bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of the Interosseous Talocalcaneal Ligament Injury on Stability of the Ankle-Subtalar Joint Complex — a Cadaveric Experimental Study
Authors: Tochigi Yuki , Takahashi Kazuhisa , Yamagata Masatsune , Tamaki Tamotsu 
Published: January 2017

The present study aims to clarify the influence of the interosseous talocalcaneal ligament (ITCL) injury associated with injury to the lateral ankle ligaments on the ankle-subtalar joint complex motion under conditions of physiologic loading. We conducted mechanical tests using five fresh cadaveric lower extremities. Each specimen was mounted in the loading device and an axial cyclic load from 9.8 to 686 N was applied. Three-dimensional rotations of the ankle and the subtalar joint were measured simultaneously by a linkage electric goniometer. Mechanical tests were repeated after sectioning of the anterior talofibular ligament (ATFL), and again after additional sectioning of the ITCL. In the intact condition, the ankle and the subtalar joints rotated consistently with increase of the load. The predominant rotations were plantar flexion and adduction at the ankle joint, with some eversion demonstrated at the subtalar joint. Although ATFL sectioning did not significantly change the motion of the two joints, additional sectioning of the ITCL significantly increased adduction and total rotation of the ankle joint. The present study demonstrated that a combined injury of the ATFL and the ITCL can induce anterolateral rotatory instability of the ankle joint under conditions of axial loading.
Sensory Thresholds of Normal Human Feet
Authors: Jeng Clifford , Michelson James , Mizel Mark 
Published: January 2017

Hypotheses/Purpose: Although several studies in the literature have evaluated the abnormal sensory thresholds of diabetic feet to Semmes-Weinstein monofilament testing, there is very limited data on the sensory thresholds of individuals without diabetes or peripheral neuropathy. The purpose of this study was to assess the dorsal and plantar sensation of the feet from 40 healthy, college-aged volunteers using Semmes-Weinstein monofilaments. Conclusions/Significance: Semmes-Weinstein testing is a useful tool in predicting which diabetic patients may be at risk for ulceration of the feet. Several studies have determined 5.07 to be the threshold for protective sensation. Based on the normal values derived in this study, the inability to feel a Semmes-Weinstein monofilament of 5.07 (as in diabetic neuropathy) represents a sensory threshold that is more than 50 times greater than normal. This means that roughly 98% of the sensory ability has been lost. Methods: 20 male and 20 female volunteers between the ages of 18 to 22 years old were selected. None had a history of any significant injury or previous surgery to the foot or ankle. There were no known medical conditions associated with decreased foot sensation, (e.g.- diabetes, syphilis, leprosy, myelomeningocele, syringomyelia, or hereditary neuropathy). Volunteers were also questioned regarding participation in athletic activities. The subjects were blindfolded with the leg resting comfortably on a chair as 14 plantar and 5 dorsal locations were tested on each foot. The right foot was always tested first. Each site on the foot had the Semmes-Weinstein monofilaments applied to it first, in an order of increasing stiffness, then repeated in decreasing order, using all twenty monofilaments in the set. A positive threshold response was recorded when the subject could feel the filament and could accurately locate where on the foot the stimulus had been applied. The left foot was then tested in an identical fashion. Results: The mean sensitivity for all sites was 3.63 (0.0075 SEM). There were significant differences between sites, between using increasing or decreasing monofilament stiffness, between subjects, and in some instances, between right foot and left foot values. When testing was performed from the higher to lower monofilament stiffness, subjects were found to have significantly better sensitivity, which indicates the importance of a consistent testing protocol (either all up or all down). Sensation in the lesser toes and the arch were the most sensitive followed by the hallux and the plantar metatarsal heads. The least sensitive site was the heel, with 1/6th the sensitivity of the most sensitive toes.
Should the Amputations of the Great Toe Be Replanted?
Authors: Ademoĝlu Yalçin , Ada Sait , Kaplan Ibrahim 
Published: January 2017

