bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early and Late Repair of Lateral Ligament of the Ankle
Authors: Gould Nathaniel , Seligson David , Gassman Jeffrey 
Published: March 2013

Utilizing an apparatus for separately testing the status of the anterior talofibular and the calaneofibular ligaments of the ankle in 25 healthy, 15 to 30-year-old adults, it became apparent that the stability of the ankle depends primarily upon the integrity of the anterior talofibular ligament. When the “fore n' aft” stress measurement exceeds 4 mm, a positive anterior drawer test is elicited, and the ankle ligament needs surgical repair. Tibial talar tilt normals ranged up to 18°. Repair (early and late) is accomplished by suturing what one finds (there is always some ligament present) and reinforcing the anterior talofibular ligament repair with overlap of the nearby lateral talocalcaneal ligament plus the marginal ankle retinaculum. Four weeks in a plaster of paris walking cast are followed by use of Ace bandages for 2 weeks. Light activity is begun 6 weeks after repair, and activity of choice is begun 8 weeks after repair. Repeat stress testing is performed at 3 months postsurgery, and a questionnaire is completed at the same time. On a point system (1 to 10) reviewing pain, stability, and swelling, the results in 50 cases rate from 8 to 10, with a lower rating improving with more time. Surgical time is approximately 30 minutes. There seems to be no need for more radical surgery utilizing other muscles. The senior author has employed this surgery for the past 19 years with approximately 165 cases. Only 50 patients with proper 3-month postoperative stress testing and questionnaire follow-up, who were operated upon 1 or more years ago, are recorded here.
Ankle Fusion with the Hoffmann External Fixation Device∗
Authors: Newman Andrew , Edwards Charles C. 
Published: March 2013

For over 100 years, many different types of external fixation have been used to immobilize fracture fragments. The greatest aceptance of external fixation has been with open fractures of the tibia. Three ankle fusions, all complex cases, were performed using the double-framed Hoffmann external fixation device. The deformities treated were a severe posttraumatic equinus deformity of the ankle and forefoot, a painful nonunion of a previous ankle fusion, and an equinus deformity secondary to a transmetatarsal amputation.
The Growth of the First Metatarsal Bone∗
Authors: Vilaseca Ramon Rochera , Ribes Eduardo Rabat 
Published: March 2013

This study presents a common finding in the first metatarsal bone of a distal epiphyseal cartilage which is considered as a physis. This growth center is omitted in the classic anatomical descriptions of the bone. Analyses of the growth of this physis relates to the metatarsal formula of the adult foot. It may result in a first metatarsal “index-plus,” where the first metatarsal is longer than the second, depending upon the duration of the activity of the physis. The presence of this physis may be related, in some cases, to:Hallux rigidus. The conformation of index-plus anatomically predisposes the development of such degeneration.Kohler's metatarsal disease. Disturbance in the arterial vascularity of the epiphyseal-metaphyseal type may, in theory, cause osteonecrosis of the first metatarsal head, although no cases have been reported in the literature.Osteochondritis dissecans. Our finding that disorders of epiphyseal ossification may lead to the development of osteochondritis dissecans.
Foot and Ankle Manifestations of Reiter's Syndrome
Authors: Chand Yogesh , Johnson Kenneth A. 
Published: March 2013

If one were to characterize the clinical presentation of Reiter's syndrome in the feet and ankles, it would be that of pain associated with mild to moderate swelling and tenderness without significant erythema. These changes would occur most commonly at the posterior calcaneus, metatarsophalangeal joint, and phalangeal regions. The ankles will usually show an effusion. It is very uncommon for the subtalar region, midfoot region, or even the metatarsal shaft area to be involved. Roentgenographic changes were present in a similar frequency as in physical findings. Erosions and soft tissue swelling affect the forefoot and ankle while “spurring” and erosions affect the hindfoot. It is readily apparent that no single clinical finding or radiographic change indicates Reiter's syndrome. The type and location of foot pain is what should prompt the physician to seek further elements allowing the diagnosis of Reiter's syndrome.
Stenosing Tenosynovitis of the Pseudosheath of the Tendo Achilles
Authors: Gould Nathaniel , Korson Roy , Weiker Garron G. 
Published: March 2013

