bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Quality and Content of Accessible Information on the Internet Regarding Hallux Rigidus
Authors: Holzer Lukas 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: The internet has grown into one of the biggest resource of easy accessible health information for the general public. Hallux rigidus (HR) is the most common arthritic disease pattern of the foot. There is no mutual consent on the ideal operative intervention for this disease. State of knowledge is essential for a decision to proceed with a HR specific treatment, since this decision is ultimately a shared one between the patient and the physician. Therefore, many patients comb through the internet for medical information related to this specific topic. The purpose of this study was to assess the quality and integrity of the online available informative content about HR using acknowledged scoring instruments, proven quality markers and a novel designed specific HR score. Methods: In December 2016 the search term “hallux rigidus” was used to search Google (Google Inc., Mountain View, CA, USA) by three independent reviewers (two experienced orthopedic surgeons and one trained medical student). The content of the first 50 hits were analyzed by the use of specific scores including the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria and the Health On the Net code (HONcode) as a seal of quality for providing complete and transparent health-related information. Also the Flesch Reading Ease (FRE), the Flesch Kincaid Grade Level (FKGL), and the Gunning Fog Index (GFI) were recorded as indicators for readability. Websites were classified as follows: academic, commercial, government or non-profit organization (NPO), physician or group, and unspecified. A HR-specific content score was developed consisting of 19 specified items to evaluate the overall aspects about the procedure, management and potential complications. Results: Of the 50 screened websites, 37 (74%) were included for analysis. Of these 37 websites, 20 were from a physician or group, 8 were commercial, 6 were academic, 3 were governmental or NPO and 1 was unspecified. The mean DISCERN score of the websites was 46±10. The highest score was 65 points, whereas the lowest was 21. HON Code certification was present in six (16%) and HON seal in two websites (5%). The FRE, RKGL and GFI were 43,2±14, 8,1±2, and 6,7±2 respectively. The HR specific content score was 7±3. Conclusion: Quality and content of accessible information on the internet on HR was analyzed by three individuals by various objective scores. 37 websites were included in the analysis. The majority of websites provided poor information on the management of HR. Patients need to be aware of this fact. In the future measures need to be taken to improve quality and content of HR related websites.
The Peroneus Brevis and Plantar Fascia Insertions Are Related to Proximal Fifth Metatarsal Fractures
Authors: Hosseini Ali , Dijk Pim Van , Breuking Sofie , Vopat Bryan , Guss Daniel , Johnson A. Holly , DiGiovanni Christopher 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: Proximal fifth metatarsal fractures (PFMF) are among the most common fractures in the foot and can be categorized into three fracture zones [1]. To investigate the fracture mechanism of PFMF in different zones, a better understanding of the anatomy of the bone and its surrounding soft tissues is required. Both the plantar fascia (PF) and the peroneus brevis (PB) tendon insertions are at the base of the fifth metatarsal, and may contribute to the pathophysiology of PFMF. However, the role of the PB and PF insertions in the pathogenesis of PFMF remains unclear. The purpose of this study was to accurately define the footprint of the PB and PF insertions of the base of the 5th metatarsal in relation to the different zones of PFMF. Methods: 21 cadaveric fifth metatarsal bones were harvested from cadaveric feet. All bones were freed of any remaining soft tissue adherence, except for the PB and the PF insertions. Three reference screws with a diameter of 1 mm were placed and secured on each bone with 2 screws distally and 1 screw proximally for registration. All bones were CT scanned to create a 3D bone reconstruction. Next, the insertions of the PB and PF and the reference screws of each bone were digitized and then mapped to its corresponding 3D bone model. In order to describe the three different fracture zones of the 5th metatarsal, an established coordinate system was made for each bone to simulate separate fracture zones (Figure a) based on Lawrence guideline [1]. The shape, location and surface areas of both insertions and their relation to the different fractures zones were determined (Figure b). Results: The insertion of the PB was oval shaped and located on the dorsal side of the base, with a mean surface area of 88.1 ± 46.4 mm2. The PF was oval shaped and situated around the tip of tuberosity, with a mean surface area of 150.7±53.5 mm2. The PB insertion was present in zone 1 fractures in 100% (21/21) of the 5th metatarsal models and 29% (6/21) of the models for zone 2 fractures. The PF insertion was involved in 100% (21/21) of the 5th metatarsal models for zone 1 fractures and 43% (9/21) of the models for zone 2 fractures. Conclusion: Results of this study demonstrate that the insertion of both the PB and PF are involved in all zone 1 PFMF and a significant percentage of zone 2 PFMF. The location of tendon insertions affect the forces exerted on the bone, which may indicate a relation of the insertions of both the PB and the PF with the fracture mechanism of many zone 1 and 2 PFMF. Moreover, in the treatment of these fractures, care should be taken to maintain or restore the anatomy of these insertions to maximize functional outcomes.