Seventeen great toes, amputated at the distal phalangeal to the level of the MTP joint, were replanted between 1990 and 1998, at Izmir Hand and Microsurgery Hospital. Replantation in five out of six complete amputations, and seven out of eleven incomplete amputations were successful, and the overall survival rate was 76.4%. In failed replantations, the base of the proximal phalanx of the great toe was preserved during closing of the stump. Nine of 17 patients were available for review in the follow-up period of mean 3.5 years (range 1-6.5 years). Clinical and biomechanical evaluations of the operated feet were carried out in five patients who had replanted great toe, and in four patients who had amputated one. The uninjured sides were used as control group. The patients in the two groups had no significant subjective symptoms, nearly normal ROM of the MTP joint and protective sensation was achieved in the replanted great toes. With the numbers available, while radiographical parameters of the involved and the control sides demonstrated no significant differences in either groups, pedographical studies revealed consistent changes in weightbearing distribution of the feet with amputated great toes. Although the great toe amputation causes no disturbance in gait, it alters the load distribution of the foot.
The ANK Device: A New Approach in the Treatment of the Fractures of the Lateral Malleoulus Associated with the Rupture of the Syndesmosis
Authors: Kabukcuoglu Yavuz , Kucukkaya Meting , Eren Tugrul , Gorgec Mucahit , Kuzgun Unal 
Published: January 2017

The ANK device was developed for the treatment of fractures of the lateral malleolus occurring with rupture of the syndesmosis. While it provides the anatomic reduction of the fracture and the syndesmosis, it allows the physiologic movements of the fibula. It is not used for comminuted fractures of the lateral malleolus and in cases where fibular medullary canal is narrow. We included forty-nine patients who had the ANK device applied and at least 2 years follow-up. The mean follow-up was 41 months (range 24–124). The fractures were evaluated according to the Lauge Hansen classification; 25 cases were evaluated as supination-external rotation, 11 cases were pronation-abduction, and 13 cases were pronation-external rotation type fractures. There were also 46 fractures of the medial malleolus and three ruptures of the deltoid ligament. Twenty-nine (59,2%) patients were evaluated as excellent, 12 (24,5%) as good, 5 (10.2%) as fair and 3 (6.1%) as poor. Arthrosis was observed in 3 (6.1%) of the patients.
Dorsiflexion contracture after the Weil Osteotomy: Results of Cadaver Study and Three-Dimensional Analysis
Authors: trnka Hans-Jörg , Nyska Meir , Parks Brent G. , Myerson Mark S. 
Published: January 2017

For metatarsalgia caused by a dislocated lesser metatarsophalangeal (MTP) joint and isolated over-long lesser metatarsals, surgical treatment options without sacrificing the joint are limited. Recently, the Weil osteotomy has been advocated for the treatment of this deformity. In our experience, preliminary results with this technique have revealed a high rate of dorsiflexion contracture of the MTP joints at follow-up. We performed a cadaver study and a three-dimensional analysis on sawbones to investigate this phenomenon. In the cadaveric portion of this study, the second MTP joints of two fresh-frozen cadavers were dissected; the entire ray, with the metatarsal shaft, MTP joint, toe, and plantar fascia, was removed en bloc. After gross anatomic structures were photographed, a Weil osteotomy was performed at 25 relative to the long axis of the metatarsal shaft. The positions of muscles°, ligaments, and tendons were noted and photographed before and after the osteotomy. In the sawbones portion of this study, a Weil osteotomy was performed at four different angles (25°, 30°, 35°, and 40°) relative to the long axis of the metatarsal. To ensure reproducibility, the sawbone models were fixed proximally to a vertical milling machine with the second metatarsals inclined 15° to simulate the anatomic position. After making the cut, the plantar fragment was translated along the dorsal fragment proximally for a distance of 5 mm. Before and after the osteotomy, selected x, y, and z coordinates were obtained using a Microscribe 3D digitizer. Data analysis was performed with Microsoft Excel, and ANOVA was used to determine significant differences (p <0.05) between the various osteotomies. Analysis of the cadaver dissection revealed that after the Weil osteotomy, the tendons of the interosseous muscles move dorsally with respect to the axis of the MTP joint due to the depression of the plantar fragment of the metatarsal. The loss of their flexion effect on the joint permits the pull of the extensor to dorsiflex the toe. The size of the depression for the various osteotomies averaged: 25° osteotomy, 3.03 mm (range, 1.8 to 3.8 mm); 30° osteotomy, 3.2 mm (range, 1.9 to 4.0 mm); 35° osteotomy, 3.5 mm (range, 1.7 to 5.7 mm); and 40° osteotomy, 4.2 mm (range, 2.8 to 6.4 mm). Amounts of shortening relative to the long axis of the metatarsal for the various osteotomies averaged: 25° osteotomy, 5.03 mm (range, 4.77 to 5.30 mm); 30° osteotomy, 4.59 mm (range, 3.47 to 5.19 mm); 35° osteotomy, 4.27 mm (range, 2.87 to 5.00 mm); and 40° osteotomy, 3.65 mm (range, 3.20 to 4.31 mm). According to our analysis, depression of the plantar fragment always occurs after a Weil osteotomy. This depression changes the center of rotation of the MTP joint, and the interosseous muscles then act more as dorsiflexors than as plantarfexors.
Intra-articular Load Distribution in the Human Ankle Joint During Motion
Authors: Michelson James D. , Checcone Mark , Kuhn Tonya , Varner Kevin 
Published: January 2017