This entity consists of a chronic inflammatory process of the peritenon of the tendo Achilles (usually bilateral) at variable points of the tendon itself but usually near the insertion in the Achilles. Its occurrence, not only in runners but in relatively sedentary individuals of both sexes, seems to be the result of microtrauma of stress with insidious onset of local pain in increasing degree with physical activity. Clinically, in the advanced cases, fibrillation, nodulation, and “yellowing” of the edematous tendon occur and probably are a precursor to later ruptures. Pathological changes consist of one or more of the following: a myxomatous degeneration of collagenous tissue; fibrosis; round cell inflammatory infiltrate; and proliferation of fibrovascular connective tissue. The use of steroid injections seems to be of no help and probably is contraindicated. Surgery consists of excision of the entire pseudosheath, allowing the tendon to assume a new, nonconstricting alignment. All but one of the nine patients with a follow-up of at least 1 year went on to clinical, painless recovery, with unrestricted future activity, in just a few months.
Giant Cell Tumor and Aneurysmal Bone Cyst of the Talus: Clinicopathological Review and Two Case Reports
Authors: Malawer Martin M. , Vance Raymond 
Published: March 2013

Two cases of giant cell tumor and aneurysmal bone cyst of the talus were analyzed with a review of eight cases from the literature. This anatomic setting represents a distinct clinical and roentgenographic entity with a less aggressive natural history than the more common sites. All lesions presented a characteristic radiographic involvement of the head and neck of the talus. Eight of ten lesions were treated by curettage, with or without bone grafting, and healed. Two underwent partial en bloc resection. None developed late fracture, recurrence, avascular necrosis, or metastases. We concluded that a giant cell tumor or aneurysmal bone cyst when located in the talus may be difficult to differentiate but tends to exhibit a less aggressive biological behavior and a more favorable prognosis than the more classical proximal lesion. Talectomy is not indicated in the primary treatment. Curettage with or without bone graft has a high success rate. Cryosurgery should be reserved for a recurrent lesion.
Investigation of Lateral Ankle Ligament Reconstruction
Authors: Horstman James K. , Kantor George S. , Samuelson Kent M. 
Published: March 2013

The problem of chronic instability of lateral ankle ligaments has been approached with both conservative and surgical measures. Many operative procedures have been devised to correct this problem, and of these the Watson-Jones, modified Elmslie and Evans procedures are the most commonly used in our community. This paper was designed to: 1) compare the results of the three procedures; 2) investigate subtalar motion in a population of uninjured ankles; and 3) compare these results to subtalar motion in ankles after lateral ligament reconstruction. We found that each of the three procedures had a surprisingly high incidence of postoperative pain. All procedures had a high rate of return to preinjury activity level, and the majority of the patients were satisfied with the results of the operation. Postoperatively, the Watson-Jones repair exhibited the highest percentage of subjective instability. Twenty-four per cent of the Watson-Jones repairs had a postoperative talar tilt greater than 5°. It was determined that subtalar motion was affected by the type of reconstructive procedure, and although this fact had been theorized in the literature, it had not been documented by objective data.
Thoughts on In-toeing and Out-toeing: Twenty Years' Experience with Over 5000 Cases and a Review of the Literature
Authors: Weseley Martin S. , Barenfeld Philip A. , Eisenstein Arthur L. 
Published: March 2013

We are reporting over 5000 cases of children presenting with toeing-in or toeing-out problems. Patients were seen over a period of 20 years. The toeing-in and toeing-out gait patterns are discussed in terms of the relationship to the hip joint and the tibiofibular unit. It is concluded by the authors that most of these problems represent normal variants in the development of the child and require no treatment. The necessity and modalities of therapy for the remainder are discussed in detail. The current literature on the subject is also reviewed.
Calcaneal Fractures: A Good Prognosis
Authors: Hammesfahr Rick , Fleming Lamar L. 
Published: March 2013

