bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foot and Ankle Severity Scale (FASS)
Authors: Manoli Arthur , Prasad Priya , Levine Robert S. 
Published: March 2013

Increasing use of air bags and seat belts has led to the saving of many lives. However, the orthopaedic surgeon is now left to manage increasing numbers of serious foot and ankle trauma. It is important to injury prevention programs to have an injury severity scale for these injuries. The Abbreviated Injury Scale is used widely; however, it is intended primarily to gauge possibility of death after accidents. It is not sensitive enough to give meaningful data about the foot and ankle trauma epidemic. The Trauma Committee of the American Orthopaedic Foot and Ankle Society has developed a rank order list of 91 foot and ankle injuries that commonly occur in vehicular crashes. The injuries are ranked according to severity (FASS-S). Estimated long-term impairment is also given for each injury (FASS-I). This scale is designed as a guideline to help rank importance and impairment of vehicular crash injuries. It is expected that the scale will be modified as future validity testing and other research dictates.
Fractures of the Calcaneus: Open Reduction and Internal Fixation From the Medial Side a 21-Year Prospective Study
Authors: Burdeaux Billie D. 
Published: March 2013

Since 1974, 61 displaced fractures of the calcaneus have been treated by open reduction and internal fixation by a modified medial approach technique. Surgery was performed through a 5-cm incision posterior to the neurovascular bundle. A single threaded pin was passed longitudinally through the tuberosity and into the sustentacular fragment, giving stable fixation. Reduction of the depressed posterior facet fragments was accomplished from the medial side in 77% of cases, occasionally assisted by fluoroscopy. Postoperatively all fractures were immobilized in a cast for 4 weeks. At the end of 4 weeks the pin was removed, and full weight bearing in a walking cast was started and continued for 4 weeks. At 8 weeks after surgery, the walking cast was removed, and the patient began walking in a shoe. These cases were evaluated at a mean follow-up of 4.4 years. There were 49 successful cases (80.3%) and 12 unsuccessful cases (19.7%). A high number of superior results was found in the successful group as shown by the mean score of 94.7 (American Orthopaedic Foot & Ankle Society Scoring System). Time to return to work was a mean of 4.9 months.
Charcot Ankle Fusion with a Retrograde Locked Intramedullary Nail
Authors: Pinzur Michael S. , Kelikian Armen 
Published: March 2013

Twenty patients with severe neuropathic (Charcot) ankle deformities underwent 21 attempted ankle fusions with a retrograde locked intramedullary nail as an alternative to amputation. All had insensate heel pads and had failed at nonoperative methods of accommodative ambulatory bracing. In 11, the talus was either absent, or the deformity was of sufficient magnitude to require talectomy to align the calcaneus under the tibia for plantigrade weightbearing. Ages ranged from 28 to −68 (average 56.3) years. Nineteen were diabetic, 12 being insulin-dependent. Their average body weight was 102 kg, with 11 greater than 90 kg at the time of surgery. Eight had chronic large full thickness ulcers overlying, but not involving bone of the medial malleolus, medial midfoot, or proximal fifth metatarsal, at the time of surgery. At a follow-up of 12 to 31 months, 19 achieved bony fusion. In the 10 patients where talectomy was not required, fusion was achieved at an average of 5.3 months without complications. In the patients who required talectomy, six of the patients required eight additional operations to achieve fusion. Three achieved fusion following removal of the nail and prolonged bracing. One opted for ankle disarticulation for chronic persistent infection, rather than attempt reoperation. One died of unrelated causes during the early postoperative period. Retrograde locked intramedullary ankle fusion is a reasonable alternative to amputation in the neuropathic (Charcot) ankle that cannot be controlled with standard bracing techniques. The potential for morbidity requiring reoperation is greatly increased when the deformity is of sufficient magnitude to require talectomy to achieve alignment of the calcaneus in a plantigrade weight-bearing position under the tibia or when there are large open ulcers.
Triggering of the Lesser Toes at a Previously Undescribed Distal Pulley System
Authors: Martin Michael G. , Masear Victoria R. 
Published: March 2013

