bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Short Oblique Fracture of the Distal Fibula Without Medial Injury: An Assessment of Displacement
Authors: Harper Marion C. 
Published: March 2013

Eighteen patients with ankle injuries presenting as short oblique fractures of the distal fibula with no clinical or radiographic evidence of injury to the medial ankle were studied for fracture displacement. Plain radiographs and computed tomography were used for analysis. All fractures were clinically diagnosed as supination-external rotation stage 2 (SE-II) injuries under the Lauge-Hansen scheme. All exhibited slight displacement on plain radiographs and were treated nonoperatively. Computerized tomography using axial cuts across the fracture site and ankle mortise revealed normal positioning of the talus beneath the tibial plafond, as evidenced by no abnormality of the medial joint space in all patients. In the majority of patients, the relationship between the talus and distal fibula also appeared undisturbed, with fracture displacement being confined to a change in position of the proximal fibular fragment relative to the tibia as compared with the contralateral ankle. In a minority of cases, in addition to the above-described displacement of the proximal fibular fragment, the distal fibular fragment was noted to shift slightly laterally relative to the talus, with mild widening of the lateral joint space. Occult-associated avulsion fractures off the distal tibia were present in 39% of the cases.
Peroneus Longus Tendon Tears: Acute and Chronic
Authors: Sammarco G. James 
Published: March 2013

Tear of the peroneus longus tendon can be difficult to diagnose and treat. Fourteen cases of clinically proven tears are reported. Patients ranged in age from 31 to 63 years. There were 10 men and four women. The onset of symptoms was acute in eight cases. Chronic onset with slowly increasing pain occurred in six cases. Despite acute onset of symptoms, only one patient was diagnosed within 2 weeks of his injury. The others had symptom duration ranging from 7 to 48 months. Twelve tears were located distally as the tendon turned into the cuboid groove. An os peroneum visible on x-ray was present in six cases, absent in seven cases, and cartilaginous in one case. The os peroneum was involved in the tear in three cases. Excision of part or all of the os peroneum was performed in four cases with a bridging tendon graft required in one case. A plantaris tendon graft was required in one case in which an os peroneum was absent. Patients with acute onset of symptoms tended to fare better than those with chronic onset of symptoms, regardless of the length of time from onset to time of surgery. Associated pathology in the peroneus brevis tendon was common, occurring in nine cases. These patients seemed to have a better surgical outcome than those with only a tear of the peroneus longus tendon. Associated findings affected diagnosis by masking symptoms but did not alter the outcome of treatment. The presence or absence of an os peroneum did not affect symptoms or treatment, but its presence on x-rays may aid in the diagnosis if migration of part or all of the sesamoid occurs.
Anatomy of the Achilles Tendon and Plantar Fascia in Relation to the Calcaneus in Various Age Groups
Authors: Snow Stephen W. , Bohne Walther H.O. , DiCarlo Edward , Chang Vivian K. 
Published: March 2013

Ten adult cadaver feet, three neonatal feet, and the feet of two fetuses were dissected to investigate whether an anatomical continuity exists between the fibers of the Achilles tendon and the plantar fascia. Histologic sections of the feet were done in three age groups: neonate, persons in their mid-20s, and the elderly. As the foot ages, there appears to be continued diminution of the number of fibers connecting the Achilles tendon and plantar fascia. The neonate has a thick continuation of fibers, while the middle-aged foot has only superficial periosteal fibers that continue from tendon to fascia. The elderly feet show simply an insertion of fibers of both structures into the calcaneus with periosteum in between.
Dynamic Orthopaedic Brace in the Treatment of Ankle Sprains
Authors: Regis Dario , Montanari Michele , Magnan Bruno , Spagnol Stefano , Bragantini Alberto 
Published: March 2013

