bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic alterations and hearing acuity
Authors: Pirodda Antonio , Brandolini Cristina , Raimondi Maria Chiara , Pelligra Irene , Strocchi Enrico , Cicero Arrigo F.G. , Rosticci Martina , Borghi Claudio 
Published: December 2015

Objective:
To contribute to assessing the extent of the clinical significance of metabolic alterations in terms of hearing deterioration.

Study design:
The design enabled comparison of the serum level of cholesterol, apolipoproteins, glucose and uric acid in a homogeneous, controlled population of subjects with normal hearing and with symmetrical sensorineural hearing loss, respectively. All subjects were enrolled within the Brisighella Heart Study (BHS), a prospective, population based longitudinal epidemiological investigation involving almost 3000 randomly selected Caucasian subjects living in Brisighella, a small town in northern Italy.

Results:
No statistical difference was identified in the metabolic assessment of the two groups (normal hearing vs. impaired hearing). In particular, alteration of the serum lipids, glucose and uric acid parameters is not significantly associated with hearing loss (p > 0.01).

Conclusions:
The findings, apparently in disagreement with common opinion, seem to imply that the role of metabolic disorders is not pre-eminent in the genesis of non-acute hearing loss. It is possible to hypothesize that all mechanisms regulating the microcirculation of the inner ear can constitute a ‘buffer’ against the related cellular damage. It is likely that if a convenient and sufficiently stable degree of oxygenation is maintained, this might be enough to preserve hearing function even under unfavourable metabolic conditions.
Early Results After Tibialis Anterior Tendon Transfer for Severe Varus in Total Ankle Replacement
Authors: Hamel Johannes 
Published: December 2015

Background: Treatment of severe ankle arthritis with varus malalignment remains controversial. Methods: In 14 consecutive total ankle replacements (TAR) with tibiotalar varus malalignment of above 15 (range, 16 to 41) degrees, a complete transfer of the tibialis anterior tendon together with other soft-tissue and bony realignment measures was added to the primary procedure. Results: After mean followup time of 33.4 (range, 21 to 49) months, only one case showed minor tibiotalar tilt in the frontal plane. The overall clinical results were good to excellent in all but two cases with an average AOFAS-score of 86.4 (range, 70 to 98) points. However, three cases of tibial nerve neuropathy due to entrapment or overtensioning were observed; one of these cases developed clinical problems with incomplete recovery. Conclusion: Tibialis anterior tendon transfer can be recommended in conjunction with TAR in cases of varus malalignment with severe muscular or ligamentous imbalance with neuropathy of the tibial nerve being the main complication. Level of Evidence: IV, Retrospective Case Series
Lesser Metatarsophalangeal Instability: Presentation, Management, and Outcomes
Authors: Peck Christopher N. , Macleod Alan , Barrie Jim 
Published: December 2015

Background: Lesser metatarsophalangeal (MTP) instability is a common cause of forefoot pain. In this prospective study, we looked at its presentation, management and outcome. Methods: We studied characteristics of patients presenting to a specialist foot and ankle clinic with lesser MTP instability. We used the drawer test to diagnose and stage instability. Patients were followed up in clinic or by telephone interview. Results: We identified 154 patients with lesser MTP instability; 127 (82%) were female, median age was 56 years. One foot was affected in 107 patients (69%). The second toe only was affected in 99 patients (64%) and multiple toes in 52 (34%) but always involving the second toe if multiple toes involved. 150 toes (52%) had Grade 1 instability, 108 (37%) Grade 2 and 21 (7%) Grade 3 instability. Twelve toes (4%) presented dislocated. Ninety nine patients (64%) were treated nonoperatively, using functional taping, shoe modifications, and injections. Fifty five patients (36%) were treated operatively, including lesser toe straightening, flexor-extensor transfer, Weil and Stainsby procedures. At followup, the mean AOFAS score and standard deviation was 69 ± 16.3 for the nonoperative group compared to 67 ± 17.8 in the operative group. The mean pain score and standard deviation was 31 mm ± 23.7 mm for the nonoperative group and 23 mm ± 24.1 mm in the operative group. Thirty-nine patients (52%) were either satisfied or very satisfied with treatment in the nonoperative group compared to 31 patients (66%) in the operative group. None of these differences were statistically significant. Conclusion: Painful MTP instability is a common cause of forefoot pain. Most patients can be treated nonoperatively. Operatively treated patients had no significant improvement in outcomes with regards to pain or function. Level of Evidence: III, Comparative Case Series
Nonoperative Management of Retrocalcaneal Pain with AFO and Stretching Regimen
Authors: Johnson Michael D. , Alvarez Richard G. 
Published: December 2015