ATFL repair alone versus combined repairs of ATFL and CFL
Authors: Hunt Kenneth , Kelley Judas , Fuld Richard , Anderson Nicholas , Baldini Todd 
Published: September 2017

Category: Ankle Introduction/Purpose: The standard for lateral ligament stabilization is direct repair of the ATFL by open or arthroscopic technique. The implications and necessity of repairing the CFL are not well understood. The purpose of this study was to assess the impact of repairing the ATFL alone compared to repairing both the ATFL and CFL, in a biomechanical cadaver model. We hypothesized that repairing the CFL will substantially augment ankle and subtalar joint stability during weight-bearing ankle inversion compared to ATFL repair alone. Methods: Ten matched pairs of fresh frozen human cadaveric ankles were dissected to expose intact ATFL and CFL. Ankles were mounted to an Instron at 20° plantar flexion and 15° of internal rotation. Each ankle was loaded to body weight and then tested from 0 to 20° of inversion for three cycles; stiffness and torque were recorded, peak pressure and contact area were recorded using a calibrated Tekscan sensor system, and rotational displacement of the talus and calcaneus relative to the ankle mortise was recorded using a three-dimensional motion capture system. Ankles then underwent sectioning of ATFL and CFL and were randomly assigned to ATFL only repair using two arthroscopic Broström all-soft anchors, or combined ATFL and CFL repair. Testing was repeated after repair to 20° of inversion, then load-to-failure (LTF). Results: The predominant mode of failure after repair was at the tissue/suture. There were no instances of anchor pullout. There was an 11.7% increase in stiffness in combined repairs, and only a 1.6% increase in ATFL-only repairs. CFL failed at lower torque and rotation than the ATFL in combined repairs. There were strong correlations between intact stiffness and stiffness after repair (r=.74) and ATFL torque in LTF testing (r=.77), across both groups. There was no significant difference in peak pressure or contact area in the tibiotalar joint between the intact ankle and ATFL or combined repair. Conclusion: We found a greater increase in stiffness following combined ATFL and CFL repair compared to ATFL repair alone. This added stability is due to complimentary contributions of the CFL, not augmented LTF strength of the ATFL. Intact specimen stiffness correlated strongly with stiffness after repair and LTF torque, suggesting that a patient’s inherent tissue laxity or inelasticity is likely a meaningful predictor of strength after repair. Restoring the CFL plays a relevant role in lateral ligament repair, however sufficient time for ligament healing should be allowed before substantial inversion stresses are applied.
Effectiveness of hyaluronic acid injection after failed arthroscopic microfracture in osteochondral lesion of the talus
Authors: Hwang Yeokgu , Park Yoo Jung , Shim Dong-Woo , Park Kwang Hwan , Han Seung Hwan , Lee Jin Woo 
Published: September 2017

Category: Ankle, Arthroscopy Introduction/Purpose: Non-operative treatment options with symptomatic OLT after failed primary arthroscopic treatment may be treated by various methods such as analgesics, anti-inflammatory drug, steroid injection, Platelet rich plasma (PRP) injection and hyaluronic acid (HA) injection. HA injection could be treated OLT besides osteoarthritis on knee or ankle joint. Effect of HA is viscoelastic and lubricating properties primarily, and other biomechanical effect can be considered. Purpose of this study is to evaluate the clinical outcomes of intra-articular HA injection in the patients with recurrent pain after the arthroscopic microfracture for OLT Methods: This study included 20 patients who received three weekly injections of intra-articular HA after arthroscopic microfracture for OLT between June 2014 and August 2016. All patients had persistent pain for more than 3 months after the index surgery. The patients were followed for 16.7 months (range: 4.6-30.9). At each visit, the efficacy of HA injection in reducing pain was evaluated by a Visual Analog Scale (VAS). In addition, subjective satisfactions were assessed by the Alexander scale. Results: The mean period from the arthroscopic microfracture to the intra-articular HA injection was 26.5 months (range: 6.0- 87.0). Mean VAS scores decreased from 6.7 ± 1.1 at a pre-injection to 3.8 ± 2.3 at post-injection six months (p = 0.02). According to the Alexander scale, there were 65.0% (13/20) good, 25.0% (5/20) fair, and 10.0% (2/20) poor results at post-injection six months. There was no severe adverse effect. Conclusion: The HA injection may be a useful treatment option after failed arthroscopic microfracture in OLT. Further studies will be needed to evaluate long-term results.