Ankle sprains may lead to disabling sequelae such as joint instability and persistent pain. Immobilization with plaster cast may give rise to joint stiffness and muscle atrophy. Twenty patients with acute inversion sprains of the ankle were treated with a “dynamic” orthopaedic brace after a 10-day plaster immobilization. A control group, consisting of 10 subjects, received a weight-bearing short-leg plaster cast for 25 days. A clinical evaluation and an instrumental isokinetic investigation (Cybex) were performed as scheduled. The clinical findings suggest an earlier and more comprehensive functional recovery in the group receiving the “dynamic” brace compared to the casted group. The isokinetic test revealed a statistically significantly better performance for most parameters in the brace group especially regarding the ankle joint invertors.
Kirschner Wire Breakage after Surgery of the Lesser Toes
Authors: Zingas Christopher , Katcherian David A. , Wu Kent K. 
Published: March 2013

A retrospective review was made of all patients operated on by the two senior authors from January 1985 to January 1993 for problems with Kirschner wire breakage following forefoot surgery. Thirty-three broken K-wires in 27 patients were encountered. All of these were 0.045-inch K-wires that had been placed across the metatarsophalangeal (MTP) joint of the lesser toes. In no case was there breakage of a K-wire that was larger than 0.045 inches or that did not cross the MTP joint. The medical records and radiographs of 565 consecutive patients having fixation with 0.045-inch K-wires that crossed the MTP joints of the lesser toes were then reviewed. A total of 1002 K-wires were used with an overall failure rate of 3.2% (4.8% of the patients). All of these K-wires failed just proximal to the point of entry into the metatarsal head. No intra-articular retained fragments were noted. Twenty-five of the retained fragments were completely within the metatarsal head and shaft, and eight of these fragments pierced the cortex of the metatarsal proximally. Twenty-three patients with retained fragments were examined in follow-up and in no case could the retained fragment be palpated or directly related to postoperative symptoms. Of the three patients who complained of persistent pain, two had mild pain with persistent MTP synovitis and one had severe pain due to lateral deviation of the toe after surgery. Patients with rheumatoid arthritis who underwent metatarsal head excision were noted to have a higher rate of failure (10.3% of patients, 4.0% of K-wires) than those without rheumatoid arthritis or metatarsal head excision (3.3% of patients, 2.3% of K-wires). Also four of the six cases with multiple K-wire breakage in the same foot had rheumatoid arthritis.
Influence of Malalignment of Feet on the Plantar Pressure Pattern in Running
Authors: Sneyers Claire Jeanne Louise , Lysens Roeland , Feys Hilde , Andries Ruoli 
Published: March 2013

When overuse injuries of the lower limbs are diagnosed in athletes, the architecture and function of the foot should be examined. Foot structure was evaluated in 10 male and 14 female athletes. Based on this examination, the subjects were classified into three groups: pes planus, pes cavus, and pes rectus. While running, the plantar pressure pattern of these athletes was assessed with pressure-measuring insoles. Using these measurements, peak pressures and impulses were calculated for different foot anatomical locations. The plantar heel load was distributed significantly ( P < 0.05) more toward the anterior part of the calcaneus in the pes planus group compared with the normal group. The relative load under the midfoot region was significantly ( P < 0.05) lower in the pes cavus group compared with the other foot types. The relative load of the forefoot was significantly ( P < 0.05) higher in the pes cavus group and lower in the pes planus group. Both feet of an athlete showed a similar plantar pressure pattern. Three successive steps were comparable in terms of impulses, but the peak pressures varied significantly from step to step. The local impulse and peak pressure values obtained in barefoot running differed significantly from the values obtained in running with sport shoes.
Prospective Study of Bone, lndium-111-Labeled White Blood Cell, and Gallium-67 Scanning for the Evaluation of Osteomyelitis in the Diabetic Foot
Authors: Johnson Jeffrey E. , Kennedy E. Jeff , Shereff Michael J. , Patel Neetin C. , Collier B. David 
Published: March 2013