Background: Retrocalcaneal heel pain is caused by a spectrum of etiologies all resulting in the same symptom of pain at the tendon-Achilles insertion. Several studies have reported the outcomes of operative treatment, but none have reported the outcomes or success rates of nonoperative treatment. We describe a detailed treatment algorithm and report the clinical outcomes. Methods: One hundred thirty-five patients were prescribed a treatment regimen consisting of an AFO and stretching program and were enrolled in our prospective study. One hundred three patients completed pre- and post-treatment Foot Function Indices and were included in the analysis. The effect on FFI from clinical and radiographic factors was examined. Results: Of the study population, 76% had a BMI greater than 25, 80% were older than 50 years, and 75% had an exostosis on radiographs. The mean pre-treatment FFI was 48.4 and the mean post-treatment FFI was 18.6 indicating a statistically significant improvement in function of 29.8. Neither BMI nor age had a significant effect on the magnitude of improvement; though, smokers had significantly less improvement. FFI improvement in patients with an exostosis were less than those without an exostosis. Patients with an exostosis less than 1 cm had less improvement than those with an exostosis of 1 cm or more. Patients with Types I and III exostoses had significantly less improvement in FFI compared to Types II and IV. Twelve of the 103 (11.6%) were not pleased with the results of nonoperative treatment and elected to have a procedure performed. Conclusion: Our study is the first to report the outcome of non operatively treated retrocalcaneal heel pain and to classify retrocalcaneal exostoses. Using our treatment algorithm, we had an 88% success rate in alleviating symptoms and avoiding surgery. Our data suggests that the use of an AFO and stretching regimen may benefit patients suffering from retrocalcaneal heel pain. Level of Evidence: IV, Case Series
Functional Results of Posterior Tibial Tendon Reconstruction, Calcaneal Ostetomy, and Gastrocnemius Recession
Authors: Kou Joseph X. , Balasubramaniam Mamtha , Kippe Matthew , Fortin Paul T. 
Published: December 2015

Background: This study aimed to assess and provide prospective outcome data following reconstruction of Stage II posterior tibial tendon insufficiency, as well as evaluate the effect of reconstruction with gastrocnemius recession on plantarflexion strength. Methods: A prospective evaluation of 24 patients undergoing reconstruction for Stage II posterior tibial tendon insufficiency was granted IRB approval. The reconstructive procedures consisted of a flexor digitorum longus transfer, medial displacement calcaneal osteotomy, lateral column lengthening, and gastrocnemius recession. Patients were asked to complete multiple outcome measures preoperatively, 6 months, 1 year, and 2 years postoperatively. A dynamometer was utilized to evaluate peak torque plantarflexion preoperatively, 6 months, and 1 year postoperatively. Results: In the study, 14 patients completed preoperative surveys, and 23 patients had 2-year followup. Patients were highly satisfied with the results of their surgery. All outcome measures showed statistically significant improvement. Improvement was seen at 6 months, but results continued to improve at the 1-year mark. By the second year, improvement largely reached a plateau. Biodex testing showed no loss of plantarflexion strength after reconstruction and gastrocnemius recession. Conclusion: Reconstruction of the flexible adult acquired flatfoot with FDL transfer, double calcaneal osteotomy, and gastrocnemius recession yielded excellent functional results for the treatment of Stage II posterior tibial tendon insufficiency. Plantarflexion weakness was not found to be a concern. A good functional outcome can be anticipated after the early postoperative period. However, it should be expected to take at least 1 year for maximal benefit. Level of Evidence: III, Prospective Case Series
Anatomic Location and Morphology of Symptomatic, Operatively Treated Osteochondral Lesions of the Talus
Authors: Orr Justin D. , Dutton Jason R. , Fowler Justin T. 
Published: December 2015