The rational treatment of injuries to the ankle is predicated on an understanding of biomechanics of the ankle. While several investigators have reported on three-dimensional dynamic kinematics of the ankle and on the static distribution of pressure within the ankle, it has not been possible to measure intra-articular forces reliably under dynamic conditions. The assumption that the distribution of forces under dynamic conditions is well represented by statically determined forces has not been validated, leaving in question the applicability to dynamic conditions of data obtained under static conditions. This study characterizes an electro-mechanical thin-membrane force transducer with potential for intra-articular use. The sensor was found to yield a reproducible linear response to loads experienced in the ankle, and was insensitive to both a moist environment and shearing forces. On the basis of these results, these force-transducers were placed in axially loaded cadaveric ankles that were either statically or dynamically cycled through a physiologic range of motion. In each of six specimens, sensors were secured to the medial and lateral malleolar articular surfaces, and to articular surfaces of the medial and lateral tibial plafond. Both medial and lateral malleolar-talar forces increased with dorsiflexion. Moving from plantarflexion to dorsiflexion caused an increase in lateral tibio-talar load accompanied by a decrease in the medial tibio-talar loading. There was no significant hysteresis in force-distribution with respect to the direction of sagittal motion. There was no difference between the forces measured under static or dynamic conditions. This study validates the use of static loading methodlogies in future studies of force-distribution. Our data in intact ankles closely corresponded to data on forces under dynamic conditions. Dorsiflexion caused an increase in both medially and laterally directed forces towards the malleoli. This is the first demonstration of such forces, which are responsible for the external rotation and lateral translation of the distal fibula that occurs in dorsiflexion of the ankle.
Bacterial Recolonization During Foot Surgery: A Prospective Randomized Study of Toe Preparation Techniques
Authors: Brooks RA , Hollinghurst D , Ribbans WJ , Severn M 
Published: January 2017

Fifty patients undergoing foot or ankle surgery were randomized into two groups for the purposes of toe preparation. Twenty-four patients underwent a standard preparation which included placing antiseptic between the toes while 26 were additionally cleaned by sliding a gauze swab soaked in topical antiseptic back and forth several times. Povidone iodine followed by chlorhexidine in alcohol was used in both groups. All toes were covered by a sterile glove during surgery unless the toes themselves were to be operated upon. Bacteria were cultured from the toe clefts in 4% of all patients immediately following preoperative disinfection. Significantly fewer patients whose toes had been additionally scrubbed (group 1) showed bacterial recolonization at the end of surgery compared with those undergoing a standard prep (group 2) (7.7% vs 20.8%). We conclude that additional scrubbing of toe clefts prior to surgery reduces the incidence of recolonization of bacteria during the surgical procedure.
The Reliability of Angular Measurements in Hallux Valgus Deformities
Authors: Coughlin Michael J. , Freund Elisha 
Published: January 2017

The purpose of this study was to determine the intra-observer and inter-observer reliability of physicians on a repetitive basis in making angular measurements of hallux valgus deformities. The hallux valgus angle, the 1–2 intermetatarsal angle, and the distal metatarsal articular angle and the assessment of congruency/subluxation of the first MTP joint were evaluated on a repetitive basis. Physicians were provided with a series of black and white photographs of radiographs with a hallux valgus deformity. Three different sets of photographs randomly ordered were sent at a minimum interval of six weeks to the participants. Participating physicians were extremely reliable in the measurement of the 1–2 metatarsal angle. 96.7% of the photographs were repeatedly measured within a range of 5 degrees or less. The angular measurements to determine the hallux valgus angle were slightly less reliable, but 86.2% of photos were repeatedly measured within a range of 5 degrees or less. In the measurement of the distal metatarsal articular angle, 58.9% of photographs were repeatedly measured within a range of 5 degrees or less. There was a wide range within physician evaluators who recognized very few congruent joints (2 of 21) and those who recognized several congruent joints (11 of 21). Most physicians appeared to be internally consistent in the assessment of MTP congruency; however, some photographs were much more difficult to assess than others. This study validates the reliability of the measurement of the hallux valgus and the 1–2 metatarsal angle. The inter-observer reliability in the measurement of the distal metatarsal articular angle is questioned.
Fractures and Fracture Dislocations of the Midfoot: Occurrence, Causes and Long-term Results
Authors: Richter Martinus , Wippermann Burkhard , Krettek Christian , Schratt Hanns Eberhard , Hufner Tobias , Thermann Hajo 
Published: January 2017