Twenty-two adult diabetic patients with clinical suspicion of foot and/or ankle infection were prospectively evaluated using radiography, technetium-99m methylene diphosphonate bone scanning (99Tc), indium-111-labeled leukocyte scanning (111In), and gallium-67 scanning (67Ga) to determine the presence of clinically suspected osteomyelitis. Biopsy for culture and histology was performed in 16 patients. The diagnosis of osteomyelitis was confirmed by biopsy in 12 patients. The remaining 10 patients had no evidence of osteomyelitis with long-term follow-up. 99mTc was snown to be of limited valued when used alone in these patients with peripheral neuropathy. 67Ga, either alone or in combination with 99mTc bone scanning, was of little diagnostic value and gave no additional information that was not available from 111In. The combination of three-phase 99mTc and 111In had the highest diagnostic efficacy (100% sensitivity, 80% specificity, and 91% accuracy), followed closely by 111In alone (100% sensitivity, 70% specificity, and 86% accuracy). We conclude that for adult diabetic patients with clinical suspicion of osteomyelitis but no radiographic findings of that disease, 111In alone is an appropriate nuclear medicine evaluation for ruling out infection if it is negative. However, if an area of 111In white blood cell uptake is present, a “simultaneous” 99mTc is often helpful in providing the anatomic correlation to differentiate osteomyelitis from infection that is limited to soft tissue.
Displaced Intra-Articular Calcaneus Fractures Treated with the Galveston Plate
Authors: Laughlin Richard T. , Carson J.G. , Calhoun Jason H. 
Published: March 2013

From January 1992 to August 1993, 59 calcaneal fractures in 48 patients were treated. Thirty-three fractures in 31 patients were displaced intra-articular fractures and were treated with open reduction and internal fixation through an extensile lateral approach with the Galveston plate (Smith and Nephew, Richards, Memphis, TN). Complete radiographs and CT scans were available for 32 of the fractures. The CT scan classification of Sanders was used. The distribution of the fractures was: IIA, N = 17; IIB, N = 2; IIC, N = 2; IIIAB, N = 7; IIIAC, N = 2; IV, N = 2. Sixteen (50%) had calcaneocuboid joint involvement. Preoperative and postoperative radiographic measurements of Bohler's angle, Gissane's angle, talocalcaneal angle, and Achilles tendon fulcrum distance were made. Clinical follow-up on 23 fractures in 22 patients at an average of 21 months is presented. Seventy percent of the patients have no pain or only occasional pain not requiring medication. Using the Maryland Foot Score for assessment, 78% of the patients had a good or excellent result. The Galveston plate was useful for maintaining reduction of intra-articular calcaneus fractures treated operatively and provided results comparable to other reported series.
Surgical Excision of Pseudotumorous Pretibial Myxedema
Authors: Pingsmann A. , Ockenfels H. M. , Patsalis Th. 
Published: March 2013

Pretibial myxedema is a well-known clinical feature of autoimmune thyroid malfunction and is classically associated with Graves’ disease. Its clinical course is frequently not related to the clinical control of the underlying thyroid disease. Treatment is primarily medical, consisting of oral and topical corticosteroids. We present a case of successful local excision of a pseudotumorous manifestation at the dorsum of the foot recalcitrant to multimodal medical and dermatological therapy.
Analysis of Failed Surgical Management of Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: The Jones Fracture
Authors: Glasgow Michele T. , Naranja R. John , Glasgow Steven G. , Torg Joseph S. 
Published: March 2013

Failure of surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity is uncommon. Only one such failure has been reported in the literature to date. The purpose of this article is to present the clinical course of 11 patients with failure of surgically managed Jones fractures reviewed by the senior author (J.S.T.). Surgical management was complicated by delayed union in three patients, refracture in seven patients, and nonunion in one patient. The 11 procedures were divided between two established techniques: (1) intramedullary screw fixation (N = 6) and (2) inlaid corticocancellous bone graft (N = 5). In the six intramedullary fixation procedures, using other than a 4.5-mm ASIF malleolar screw for internal fixation correlated with failure. In the five inlaid bone graft procedures, undersized corticocancellous grafts and incomplete reaming of the medullary canal correlated with failure. Also, after both procedures, early return to vigorous physical activity is believed to have played a role in delayed union and refracture.
Surgical Treatment of Recalcitrant Plantar Fasciitis
Authors: Sammarco G. James , Helfrey Richard B. 
Published: March 2013