Functional Outcomes of Peroneal Reconstruction with Peroneal Tendon Transfer
Authors: Jaffe David , Vier David , Kane Justin , Brodsky James 
Published: September 2017

Category: Hindfoot Introduction/Purpose: Tears of the peroneal tendons are a frequent cause of pain and disability. Surgical intervention is frequently warranted for symptoms that persist despite conservative management. Surgical treatment can include repair, local tendon transfers (i.e. peroneus longus to brevis transfer), or allograft reconstruction. While allograft reconstruction has been advocated for reconstruction of even a single peroneal tear, the indications are not widely agreed upon. The hypothesis of this study was that reconstruction with excision of the diseased tendon and transfer to the adjacent peroneal tendon produces significant improvements in both pain and function. Methods: Patients that underwent surgical intervention for peroneal tendon pathology at a single institution by a fellowship- trained foot and ankle orthopaedic surgeon were prospectively followed. Operative reports were reviewed to identify patients that underwent peroneal reconstruction with excision of the diseased tendon and local tendon transfer for chronic, severe peroneal tearing. Preoperative AOFAS and Visual Analog Scores (VAS) were obtained as a baseline and then repeated at one year following surgery. Statistical analysis was performed to compare preoperative and postoperative pain and function. Results: 14 patients were identified that underwent peroneal reconstruction without allograft tendon using reconstruction with excision of the diseased tendon and transfer to the adjacent peroneal tendon. Average age was 41.2 years (range 23-61 years) and average follow-up was 26.7 months (range 12-67 months). At one year, patients’ AOFAS scores improved from 51.9 +/- 12.2 to 90.7 +/- 3.4 (p<0.0001). VAS scores decreased from 6.5 +/- 1.2 to 1.6 +/- 0.9 (p<0.0001). There was 100% survivorship of the reconstruction procedure at one year. One patient underwent an allograft reconstruction for recurrent tearing five years after initial surgery and no other patients underwent a revision procedure. Demographic data and functional scores before and after surgery are displayed in Table 1. Conclusion: Peroneal reconstruction performed via excision of the torn tendon and local transfer to the adjacent tendon results in clinically significant improvement in pain and function without the need for allograft tissue. Patients may be counselled that peroneal transfer for chronic, severe tears leads to significant improvement and excellent clinical outcomes. This study shows excellent results can be obtained with local tendon transfer and the authors advocate this procedure to avoid the cost and risk of allograft transplant.
Comparison between Absorbable and Nonabsorbable Suture Material in Modified Broström Operation
Authors: Kang Chan , Kang Donghun , Song Jaehwang , Noh Chang-Kyun , Ahn Ki-Jun , Lee Gi-Soo 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: The current clinical standard for the surgical treatment of lateral ankle instability remains the modified Broström procedure. Almost surgeons are using non-absorbable suture material because of their strength & permanent. But this has several complications such as irritation, surface tenderness, etc. So we compare the clinical result between nonabsorbable and absorbable suture material. Methods: All patients who underwent the modified Broström operation of the anterior talofibular ligament and/or the calcaneofibular ligament by a single surgeon between July 2011 and May 2015 were included in this study. A total of 96 patients were included in this study: 63 men and 33 women (mean age, 33.16 years; range, 14-72 years). Non-absorbable suture(2-0 Fiberwire®, Arthrex, Naples, FL) patient were 50 (33 men, 17 women) and absorbable suture(0-Vicryl®, Ethicon, Sommerville, NJ) patient were 46(30 men, 16 women). Mean follow-up duration was 2.5 years (range, 1.0-4.7 years). Patients completed a subjective questionnaire. Outcomes measures included the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot and Ankle Society (AOFAS) and Reoperation cases by the recurred lateral ankle instability. All data were collected prospectively and reviewed retrospectively. Results: In non-absorbable suture group, The mean talar tilt angle in preoperative talar tilt test was 14.4 and in absorbable suture group, 13.7, respectively. The mean talar tilt angle in postoperative talar tilt test was 5.3 and in absorbable suture group, 6.1, respectively. There were no significant differences between non-absorbable suture method and absorbable suture method with talar tilt angle in varus stress x-ray (P > .05). There was no significant difference in FADI (87 vs 91; P = .553), AOFAS (83 vs 87; P = .372) score between non-absorable suture method group and the absorbable suture method group. During follow up, Except of 2 patients, they were no clinical symptom. Each one patient in non-absorbable and absorbable suture group underwent revision lateral ligament surgery. Conclusion: As compared with non-absorbable suture in open modified Broström procedure, absorbable suture method produced similarly favorable outcomes.
Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity
Authors: Kang Hwa Jun , Jung Hong-Geun , Lee Jong-Soo , Kim Sungwook , Sun Mao Yuan 
Published: September 2017

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.