Calcaneal fractures at Grady Memorial Hospital were reviewed for the period of 1973 to 1980. Sixty-two of these fractures were available for follow-up. Treatment was with compression dressings, plaster, pin reduction or open reduction. Grading was by the previously published criteria of Allen and Lindsey. 1 , 21 This paper identifies a positive correlation between facet reduction and successful treatment results. Recommendations are made for fracture classification, surgical treatment and postoperative management.
Surgical Principles Based on Anatomy of the Foot: Preoperative Planning
Authors: Acton Rush 
Published: March 2013

The time for planning an operative incision and approach begins in the office when the patient is first examined and his problem is reviewed. The area anatomy should be carefully studied in the interim prior to the surgical date. At surgery, a sterile marking pencil is employed and its outline carefully studied before the actual incision is made. A thorough knowledge of biomechanics dictates the procedures which may be considered feasible. Only by following such a carefully outlined course, can the surgeon feel reasonably secure that the surgery he proposes to his patient in his office, has a logical chance for a successful outcome.
Office Practice: Footwear and Orthotic Therapy
Authors: Cracchiolo Andrea 
Published: March 2013

The evaluation of a patient with a foot disorder should include a careful history and examination of the foot. A more extensive evaluation may be indicated as many systemic diseases may initially involve the foot. The patient's shoes are most important and frequently correlate well with the foot pathology. Appropriate radiographs which should include weightbearing views are essential, and selected laboratory studies may be indicated. Although it may be practical to divide the foot into the components of forefoot, midfoot, and hindfoot; these three areas are functionally connected. A deformity in one area usually affects the other areas of the foot. Office procedures should include practical care of the nails and hyperkeratotic lesions which are easy to trim. Shoes must be of appropriate size to fit the forefoot and heel. The shoe may require modification or orthotic devices to accommodate existing pathology.
Revision Rates in Forefoot Surgery
Authors: Cameron Hugh U. , Fedorkow Donna M. 
Published: March 2013

In an attempt to determine failure or reoperation rates for common forefoot procedures, the records of 706 patients who had 1003 forefoot operations were studied. The revision rate for the Keller procedure was 2.26% when no interposition implant was used. The revision rate for metatarsal osteotomies, mainly due to nonunion, was 2.7%. The revision rate for proximal phalangectomies was 3.3%, being 1.9% when the distal end of the phalanx was removed and 4.4% when the proximal end was removed. The failure rate for proximal interphalangeal joint fusion was 17.8%. These results demonstrate that the antiquity of a procedure is not necessarily a recommendation.
The Modified Blair Fusion
Authors: Lionberger David R. , Bishop John O. , Tullos Hugh S. 
Published: March 2013

The Blair fusion is the accepted method to achieve an ankle arthrodesis in the presence of avascular necrosis or absence of the body of the talus. This procedure has not however, been reliable. A pseudarthrosis rate of 28% and fibrous ankylosis of the foot secondary to prolonged immobilization compromise the end result. A tibiotalar compression arthrodesis has been developed using an intermediate hip compression screw and a modified Stone staple. Five patients with avascular necrosis of the talus underwent a modified Blair fusion. Protected weightbearing was started at 6 weeks and healing occurred within 3 months. Although the number of cases is small, this study indicates that the addition of compression fixation to the Blair arthrodesis will significantly decrease the pseudarthrosis rate and perhaps the healing time.
Surgery of the Forepart of the Foot in Rheumatoid Arthritis
Authors: Gould Nathaniel 
Published: March 2013