Twenty-six patients (35 feet) underwent partial plantar fasciectomy with neurolysis of the nerve to the abductor digiti quinti muscle. Nonsurgical treatment for plantar fasciitis had been unsuccessful in these patients. Patients were followed after surgery for an average of 37.5 months. Six patients were male and 20 patients were female; the average age was 49 years. All patients had failed to respond to nonsurgical treatment for an average of 21.5 months. In addition to routine history and physical examination patients were evaluated before and after surgery with a subjective foot rating system, and a detailed questionnaire was used to assess postoperative functional outcome. Thirty-two patients (92%) had a satisfactory functional outcome, and three patients (8%) had an unsatisfactory result (21 excellent, 11 good, 3 fair, 0 poor). The Maryland Foot Score increased from a preoperative average of 74.8/100 points to a postoperative average of 90.6/100 points. Four patients (11%) had postoperative complications, including superficial wound infection (two patients), deep venous thrombosis (one patient), and superficial phlebitis (one patient), all of which resolved uneventfully with treatment. Ten patients (28.6%) reported some degree of heel pain after surgery. All 10 patients denied limitation in activity related to postoperative pain. The average period before return to daily activity and restricted work duty was 5.6 weeks and to full work duty without restriction was 8.7 weeks. Although the length of time for partial or complete resolution of symptoms is variable, a successful treatment outcome can be expected in most patients who are treated for recalcitrant plantar fasciitis.
Calcaneocuboid Joint Involvement in Calcaneal Fractures
Authors: Ebraheim Nabil A. , Biyani Ashok , Padanilam Thomas , Christiensen Greg 
Published: March 2013

The charts and radiographs of 48 surgically treated patients who underwent surgery for calcaneal fractures (right in 25 patients, left in 22, and bilateral in 1) between 1987 and 1994 were retrospectively reviewed. Coronal computed tomographic scans alone were obtained in 33 patients, and both coronal and axial computed tomographic scans were obtained in 9 patients. Three fractures exiting close to the calcaneocuboid joint (CCJ), but not involving the joint, were excluded. Nineteen patients (38.7%) had involvement of the CCJ. The extension of the fracture to the CCJ was apparent in anteroposterior or oblique radiographs or both in 18 patients. There was intra-articular fracture displacement of ≤1 mm in 6 patients, and 13 patients had a step or a gap of ≥2 mm with or without angulation. Eleven patients had joint depression type fractures, 6 had tongue type fractures, and 2 had comminuted fractures. Extension of the calcaneal fracture into the CCJ was significantly more common with the joint depression type calcaneal fractures (chi-square test; P = 0.008). The coronal computed tomographic images showed significant lateral subluxation of posterior facet fragments in 8 patients and considerable comminution of the lateral calcaneal wall with or without lateral subluxation of posterior facet fragment in 10 patients. These patients also had CCJ involvement, thus establishing a strong correlation between lateral subluxation of the posterior facet fragment or comminution of the lateral calcaneal wall and CCJ involvement. CCJ involvement is more common with joint depression type fractures. Extension of the fracture line into the CCJ should be suspected in presence of significant lateral column comminution or lateral talar subluxation.
A Comparison Study of Plantar Foot Pressure in a Standardized Shoe, Total Contact Cast, and Prefabricated Pneumatic Walking Brace
Authors: Baumhauer J.F. , Wervey R. , McWilliams J. , Harris G.F. , Shereff M.J. 
Published: March 2013