We have treated five patients with metatarsalgia and triggering of the lesser toes. This paper describes a mechanism of triggering that involves a previously undescribed flexor pulley system in the toes that is very similar to the pulley system in the fingers. The specific anatomy of the toe flexor pulleys is described based upon the dissections of 50 fresh-frozen cadaver toes. These pulleys were composed of transverse to obliquely oriented fibrous bands within the flexor sheaths from the metatarsal heads to the distal phalanges. We found a system of pulleys in the lesser toes and the great toe, analogous to that found in the hand. Trigger toe is a rare entity and is only briefly described in the literature. We believe it is more common than is now recognized and may be an important underdiagnosed cause of metatarsalgia. The diagnosis is made when active plantarflexion causes the toes to catch in flexion and the patient is then unable to extend them. Nonsurgical therapy consisting of steroid injection, NSAIDs, or changing footwear may be effective, otherwise surgical release of the A1 pulley may be required.
Effect of Medial Displacement Calcaneal Osteotomy on Ankle Kinematics in a Cadaver Model
Authors: Michelson James D. , Mizel Mark , Jay Peter , Schmidt Guy 
Published: March 2013

Although medial displacement calcaneal osteotomy has been advocated for treatment of acquired pes planus, no studies have determined the biomechanical consequences at the ankle of such a procedure. The present investigation examined the alteration in ankle motion that resulted from a medial sliding calcaneal osteotomy. In dorsiflexion, the ankle specimens were found to have altered internal rotation and varus alignment. At maximal dorsiflexion, there was a 76% increase in internal rotation (4.4° ± 2.5° versus 2.5° ± 1.7° for intact ankles, P < 0.0004) and an increase of 425% in varus (0.42° ± 0.56° versus 0.08° ± 0.34° for intact ankles, P < 0.003). There were no significant differences seen in plantar flexion. Based on these results, caution is advised in the indiscriminate use of medial sliding osteotomies, because this procedure may predispose the patient to premature ankle arthritis as a consequence of the altered ankle motions.
Treatment of Displaced Pylon Fractures with Circular External Fixators of Ilizarov
Authors: Aktuǧlu Kemal , Özsoy M. Hakan , Yensel Uǧur 
Published: March 2013

Twenty cases of pylon fractures were treated with Ilizarov circular external fixators using the technique of ligamentotaxis. Fourteen men and six women, ranging in age from 20 to 59 years, with open or closed distal tibial fractures were included in this study. The fractures were classified according to the AO system and distributed as seven C1, eight C2, and five C3 fractures. Independent from the type of fracture, six were grade II open according to the Gustilo-Anderson classification. For all fractures, an external fixator was constructed, after reduction by traction and olive wires. Mean follow-up was 29 months. All fractures healed by 14 weeks postreduction. The results were assessed using Weber's criteria: 5 (25%) had excellent results, 10 (50%) good, and 5 (25%) poor results. This technique lowers the rated complications of open reduction and internal fixation, and allows restoration of joint-surfaces, reconstruction of length, and alignment of the extremity while maintaining a sufficient range of motion at the joint. We concluded that use of the Ilizarov circular external fixator enables good results in selected ankle traumas when applied with good indications, planning, and surgical experience.
Elongation Behavior of Calcaneofibular and Cervical Ligaments during Inversion Loads Applied in an Open Kinetic Chain
Authors: Martin Lewis P. , Wayne Jennifer S. , Monahan Timothy J. , Adelaar Robert S. 
Published: March 2013

The cervical ligament plays a significant role in lateral stability of the subtalar joint but has received little attention compared with other ankle and subtalar joint ligaments. The purpose of this research was twofold. First, the elongation behavior of the cervical ligament was assessed with the calcaneofibular ligament intact and cut during two different types of inversion loads (manual and mechanical). Second, inversion range of motion was determined concomitantly with inversion loading and the difference in inversion range of motion between the calcaneofibular ligament intact to cut state was compared. The mean elongation of the cervical ligament with the calcaneofibular intact was 0.58 mm (± 0.33 mm) and 0.46 mm (± 0.23 mm) for manual and mechanical methods, respectively, and 0.88 mm (± 0.37 mm) and 0.78 mm (± 0.37 mm), respectively, for the same methods in the absence of the calcaneofibular ligament. This difference was statistically significant ( P < 0.05 manually and P < 0.02 mechanically). An average increase in the inversion range of motion was noted with both methods [7.5° manually (± 2.75°) and 7.7° mechanically (± 2.95°)] after lesioning of the calcaneofibular ligament. This difference was statistically significant ( P < 0.001) for both manual and mechanical range of motion testing. The results of this study indicate that there is a significant increase in elongation of the cervical ligament in the absence of the calcaneofibular ligament during manual and mechanically applied inversion loads in a open kinetic chain. Clinical and theoretical implications of this data are discussed.
Intratendinous Alterations as Imaged by Ultrasound and Contrast Medium-Enhanced Magnetic Resonance in Chronic Achillodynia
Authors: Movin Tomas , Kristoffersen-Wiberg Maria , Shalabi Adel , Gad Adel , Aspelin Peter , Rolf Christer 
Published: March 2013