Etiology and outcome of 155 patients with midfoot fractures between 1972 and 1997 were analyzed to create a basis for treatment optimization. Cause of injuries were traffic accidents (72.2%), falls (11.6%), blunt injuries (7.7%) and others (5.8%). Isolated midfoot fractures (I) were found in 55 (35.5%) cases, Lisfranc fracture dislocations (L) in 49 (31.2%), Chopart-Lisfranc fracture dislocations (CL) in 26 (16.8%) and Chopart fracture dislocations (C) in 25 (16%). One hundred and forty eight (95%) of the midfoot fractures were treated operatively; 30 with closed reduction, 115 with open reduction, 3 patients had a primary amputation. Seven (5%) patients were treated non-operatively. Ninety seven (63%) patients had follow-up at an average of 9 (1.3–25, median 8.5) years. The average scores of the entire follow-up group were as follows: AOFAS – sum of all four sections (AOFAS-ET): 296, AOFAS-Midfoot (AOFAS-M): 71, Hannover Scoring System (HSS): 65, and Hannover Questionnaire (Q): 63. Regarding age, gender, cause, time from injury to treatment and method of treatment no score differences were noted (t-test: p > 0.05). L, C or I showed similar scores and CL significantly lower scores (AOFAS-ET, AOFAS-M, HSS, Q). The highest scores in all groups were achieved in those fractures treated with early open reduction and operative fixation. Midfoot fractures, particularly fracture dislocation injuries, effect the function of the entire foot in the long-term outcome. But even in these complex injuries, an early anatomic (open) reduction and stable (internal) fixation can minimize the percentage of long-term impairment.
Long-Term Outcome of Anatomical Reconstruction Versus Tenodesis for the Treatment of Chronic Anterolateral Instability of the Ankle Joint: A Multicenter Study
Authors: Krips Rover , van Dijk C. Niek , Halasi Tamas , Lehtonen Hannu , Corradini Constantino , Moyen Bernard , Karlsson Jon 
Published: January 2017

The long-term clinical outcome after anatomical reconstruction and tenodesis in the treatment of chronic anterolateral ankle instability was assessed in a retrospective multicentre study. The first group (AR) consisted of 25 patients (mean age at operation 22 yrs ± 5.7) who underwent anatomical reconstruction and the second group (TE) of 29 patients (mean age 23 yrs ± 6.6) who underwent tenodesis. For both groups, the mean follow-up period was 12.3 yrs (AR ± 2.5 yrs, TE ± 2.7 yrs). At physical examination, there were significantly more patients in the TE group (n = 18) with a positive anterior drawer sign as compared with the AR group (n = 7) (p = 0.02). Medially located degenerative changes in the ankle joint as seen on standard radiographs were seen more often in the TE group (n = 7) than in the AR group (n = 1) (p = 0.03). The mean talar tilt, 4.7° in the AR group vs 6.9° in the TE group, (p = 0.02) and anterior talar translation, 2.9 mm in the AR group vs 4.3 mm in the TE group, (p = 0.04) were significantly higher in the TE group at radiographic stress examination. According to the rating system developed by Good et al. (1975), significantly fewer patients in the TE group (n = 8) had an excellent result as compared with the AR group (n = 15) (p = 0.03) and more patients in the TE group (n = 9) had a fair or poor result (p = 0.04) as compared with the AR group (n = 2). We conclude that a tenodesis procedure does not restore the normal anatomy of the lateral ankle ligaments. When compared with anatomical reconstruction, a tenodesis leads to inferior results in terms of functional and mechanical stability, as well as overall satisfaction at long-term follow-up.
Intramedullary Screw Fixation of Jones Fractures
Authors: Kelly Ian Peter , Glisson Richard R. , Fink Christian , Easley Mark E. , Nunley James A. 
Published: January 2017