Total contact casting is the current recommended treatment for Wagner Stage 1 and 2 neuropathic plantar ulcers. The rationale for this treatment includes the equalization of plantar foot pressures and generalized unweighting of the foot through a total contact fit at the calf. Total contact casting requires meticulous technique and multiple cast applications to avoid complications before ulcer healing. An alternative to total contact casting is the use of a prefabricated brace designed to maintain a total contact fit. This study compares plantar foot pressure metrics in a standardized shoe (SS), total contact cast (TCC), and prefabricated pneumatic walking brace (PPWB). Five plantar foot sensors (Interlink Electronics, Santa Barbara, CA) were placed at the first, third, and fifth metatarsal heads, fifth metatarsal base, and midplantar heel of 10 healthy male subjects. Each subject walked at a constant speed over a distance of 280 meters in a SS, PPWB, and TCC. A custom-made portable microprocessor-based system, with demonstrated accuracy and reliability, was used to acquire the data. No significant differences in peak pressure or contact duration were found between the initial and repeat SS trials ( P > 0.05). Peak pressures were reduced in the PPWB as compared to the SS for all sensor locations ( P < 0.05). Similarly, peak pressures were reduced in the TCC compared to the SS for all sensor locations ( P < 0.05) with the exception of the fifth metatarsal base ( P = 0.45). Our results are summarized as follows: (1) the methods used in the current study were found to be reliable through a test-retest analysis; (2) the PPWB decreased peak plantar foot pressures to an equal or greater degree than the TCC in all tested locations of the forefoot, midfoot, and hindfoot; (3) compared to a SS, contact durations were increased in both the TCC and PPWB for most sensor locations; and (4) the relationship of peak pressure over time, the pressure-time integral, is lower in the brace compared to the shoe at the majority of sensor locations. The values are not significantly different between the cast and shoe. These findings suggest an unweighting of the plantar foot and equalization of plantar foot pressures with both the PPWB and TCC. Based on these findings, the PPWB may be useful in the treatment of neuropathic plantar ulcerations of the foot.
A New Operative Approach for Flatfoot Secondary to Posterior Tibial Tendon Insufficiency: A Preliminary Report
Authors: Pomeroy Gregory C. , Manoli Arthur 
Published: March 2013

The treatment of Johnson stage 2 posterior tibial tendon insufficiency remains controversial. Because the deformities remain flexible in stage 2, bony osteotomies are preferable over fusion operations. It is our contention that operative intervention should address all of the components of the pes planovalgus deformity that exists in stage 2 disease. Seventeen patients with 20 cases of stage 2 posterior tibial tendon insufficiency were treated with heel cord lengthening, flexor digitorum longus to medial cuneiform tendon transfer, lateral column lengthening, and medial displacement calcaneal osteotomy. Preoperative, postoperative, and final radiographs while standing were analyzed to determine radiographic correction of the deformities. In addition, the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale was applied to all patients before surgery and at 6-month intervals after surgery. Currently, the average follow-up is 17.5 months. The average foot rating score preoperatively was 51.4 and has improved to 82.8. Radiograph measurements have demonstrated statistically significant correction of the pes planovalgus deformity, as well as maintenance of the correction to date. It is our conclusion that this combination of surgical procedures provides correction of the symptomatology and deformity associated with stage 2 posterior tibial tendon insufficiency. The long-term result of the procedure is unknown.
Clinical and Radiographic Outcome of Revision Surgery for Failed Triple Arthrodesis
Authors: Haddad Steven L. , Myerson Mark S. , Pell Richard F. , Schon Lew C. 
Published: March 2013

Between 1987 and 1994, we treated 33 patients with surgical revision for failed triple arthrodesis, 28 (29 feet) of whom returned for final examination (mean, 4.4 years; range, 2–7 years). The average age of these 16 women and 12 men was 46 years (range, 14–69 years). Before the revision procedure, patients had undergone nonoperative therapies for an average of 3.7 years (range, 0.5–12 years) and an average of three foot operations (range, 1–6 operations) after the primary triple arthrodesis. All patients were managed with rigid internal fixation via cannulated screws and power staples. Calcaneal osteotomy and/or revision of the transverse tarsal arthrodesis via appropriate saw cuts and bone wedges were used. Iliac crest bone graft was added, when a bone block arthrodesis was required, for those patients with nonunion or ankle impingement. Arthrodesis was achieved in all 29 feet, although 4 patients (4 feet) (14%) required additional procedures for malunion (2 patients), deformity recurrence (1 patient), deep infection (1 patient), and skin graft (1 patient). Comparison of the average pre- (retrospective) and postoperative American Orthopaedic Foot and Ankle Society 94-point hindfoot and ankle scores showed a significant improvement: 31 points (range, 13–61 points) versus 59 points (range, 24–91 points), respectively ( P < 0.05). On a scale of 0 to 10 points, average patient satisfaction was 7.8 points (range, 2–10 points). This study demonstrated a satisfactory improvement in patient outcome after surgical correction of failed triple arthrodesis. We conclude that such a revision, although complex, may be attempted to establish a plantigrade foot free of infection and able to wear shoes without an orthosis or brace.