Objectives: We performed a comparative study of ultrasonography and gadolinium imaging contrast-enhanced T1-weighted magnetic resonance to evaluate tendon pathology in chronic Achilles tendon disorder. Another main issue was to evaluate the structural basis as defined by histopathology from hypoechoic compared with normoechic areas within the same tendon. Materials and Methods: Twenty patients (16 male, 4 females, median age 40 years) with chronic achillodynia participated in the study. Clinical examination revealed swelling and tenderness localized to the midportion of the Achilles tendon. Contrast medium-enhanced magnetic resonance imaging (CME-MRI) was performed in all patients. Ultrasonography-guided core biopsies were taken from regions with a clear widening of the tendon and a pathologic low-echo signal as well as from normoechoic areas. The specimens were analyzed with a standardized protocol giving a total tendon score (0–24), and a stereologic method for quantification of glycosaminoglycan (GAG)-rich areas. Results: The volume of the intratendinous abnormality was larger in 13 of 20 when imaged by CME-MR ( P < 0.05), whereas the shape and enlargement of the tendon per se were similarly imaged by ultrasound (US) and CME-MR. Tendon pathology as imaged by US was graded as severe from hypoechoic regions and moderate from normoechoic regions. The corresponding quantification of GAGs was 0.36 compared with 0.17, respectively ( P < 0.001). Conclusion: CME-MR imaging revealed greater sensitivity in demonstrating intratendinous pathology than the ultrasound; this was documented by the larger size of the corresponding lesion and the fact that the pathology was occurring in areas that were considered normal by ultrasonography. US hypoechoic areas showed a markedly abnormal tendon structure including an increased amount of GAG-rich areas. However, moderate pathology was also found in the neighboring normoechogenous areas within the same tendon, indicating a more generalized disorder than depicted by echogenic properties.
Effect of Calcaneal Osteotomy and Plantar Fasciotomy on Arch Configuration in a Flatfoot Model
Authors: Thordarson David B. , Hedman Thomas , Lundquist Davin , Reisch Robert 
Published: March 2013

Seven fresh-frozen cadaver specimens had a calcaneal osteotomy performed obliquely through the posterior portion of the calcaneus. Angular relationships between the first metatarsal and talus were recorded with the use of a motion-analysis system in the transverse, sagittal, and coronal planes. The specimen was mounted in a testing machine and loaded via an intramedullary rod to 150, 350, and 550 N. A flatfoot model was created, and repeat measurements were obtained. The calcaneal osteotomy was then displaced 1 cm medially, and repeat measurements were made at each of the three load levels. The calcaneal osteotomy was then returned to its original position, the plantar fascia was divided, and the new angular measurements were obtained. The calcaneal osteotomy was again displaced 1 cm, and repeat angular measurements were obtained. A mild consistent flatfoot deformity was created in all three axes before the plantar fascia was cut. A statistically significant increase in deformity was noted after cutting the plantar fascia. A correction of the flatfoot deformity in all three planes occurred with the medial displacement of the calcaneal osteotomy, which was greater at the lower load levels. We noted that a medial displacement calcaneal osteotomy partially corrected a flatfoot deformity in all three planes. The correction occurred with or without an intact plantar fascia and, therefore, is independent of the structure. We also noted an increased deformity after dividing the plantar fascia. This study provides some biomechanical insight as to the corrective effect of a medial displacement calcaneal osteotomy in correcting a flatfoot deformity.
Osteoid Osteoma of the Phalanx: Enlargement of the Toe—Two Case Reports
Authors: Barca Francesco , Andrea Leti Acciaro , Maria Daniela Recchioni 
Published: March 2013