The purpose of this paper is to introduce a surgical approach to treatment of severe forefoot deformities of rheumatoid arthritis. Briefly, the surgery consists of base of the first metatarsal osteotomy to correct metatarsus primus varus, and metatarsal head resection beginning with the fifth metatarsal and carried around in crescentic fashion through the necks of the other metatarsals, so that as an end result the great toe is the longest, the second next to the longest, etc. The short extensor tendons are dissected to their insertions and, since they have drifted laterally into the “valleys” pulling the toes into lateral drift with them, they are usually sacrificed. The long extensor tendons are appropriately lengthened to proper tension. All the toes are straightened by plantar capsulotomies, dermotomies, and long flexor tenotomies, and the toes held straight with C-.045 wire in shishkabob fashion. Then, under direct vision, each wire is drilled up into the metatarsal shaft, aligning the toes into parallel cosmetic fashion. In the early cases, a single stem silastic implant was utilized but for the past 5 years now the double stem silastic implant is employed for the first MTP joint and is inserted “upside down” in order to give its greater power towards the floor. A cast is not used, but the patient ambulates on a well-padded bandaged foot by the second or third day. Twenty patients (40 feet) were operated upon (17 females and 3 males, ages 28 to 72 years, average 47 years), with a follow-up of 3 to 5 years. Pain relief has been remarkable. Good great toe function has been obtained in all cases with excellent power to the floor and a satisfactory range of dorsiflexion ability. About 67% have developed some mild recurrence of hallux valgus, but none so severe that it has been disabling. All patients have been pleased with their final results.
An Anatomic Study of the Anterior Superior Process of the Os Calcis and Its Clinical Application
Authors: Jahss Melvin H. , Kay Bruce S. 
Published: March 2013

The anatomy of the anterior superior process of the calcaneus was studied from 15 fresh amputation specimens and from two cases of surgical intervention of fractures of this process. Specific anatomic relationships exist between the associated ligamentous attachments and the production of fractures of this process. It was found that both the anterior interosseus talocalcaneal and calcaneocuboid ligaments were tight on inversion and on inversion plus plantarflexion, suggesting that both of these ligaments may play a part in the production of avulsion fractures of the anterior calcaneal process. The relationship between the articular facets of the calcaneal process, including the inconstant anterior talocalcaneal facet, and the occasional unexpected poor results encountered with these fractures is described. Finally, the local anatomy is correlated with tarsal coalitions found in this area.
The High Incidence of Mismated Feet in the Population
Authors: Rossi William A. 
Published: March 2013

All Americans, and most likely all individuals in all societies, have mismated feet; that is, the two feet of probably no individual are exactly alike in size, shape, or proportions. This conclusion was based on the findings of a demographic foot-measurement survey embracing 6800 adults (4000 females, 2800 males), conducted in 1981–1982 by the Prescription Footwear Association. The findings may explain why the ideal or expectation of “perfect” shoe fit is virtually impossible, although they do not suggest that adequate or satisfactory shoe fit is not attainable in most instances involving so-called “normal” feet. They also indicate that a mild degree of “breaking in” is required with most new footwear, although never necessitating any distress. This article presents the methodology of the survey and foot measurements, along with the found data and their significance regarding the traditional processes of search of “proper” shoe fit and the obvious need for higher levels of professional shoe-fitting skills and service. The article also analyzes and discusses some little known or seldom considered complexities of shoe fit and the foot-shoe relationship that surfaces from this study, for example, the role of shoe design, shoe-sizing systems, consumer shoe-buying attitudes, and shoe materials, the four variable phases of shoe fit (static, weightbearing, functional, and thermal), and the availability of shoe sizes in stores.
Total Joint Prosthetic Arthroplasty of the Great Toe—A 12-Year Experience
Authors: Kampner Stanley L. 
Published: March 2013

This report describes the use of a double-stemmed flexible hinge silicone elastomer implant for use as a total joint replacement for the metatarsophalangeal joint of the great toe. Experience with this prosthesis has been since 1971 with 103 prostheses implanted in 71 patients with a minimum follow-up of 12 months and an average follow-up of 7.4 years. Of the 71 patients, 40 had osteoarthritis with 64 joints replaced, 22 had rheumatoid arthritis with 29 joints replaced, four patients were revised from a failed excisional hemiarthroplasty, three patients with four joints involved were revised from a failed silicone implant hemiarthroplasty, and two patients had a surgically arthrodesed metatarsophalangeal joint taken down and revised to a total joint arthroplasty. Of the total number of patients involved, eight were men, 63 were women, and the average age per joint was 56 years. The results were graded as excellent, good, fair, and poor on two bases: relief of pain and the cosmetic result. Overall results were good. On the basis of these results over a 12-year period, it was concluded that there is a place for total joint prosthetic replacement in the surgical reconstruction of the painful, destroyed metatarsophalangeal joint of the great toe.
Correction of Clawtoes by the Girdlestone-Taylor Flexor-Extensor Transfer Procedure
Authors: Barbari Stephan G. , Brevig Knut 
Published: March 2013