Background: Jones fractures of the fifth metatarsal can be stabilized using intramedullary screw fixation techniques. A range of screw diameters from 4.5 mm to 6.5 mm can be used, but the optimal screw for this procedure has yet to be defined. In clinical practice, we have observed that failure is more likely when smaller diameter screws are used. Methods: Experimental Jones fractures were created in 23 pairs of human cadaver fifth metatarsals, which were fixed using either 5.0 mm or 6.5 mm screws. Fracture stiffness and pull-out strengths were measured for either screw type and their relationships with bone mineral density and medullary canal diameter were determined. Results: There was no significant difference in the bending stiffness of fractures stabilized with 5.0 mm and 6.5 mm screws; however, different mechanisms of failure were noted for either screw type. Poor thread purchase within the medullary canal was noted with the 5.0 mm screws, while excellent purchase was noted with 6.5 mm screws. Pull-out strength testing revealed significantly higher pull-out strengths for the larger 6.5 mm screws. There was no significant difference in bone mineral density or medullary canal diameter between right and left metatarsals. Conclusions: Fifth metatarsals can often accommodate a 6.5 mm screw for the stabilization of Jones fractures. Larger diameter screws did not result in greater fracture stiffness in our model, but did result in significantly greater pull-out strengths. Clinical Relevance: Larger diameter screws may be more appropriate for intramedullary screw fixation of Jones fractures.
Surgical Management of Severe Deformity Resulting from Posterior Tibial Tendon Dysfunction
Authors: Coetzee J. Chris , Hansen Sigvard T. 
Published: January 2017

A retrospective case study format was used to evaluate the results of surgical treatment of severe deformities due to long-standing tibialis posterior tendon dysfunction. To be included in the study, the peri-talar (talonavicular) subluxation on a weight-bearing AP X-ray should have been at least 75%. This criterion limited the field to patients with long-standing, rigid, severe deformities. Surgical correction was obtained through a two-incision approach, dorsomedial and dorsolateral. Significant shortening of the medial column and extensive removal of adaptive bone formation was necessary to allow reduction of the hind- and midfoot deformity. Stable internal fixation using multiple screws was used to secure the reduction. Eleven patients, 12 feet were evaluated. The patients were evaluated using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Score as well as a questionnaire on footwear and satisfaction rating. The average score improved from 30 points pre-op to 74 points post-op (out of 100). P-value 0.0001. Pain score improved from 11/40 to 33/40. Function improved from 19/50 to 33/50. Alignment improved from 0/10 to 8/10. The radiological parameters showed an average improvement of 31° in the lateral talo-1st metatarsal angle, 11° in the calcaneal pitch, and 35° in the AP talo-1st metatarsal angle. All three parameters were highly significant with P-values of 0.0001. Multiple complications occurred. This included two delayed unions with breakage of screws and partial loss of correction, four wound problems, two sural nerve impairments and three patients requiring hardware removal. Even though it is an extensive procedure with multiple potential complications it still offers a substantial improvement in quality of life.
Mobility of the First Tarsometatarsal Joint in Hallux Valgus Patients: A Radiographic Analysis
Authors: Faber Frank W.M. , Kleinrensink Gerrit-Jan , Mulder Paul G.H. , Verhaar Jan A.N. 
Published: January 2017

Hypermobility of the first tarsometatarsal (TMT 1) joint in the sagittal plane plays a role in the etiology and treatment of the hallux valgus complex. However, objective quantification of this mobility is still a problem. We performed a radiographic analysis of TMT 1 mobility in the sagittal plane in 94 hallux valgus patients aged 15 to 65 years. We examined 94 feet with symptomatic hallux valgus deformity requiring operative correction. Excluded were patients with osteoarthritis, inflammatory diseases or previous operations on the foot. The TMT 1 mobility was tested with a clinical test and by radiographic measurement using the modified Coleman block test. The mean mobility of the TMT 1 joint in the sagittal plane in the patient group was 12.9° (SD 4.80). In addition, there was a statistically significant difference between two sub-groups: patients with and without clinical TMT 1 hypermobility. No correlation of TMT 1 (hyper)mobility and radiographic second ray hypertrophy was found. This simple method can produce additional information to the clinical TMT 1 hypermobility test in the sagittal plane.