After a review of the literature, two cases of osteoid osteoma involving phalanges of the toes are reported. Physical findings of osteoid osteoma vary with the site of the tumor; in the foot, particularly the toes, it presents various atypical and characteristic features. Its more frequent cancellous and subperiosteal localization in the small bones of hand and foot, showing atypical roentgenographic findings, poses particular problems in diagnosis. In the osteoid osteoma of the phalanges, characteristic enlargement of the toe or finger seems to be frequent and with a typical clinical history may be considered a reliable sign of suspected osteoid osteoma. Specialized imaging techniques may hasten diagnosis, but only an accurate clinical history and the characteristic findings with a high index of suspicion can allow for a proper diagnosis.
Comparison of Open Isolated Subtalar Arthrodesis with Autogenous Bone Graft Versus Outpatient Arthroscopic Subtalar Arthrodesis Using Injectable Bone Morphogenic Protein-enhanced Graft
Authors: Scranton Pierce E. 
Published: March 2013

Isolated subtalar joint arthrodesis is an established salvage procedure that can be performed in various ways for varying diagnoses. The purpose of this article is to report a new arthroscopic subtalar arthrodesis technique that has been developed. The results of this method versus an open technique were compared. Length of hospital stay, tourniquet time, morbidity, and fusion rate were studied in 17 fusion patients between 1990 and 1997. Twelve patients had open arthrodesis with bone graft and 5 patients had arthroscopic arthrodesis with supplemental, injectable, osteoinductive enhanced-graft gel. The length of stay decreased 1.7 days with the arthroscopic procedure. Tourniquet time was not significantly different. One open procedure required refusion, whereas none did in the arthroscopic group. One patient in each group required AO screw removal. In selected patients with subtalar arthrosis without significant hind-foot deformity, arthroscopic arthrodesis can be an effective. It is too early to determine if there are specific advantages in this procedure compared with a conventional open arthrodesis.
Subtalar Arthrodesis for Late Sequelae of Calcaneal Fractures: Fusion In Situ Versus Fusion with Sliding Corrective Osteotomy
Authors: Huang Peng-Ju , Fu Yin-Chih , Cheng Yuh-Min , Lin Sen-Yuen 
Published: March 2013

Primary subtalar arthritis is not common. In most cases, it is the late sequela of intra-articular calcaneal fracture. 7 Subtalar arthrodesis is mostly used for the treatment of traumatic subtalar arthritis in our clinics. We have compared our early cases of in-situ subtalar fusion with our recent cases of fusion with sliding corrective osteotomy in this clinical report. From 1989 to 1992, 15 feet of 13 patients were treated with subtalar arthrodeses for subtalar arthritis caused by malunion of calcaneal fractures. Fusion in situ was done by Ollier's approach, and resection of bony protrusion was done if there was lateral entrapment syndrome. From 1992 to 1995, 13 feet of 12 patients also received subtalar arthrodeses to salvage their calcaneal fractures, but the subtalar fusion was done by wide lateral approach, calcaneal sliding corrective osteotomy, and sometimes (11 of 13 feet) with Achilles tendon lengthening to restore the calcaneal height and width. Patients of both groups experienced obvious clinical improvement in subtalar pain relief, but there was no difference with walking distance, running, or jumping. The group undergoing fusion with sliding corrective osteotomy was more satisfied with regard to cosmetic results and shoe wear. The overall satisfactory rate in the group who underwent fusion with sliding corrective osteotomy (92%) was superior to the group who underwent fusion in situ (77%). Though our method of sliding corrective osteotomy does not provide much improvement to the talus declination angle, it is suitable for those patients with a “banana”-shaped calcaneus malunion. If the patient has prominent anterior ankle pain caused by tibiotalar impingement, we believe that a distraction subtalar arthrodesis would be more appropriate.
Clinical Outcome of Arthrodesis of the Ankle Using Rigid Internal Fixation with Cancellous Screws
Authors: Monroe Michael T. , Beals Timothy C. , Manoli Arthur 
Published: March 2013