Background: Historically, osteochondral lesions of the talus (OCLTs) were thought to occur most commonly in the anterolateral and posteromedial talar dome; however, new classification systems are able to describe OCLT location more precisely. A recent magnetic resonance imaging (MRI) study introduced a novel nine-zone anatomic grid of the talar dome, demonstrating that most OCLTs occur in the central portion of the medial and lateral talar dome, with medial lesions being more common as well as larger in depth and surface area. The current study sought to determine if similar location and morphology patterns were consistent in symptomatic, operatively treated OCLTs. Materials and Methods: The preoperative MRI images of 65 consecutive patients who underwent operative management for symptomatic OCLTs at a single institution were reviewed using a previously described nine-zone anatomic grid of the talar dome to determine location frequency, morphology, and Hepple et al. MRI staging classification characteristics. All patients were active-duty service members in the United States Armed Forces. The cohort consisted of 60 (92%) males and 5 (8%) females with an overall mean patient age of 34 (range, 19 to 58) years. Statistical analyses were performed, and significant differences are reported. Results: The most common location for symptomatic, operatively treated OCLTs was the central third of the lateral talar dome, followed by the central third of the medial talar dome. Anterolateral and posteromedial lesions accounted for relatively few OCLTs. Compared with lateral OCLTs, medial OCLTs were significantly larger in transverse and anteroposterior diameters and surface area, but no significant differences existed with regard to lesion depth. Overall, the majority of lesions were MRI stage II; however, stage II lesions were more likely located laterally, whereas stage III lesions were more likely located medially. Conclusions: With regard to symptomatic, operatively treated OCLTs, the results of the current study parallel current evidence that posteromedial and anterolateral OCLTs are not the most common locations of OCLTs. As well, medial OCLTs were larger in surface area than lateral OCLTs, but no differences existed with regard to lesion depth. It is interesting that operatively treated OCLTs were twice as commonly located in the centrolateral third rather than the centromedial third of the talar dome. Level of Evidence: IV (Retrospective Chart Study)
Comparison of Arthroscopic and Magnetic Resonance Imaging Findings in Osteochondral Lesions of the Talus
Authors: Bae SooHo , Lee Hyeon Kyeong , Lee Kyunghee , Lim Sanghyeok , Rim Nae-Jung , Kim Jin-Su , Cho Jaeho 
Published: December 2015

Background: Magnetic resonance imaging (MRI) is widely used for diagnosing osteochondral lesions in the talus. The purpose of this study was to directly compare the MRI with the arthroscopic findings. Materials and Methods: MR images of 42 ankles were retrospectively reviewed during a period of 67 months. The osteochondral lesions were evaluated by both MRI (0, normal; 1, subchondral trabecular compression and marrow edema; 2A, subchondral cyst; 2B incomplete separation fragment; 3, unattached, nondisplaced fragment with synovial fluid surrounding it; 4, displaced fragment) and arthroscopy (A, smooth and intact, but soft and ballottable cartilage; B, rough surfaces; C, fibrillations or fissures; D, flap present or bone exposed; E, loose, undisplaced fragment; F, displaced fragment). Arthroscopic grade A was considered to be equivalent to MR grade 1, B and C to MR grade 2A, D to 2B, E to 3, and F to 4. Results: Of the 44 lesions in 42 ankles, 29 lesions marked the same grade on both MRI and arthroscopy (65.9%). Nine lesions were upgraded on arthroscopy (20.5%), and six were downgraded (13.6%). MR grade 3 lesions showed the best correlation (83.3%) and MR grade 1 and 2B lesions showed the worst (50.0 and 55.6 %). Arthroscopic grade A and F showed good correlation (80 and 100%). Grade C and E showed poor (25.0%) and intermediate correlation (66.7%), respectively. Conclusion: The MRI grading of osteochondral lesions in the talus was useful and showed a fairly good correlation with arthroscopic classification. Level of Evidence: IV, Retrospective Case Series
Treatment of Osteomyelitis in Charcot Foot with Single-Stage Resection of Infection, Correction of Deformity, and Maintenance with Ring Fixation
Authors: Pinzur Michael S. , Gil Joseph , Belmares Jaime 
Published: December 2015