Joint space widening may be a paradoxical pathologic feature of early ankle arthritis
Authors: Kim Ji-Beom , Lee Woo-Chun , Yi Young , Choi Seung-Myung 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Joint space narrowing and bony spur are typical pathologic feature of early ankle osteoarthritis. The meaning of joint space widening has never been discussed in previous literature. However, we found some osteoarthritic ankles which showed joint widening with diffuse spur change.(Fig.1) We hypothesized that joint space widening may be caused by malpositioning of the talus which may lead to degenerative arthritis. The purpose of this study were to investigate the radiological abnormalities in ankles with joint space widening. Methods: In order to define joint space widening and anterior subluxation of the talus, we included 72 ankles (66 people) with no abnormalities on plain radiographs into control group. We measured joint space and lateral talar station(LTS) on plain weight- bearing radiographs.(Fig.2) The 95% prediction interval of joint space (2.4 mm to 4.2 mm) and the LTS (-0.9 mm to 3.8 mm) in the control group were regarded as a normal range. The joint space widening was defined when the joint space was wider than 4.2 mm, and the anterior subluxation of talus was defined when the LTS was larger than 3.8 mm. Thirty-two ankles (29 people) with the joint space widening which underwent operation in our clinic between 2009 and 2014 were included in patient group. Ankle instability was determined on stress radiographs (Fig.2). In the patient group, we investigated the anterior subluxation of talus and the ankle instability, and the sites of spur in conventional CT. Results: The average age was 26 years (range:18 - 35) in the control group and 33 years (range:16 - 71) in the patient group. The mean joint space of the patient group was 4.7 mm (range: 4.3 mm to 6.0 mm). In the patient group, the LTS showed a mean of 6.4 mm (range 3.9 mm -10.7 mm). Because all the LTS in the patient group was over the 3.8 mm, the anterior subluxation of talus was showed in all ankles of the patient group. In the patient group, 31 ankles (97%) showed instability on anterior stress radiograph and 24 ankles (75%) showed instability on varus stress radiograph. All ankles in the patient group showed spurs on 4 sides of ankle, anterior, posterior, medial and lateral side. Conclusion: This study showed that paradoxical joint space widening may be a pathologic feature of early ankle arthritis which had diffuse spur change, anterior displacement of the talus and ankle instability.
Plantar Fascia Release Through a Single Lateral Incision
Authors: Kiskaddon Eric , Meeks Brett , Laughlin Richard , Roberts Joseph 
Published: September 2017

Category: Hindfoot, Midfoot/Forefoot, Cadaver Study Introduction/Purpose: Plantar fascia release (PFR) and calcaneal slide osteotomy (CSO) are often components of surgical management for cavus deformities of the foot. In this setting, the PFR has traditionally been performed through an incision over the medial calcaneal tuberosity, while the CSO is performed through a lateral incision. Two separate incisions can potentially increase surgical morbidity. We hypothesized that the plantar fascia could be fully released from the same lateral based incision that is used for the CSO, obviating the need for a medial incision. Methods: Six cadaver feet were dissected. A medial sided dissection was performed to isolate the tibial, medial plantar, lateral plantar, and calcaneal nerves, and the origin of the plantar fascia. Next, an incision was made on the lateral aspect of the ankle inferior and parallel to the peroneus longus tendon. Dissection was carried to bone. A curved face osteotome was utilized to sweep the plantar fascia off the calcaneus just distal to its proximal insertion. A #10 scalpel was inserted into this space, parallel to the plantar fascia and was directed towards the plantar fascia insertion; it was then turned ninety degrees so that the blade was perpendicular to the plantar fascia. The ankle was dorsiflexed until a full release was achieved. A Stryker oscillating saw was used to create a CSO through the lateral incision. We then inspected the medial structures in their relationship to the PFR and CSO. Results: In all six cadavers, the plantar fascia was fully released from its origin at the medial calcaneal tuberosity through the lateral incision. There was no obvious damage to the medial and lateral plantar nerves with this lateral based PFR. The CSO made through the lateral incision reliably crossed the calcaneal branch of the tibial nerve in all specimens and the osteotomy was posterior to the lateral and medial branches of the tibial nerve. Conclusion: PFR through a lateral incision is a safe and reliable method as part of the surgical treatment for cavus deformities of the foot. We achieved a full PFR in each cadaver specimen. An added benefit is that PFR through a lateral incision avoids the morbidity of an additional surgical incision. Further, a calcaneal slide osteotomy performed through a lateral based incision reliably crosses the calcaneal branch of the tibial nerve. Both PFR and CSO can be safely performed through a lateral incision; however, care must be taken when completing the CSO to ensure that the medial neurovascular structures remain uninjured.