Thirty consecutive patients underwent arthrodesis of the ankle using rigid internal fixation with cancellous screws between 1992 and 1996. One patient died of causes unrelated to the surgery before bony union. Primary fusion occurred in 27 of the remaining 29 patients (93%). The average time to primary union was 9 weeks. Two patients developed a delayed union and were treated with an additional bone-grafting procedure. Ultimately, each of the 29 patients went on to fusion. Use of tobacco during the postoperative period had no apparent effect on the rate of fusion or time to fusion. Twenty-five patients were available for clinical evaluation at an average of 24 months after surgery. Subjective evaluation using questionnaires revealed a high level of satisfaction. All patients stated that they would undergo the procedure again. The mean postoperative score on the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale was 81 points, compared with 48 points preoperatively (of a possible 100). Constant pain was the reason given by all patients for seeking treatment. After the arthrodesis, pain was reported as absent in 13 and occasional in 12 patients. All patients noted less pain in the hindfoot after fusion of the ankle. Active litigation and Workers’ Compensation claims during the perioperative period had a significant negative effect on scores on the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale and seemed to decrease patients’ perceived ability to return to work.
Forefoot Reconstruction in Rheumatoid Arthritis Patients: Keller-Lelièvre-Hoffmann Versus Arthrodesis MTP1-Hoffmann
Authors: Vandeputte Geoffroy , Steenwerckx Annie , Mulier Tom , Peeraer Louis , Dereymaeker Greta 
Published: March 2013

The aim of this study was to compare the subjective, clinical and pedodynographic results of two large groups of patients operated on in our department. From January 1987 to December 1992, 38 rheumatoid patients (59 feet) underwent a Keller-Lelièvre arthroplasty of the first metatarsophalangeal (MTP1) joint and a Hoffmann resection of the lesser metatarsal heads. The mean follow-up was 35 months. From June 1992 to August 1997 48 patients (62 feet) with rheumatoid arthritis underwent an arthrodesis of the MTP1 joint and Hoffmann resection of the lesser metatarsal heads. The mean follow-up was 25 months. In 10 feet the arthrodesis was performed as a revision procedure of a failed Keller-Lelièvre arthroplasty. The patients of both series were assessed in the same way: personal interview, clinical examination, radiographs, bilateral footprints, and pedodynographic measurements. Static and dynamic pedodynographic measurements were taken with a 64-sensor matrix insole in a standard shoe. Six of our patients had an arthrodesis-Hoffmann procedure performed on one foot and a Keller-Lelièvre-Hoffmann procedure on the contralateral side. Although there is better loadbearing of the first ray with relative unloading of the central metatarsal heads in the arthrodesis MTP1-Hoffmann group, subjective evaluation of the procedure was slightly better in the Keller-Lelièvre-Hoffmann group. Ninety-three percent of the patients in the Keller group were satisfied or satisfied with minor reservations versus 87 percent in the arthrodesis group. This difference is not statistically significant. Recurrent deformity was not more prominent in the Keller-Lelièvre-Hoffmann group; however, it may be that with a longer follow-up, the feet in the arthrodesis-Hoffmann group hold up better over time. The arthrodesis MTP1-Hoffmann procedure can be used as a revision procedure for a failed Keller-Hoffmann operation, although these procedures were more difficult and needed a longer recovery time than the primary MTP1 arthrodesis.
Defining Flatfoot
Authors: Tareco Jennifer M. , Miller Nancy H. , MacWilliams Bruce A. , Michelson James D. 
Published: March 2013

Pes planus is a term frequently used in describing flatfoot; however, no study has objectively defined flatfoot. We evaluated the single leg stance footprint of 40 feet in 21 people with no history of foot problems, using pressure-sensitive film and a Harris mat. The medial and lateral aspects of the forefoot, midfoot, and hindfoot were assessed. The midfoot was further analyzed by dividing the medial midfoot force by the total midfoot force. The mean medial midfoot force/total midfoot force was 11.1 % (SD = 6.5%). Pes planus was defined as the medial midfoot force/total midfoot force > 24.0% (mean + 2 SD). A population associated with pes planus (124 feet in 63 patients with Marfan syndrome) was then evaluated in the same fashion. Although the mean medial midfoot force/total midfoot force was not statistically different (16.0%), a distinct group of patients (25%) had forces that were outside the range of normal midfoot forces.