Background: There is both increased interest and awareness in diabetes-associated Charcot foot arthropathy. The number of affected patients will likely increase as the incidence of both diabetes and morbid obesity increases. Many experts now favor surgical correction of the deformity rather than longitudinal management with accommodative bracing. In patients with open wounds and exposed bone and/or chronic osteomyelitis, it is controversial whether resolution of the bony infection should be achieved before attempting surgical correction of the acquired deformity. Methods: During a 78-month period, 178 patients underwent surgical correction of deformity with diabetes-associated Charcot foot or ankle arthropathy by a single surgeon. Seventy-three had evidence of osteomyelitis at the time of surgery. There were 41 males and 32 females. Their average age was 57.9 (range, 31 to 76) years, and body mass index was 36.9 (range, 21.8 to 60.9). The clinical diagnosis of osteomyelitis was made by ( a) an open wound overlying the deformity with exposed bone and chronic drainage; ( b) a history of biopsy-diagnosed osteomyelitis that was not currently draining, but had clinical and pathologic evidence of abnormal bone in the region of the previous infection; or ( c) a history of previous wound overlying bony deformity with abnormal bone observed at the time of surgery. Surgery involved radical resection of the clinically infected bone, combined with acute correction of the deformity to a plantigrade foot. Parenteral culture-specific antibiotic therapy was administered and monitored by an infectious disease comanagement service. A three-level preconstructed static circular external fixator was applied to maintain the surgically obtained correction. Results: Sixty-eight of 71 patients (95.7%) achieved limb salvage and were able to ambulate with commercially available therapeutic footwear. One patient died shortly after removal of the external fixator from unrelated causes. Three patients required amputation. Resolution of infection and wound closure was achieved in five patients following a second surgical debridement. Two noninfected wounds were resolved with local soft tissue flaps. Two patients have persistent noninfected wounds that have been resistant to wound care therapy. Discussion: A plantigrade noninfected foot can be achieved in patients with infected diabetic Charcot foot deformity with single-stage radical resection of osteomyelitis, correction of the deformity, maintenance of the correction with static external fixation, and culture-specific antibiotic therapy. Level of Evidence: IV, Retrospective Case Series
Gastrocsoleus Fascial Release for Correction of Equinus Deformity in Residual or Relapsed Clubfoot
Authors: Park Soo-Sung , Lee Ho Seong , Han Sang-Ho , Park Jin-Woong , de Peralta Maria Josephine B. 
Published: December 2015

Background: Regardless of the mode of treatment, clubfoot has a strong tendency to relapse, especially hindfoot equinus. Because contraction or shortening of the Achilles tendon causes an equinus deformity of the ankle, release of this tendon is required to correct equinus deformity in patients with residual or relapsed clubfoot. This study assessed the effectiveness of the Vulpius technique in correcting equinus deformity in patients with residual or relapsed clubfoot. Methods: Of the 80 idiopathic clubfeet treated conservatively using the Ponseti protocol, between March 2000 and July 2008, 32 were found to have residual or relapsed equinus deformity, with 22 feet in 17 patients undergoing Vulpius-type Achilles tendon lengthening. Mean age at the time of surgery was 29 (range, 6 to 52) months, and mean follow-up was 48 (range, 24 to 78) months. Clinical evaluation included the dorsiflexion angle of the ankle and radiographic evaluation included the talocalcaneal and tibiocalcaneal angles on dorsiflexion lateral views. Results: All 22 feet showed satisfactory results at last follow-up, with significant improvements in mean ankle dorsiflexion angle, mean tibiocalcaneal angle, and mean lateral talocalcaneal angle ( p <.05 each). Conclusion: The Vulpius procedure is an effective surgical procedure for correcting equinus deformity in residual and relapsed clubfeet. Level of Evidence: IV, Case Series
Long-Term Follow-up of Lateral Reconstruction with Extensor Retinaculum Flap for Chronic Ankle Instability
Authors: Tourné Yves , Mabit Christian , Moroney Paul J. , Chaussard Christophe , Saragaglia Dominique 
Published: December 2015