Several techniques have been suggested for correction of clawtoe deformities in the lateral toes, ranging from multiple arthrodesis of the interphalangeal joints to phalanx resections, partial or total amputation of the impaired toes. An evaluation of the flexor-extensor transfer procedure is the basis of this study. Between 1977 and 1983, 39 feet were operated on in 31 patients, presenting a wide variation in etiology, degree of deformity, and symptoms. Average age at the time of surgery was 57.5 (16 to 80). All of the patients were available for recall and were able to return for an interview and examination. Average length of follow-up was 38 months (range, 10–80 months). The report includes a general discussion of the deformities, description of the operative technique, and the results obtained in our series. Assessment emphasized a subjective report including patient satisfaction, cosmetic result, relief of pain, and objective examination to evaluate the presence of recurrent callosities, range of movement at the metatarsophalangeal joint, and degree of residual passive mobility of the toes. Reduction of metatarsalgia and callosities with improved shape of the toes was achieved in most cases. Our experience indicates that the treatment can be recommended for use in the elderly, too, in appropriate cases. Radical procedures are rarely accepted for cosmetic as well as for functional reasons.
The Risks and Benefits of Distal First Metatarsal Osteotomies
Authors: Meier Peter J. , Kenzora John E. 
Published: March 2013

From a total of 138 patients who initially underwent either Chevron or Mitchell distal metatarsal osteotomies, 50 were available with complete pre- and postoperative data for study. Chevron osteotomies were performed on 60 feet (41 patients) and Mitchell osteotomies on 12 (nine patients). The results indicate that both procedures provide good or excellent subjective and objective results in about 90% of cases. There was no statistically significant difference between the procedures as regards the results. Age did not influence the outcome. Complications included damage to the proper digital nerve of the great toe in 30% indicating either direct injury to the nerve with subsequent neuroma formation or indirect injury by nerve entrapment. Osteonecrosis of the first metatarsal head occurred following Chevron osteotomies in 12 feet (12 of 60 or 20%) and following a Mitchell in one (one of 12 or 8%). However, four of the 10 (40%) patients who had a Chevron osteotomy plus a lateral adductor release developed osteonecrosis. Osteonecrosis is described and classified into three stages: stage I, the precollapse condition; stage II, the collapsed condition; and stage III, the osteoarthritic condition. The major causes of failure were preexisting osteoarthritis, injury to the dorsal proper digital nerve, and osteonecrosis. Theoretically, most of these should be avoidable. Significant metatarsus primus varus and MTP osteoarthritis are contraindications to distal metatarsal osteotomies. A tourniquet should be routine and the nerve, visualized and protected. If a distal osteotomy is performed, a concomitant lateral adductor release is contraindicated and stripping of the distal soft tissues should be minimal.
Post-Fracture, Late Debridement Resection Arthroplasty of the Ankle
Authors: Gould Nathaniel , Flick A. Bart 
Published: March 2013

Seven patients (three male and four female), aged 10 to 45 years (average, 36 years), who suffered fractures at the ankle (three right and four left) from 6 months to 20 years ago (average, 7.6 years), underwent late debridement resection arthroplasty. Follow-up ranged from 3.5 to 7 years (average, 5 years). Six patients improved in range of motion, endurance, and freedom from pain and swelling and were able to engage thereafter in increased activities, including sports. The oldest female (aged 45), because of continual pain 15 months later, had an ankle arthrodesis. No “normal” ankles resulted, but final rating determinations based on range of motion, endurance, swelling, pain, and subjective analyses were: excellent (1), good (3), fair (2), poor (1) (arthrodesis patient). Results of the 5-year follow-ups suggest that this type of surgery in selected cases is a feasible, at least interim, alternative to more radical total ankle arthroplasty or ankle arthrodesis.