior talus and the hindfoot, with no or minimal limb shortening. The purpose is to assess the technique of removing all avascular bone followed by autograft and hindfoot nail to achieve this aim. Methods: The study included eight patients, five males and three females with non union of talar neck fractures associated with extensive avascular necrosis of talar dome as a consequence of trauma. The operative technique includes posterior approach to the ankle with tendoachilles splitting (except in one patient where anterior approach was used to remove a tibial plate), removal of all avascular bone until the fracture line is reached, removal of articular cartlilage of ankle and subtalar joints, filling the defect by iliac crest autogenous graft to maintain length and fixation by hindfoot arthrodesis nail. No fixation was used between the graft and the anterior talus. Also, the anterior talus was not fixed to the anterior tibia as this would shorten the limb. The union was assessed clinically and radiologically. The functional outcome was assessed using the AOFAS score. The minimal follow up duration is one year (range: one to five years). Results: Six out of eight patients (75%) achieved solid union as evident clinically and radiologically within three to four months. This includes union of the ankle and subtalar joints as well as union between the graft and the anterior talus. Two patients did not achieve union after six months and required another bone grafting. One of them had also non union between the graft and the anterior talus and required additional fixation of the anterior talus. Both cases achieved union after the second procedure. Other complications included one superficial infection and one case of mild equines. The mean AOFAS score improved from 38.8 preoperatively ( range: 22 to 55) to 70.8 in the last follow up ( range: 65 to 86). Conclusion: The technique described is a good option in treating cases with talar non union associated with extensive AVN. It has a good union rate and preserves the limb length without the need to proximal bone transport. Posterior approach allows easy access to both ankle and subtalar joints. Our results also suggest that there is no need to fix the anterior talus to the hindfoot as it fuses spontaneously to the graft.