Background: Chronic instability is a common complication of lateral ankle sprains. Furthermore, patients often have unrecognized associated lesions affecting the ankle and subtalar joints. Many stabilizing surgical techniques have been described, each with variable results. This article reports the long-term results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap. Patients and Methods: This is a retrospective, multicenter study. One hundred fifty cases were reviewed at a mean follow-up of 11 years. Functional results were assessed using the Karlsson score. Pre- and postoperative radiological assessment employed stress x-rays to measure varus tilt and anterior drawer and the Van Dijk classification to grade osteoarthrosis. The Stata 10 program was used for statistical analysis. Results: A thorough preoperative workup identified ligamentous lesions of the subtalar joint in 30% of cases. At review, 93% of patients were satisfied. Residual instability was present in only 4.8%. Radiographic analysis of both ankles revealed a differential in varus tilt of only 0.12° and in anterior drawer of 0.17 mm. There was no deterioration of the articular surfaces after 11 years of follow-up. Conclusion: To the authors' knowledge, this is the largest series reported with such a follow-up. This technique addressed both lateral ankle and subtalar instability without sacrificing the peroneal tendons. It protected against progression of posttraumatic arthrosis and provided superior results to other reported techniques in terms of patient satisfaction and residual instability. Level of Evidence: IV, Retrospective Case Series
Modified Mitchell Osteotomy with Screw Fixation for Correction of Hallux Valgus
Authors: Huang Shih-Hao , Cheng Yuh-Min , Chen Chung-Hwan , Huang Peng-Ju 
Published: December 2015

Background: The authors have performed more than 1500 cases of a Mitchell osteotomy and traditionally used two crossed pins for fixation. The previous series showed some complications related to pin tract infection, pin migration, and transfer metatarsalgia. Since 2009, the authors have used a compression screw for fixation and made some technical modifications and the results are reported in this article. Methods: A total of 95 patients underwent a Mitchell ostotomy to correct hallux valgus deformity with fixation with multi-use compression (MUC) screws. Hallux valgus angle (HVA), intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale were measured preoperatively and postoperatively. Results: There were statistically differences between the preoperatively and postoperatively HVA, first IMA, and AOFAS hallux metatarsophalangeal-interphalangeal scores. Five patients (8/137 feet, 5.8%) underwent removal of the screw because of screw tip irritation. Eight patients (9/137 feet, 6.5%) had transfer metatarsalgia of the second metatarsal, with two of them caused by dorsal tilt of the metatarsal head. One patient (1/137 feet, 0.7%) had undercorrection. There was no superficial infection, deep infection, nonunion, or osteonecrosis of the first metatarsal head. Conclusion: On the basis of the results observed in this study, it appears that the use of a multi-use compression screw provides satisfactory stabilization of the modified Mitchell osteotomy and was not associated with any serious complications. The modified technique also helped reduce transfer metatarsalgia. Level of Evidence: IV, Retrospective Case Series
Arthroscopic Treatment of Tenosynovitis of the Flexor Hallucis Longus Tendon
Authors: Corte-Real Nuno Manuel , Moreira Rodrigo Manuel , Guerra-Pinto Francisco 
Published: December 2015

Background: Tenosynovitis of the flexor hallucis longus (FHL) tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. A traumatic cause for this situation, such as an ankle sprain, is considered rare. In case of failure of conservative treatment, the tendon can be surgically released, which is usually done through an open procedure. This article presents the results of an arthroscopic release of the FHL. Methods: Twenty-seven patients underwent surgery for FHL tenosynovitis over a period of 18 months. The mean age of the patients was 34 years. All patients related the onset of the condition with an ankle sprain. Eighteen patients were on worker's compensation and five had sport-related accidents. None of the patients was a professional athlete or a ballet dancer. The mean follow-up was 32 months. The outcome was measured with a satisfaction questionnaire and with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system. Results: The mean postoperative AOFAS score was 89 with 70% excellent or good results. Mean satisfaction rate was 4 (range, 0 to 5); 89% of the patients would undergo the procedure again. Twenty-two patients (81%) returned to the same level of activity in work and sports. A complication rate of 18% (five patients) and reoperation rate of 4% (one patient) were found. Conclusion: Arthroscopic release of the FHL tendon was a valid procedure. It was a minimally invasive surgery that allowed good visualization of the involved structures and yielded good results. This condition can be related to trauma and is not an exclusive disease of ballet dancers or overuse. Level of Evidence: IV, Retrospective Case Series