bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnetic Resonance Imaging of Acute Maisonneuve Fractures
Authors: Morris John R. , Lee Jackson , Thordarson David , Terk Michael R. , Brustein Marshall 
Published: March 2013

Magnetic resonance imaging (MRI) studies were performed on five patients with acute Maisonneuve fractures. All patients had sustained a twisting injury to their ankles and complained of ankle pain and pain over their proximal fibula. High quality images with excellent visualization of all the ankle ligamentous structures were obtained. MRI showed that the anterior inferior tibiofibular ligament was disrupted in ail patients and the posterior inferior tibiofibular ligament was intact in three of five patients. Also, the anterior talofibular ligament was disrupted in all patients and the calcaneofibular ligament was ruptured in two of five patients. This raises the question of whether patients with Maisonneuve fractures have lateral ankle instability at long-term follow-up. Although the superficial deltoid ligament was disrupted in all patients, the deep deltoid ligament was intact in one patient, partially disrupted in one patient, and completely disrupted in three patients. The interosseous ligament was disrupted at the ankle in all patients, while the interosseous membrane was disrupted in the leg in all patients except one. This patient had an intact interosseous membrane despite rupture of the interosseous ligament at the ankle, and the presence of a proximal one third fibula fracture.
Contribution of the Deltoid Ligament to Ankle Joint Contact Characteristics: A Cadaver Study
Authors: Earll Mark , Wayne Jennifer , Brodrick Christopher , Vokshoor Amir , Adelaar Robert 
Published: March 2013

Changes in ankle biomechanics lead to altered load transmission through the ankle joint, possibly predisposing it to osteoarthritis. Contributions of the different bands of the deltoid ligament to the contact characteristics in the ankle were examined. Fifteen normal cadaveric lower extremities were axially loaded to 445 N after intra-articular Fuji film placement. Ankles were tested in neutral, 10° dorsiflexion, and 10° plantarflexion. Repeated testing was done following sequential sectioning of the deltoid ligament, and the contact characteristics were analyzed. The greatest significant tibiotalar changes ( P < 0.0001) occurred after sectioning of the tibiocalcaneal fibers of the superficial deltoid ligament complex. Contact areas decreased up to 43%, peak pressures increased up to 30%, and centroids moved 4 mm laterally, on average. In contrast, sectioning of the other bands led to insignificant changes in joint contact characteristics. The data indicate that significant changes in contact characteristics occur before radiographic evidence of deltoid ligament damage is evident, and may indicate that greater attention to the medial side of the ankle is indicated to restore normal biomechanics to this joint.
Surgical Reconstruction of the Diabetic Foot: A Salvage Approach for Midfoot Collapse
Authors: Early John S. , Hansen Sigvard T. 
Published: March 2013

Between 1985 and 1993, 18 patients representing 21 feet underwent surgical reconstruction for diabetic neuroarthropathy with collapse of the midfoot. Forty-seven percent (10/21) of these feet presented with plantar pressure ulcers. Reconstruction involved reduction and fusion of collapsed joints, using internal fixation to restore foot shape and improve weightbearing alignment. The average follow-up in these patients was 28 months (range, 6–84 months). Limb salvage was obtained in 18 of 21 feet. Average time to radiographic union was 5 months (range, 3–9 months). Improvement in shoe fit and ambulatory status was noted for 13 of the 15 patients who had successful reconstruction. Forty-seven percent of the reviewed cases were without any complication throughout their postoperative course. Seventy percent of the presenting ulcers healed without incident. There were no recurrent midfoot ulcers.
Trochanteric Bone Grafts in Foot and Ankle Surgery
Authors: Hayes W. Richard , Smith Ronald W. 
Published: March 2013

Eighty-five patients who underwent trochanteric bone graft harvest in association with foot and ankle surgery were studied retrospectively by patient questionnaire. The average follow-up was 49 months (range, 14–101 months). Ninety-five percent of the patients expressed satisfaction with the procedure, in that they would choose to accept the trochanteric bone graft again if required to make the choice. However, 31 % of the patients acknowledged some degree of hip discomfort and 4% reported some daily pain. Nineteen of 85 patients (22%) were treated for trochanteric pain. Most patients responded to strengthening/stretching and heat/ice. Four patients (5%) had failed or delayed union of the arthrodesis in which trochanteric bone graft was utilized. The greater trochanter may be considered as an alternative for major bone graft when the iliac bone is not available and when weightbearing is restricted for at least 6 weeks after surgery. As with the use of iliac bone graft, patients should be alerted to the possibility of postoperative discomfort. Surgical details should be followed to minimize the risk of peritrochanteric fracture.
Clinical Safety and Efficacy of Calf Tourniquets
Authors: Michelson James D. , Perry Mark 
Published: March 2013

A clinical study was undertaken to ascertain the utility and complication rate of proximal calf tourniquet use for foot and ankle surgery. The surgical and clinical records of 446 patients undergoing foot and ankle surgery between March 1992 and December 1994 were examined for details pertaining to intraoperative tourniquet use and postoperative evidence of neurologic or vascular complications. All patients who had surgery performed under tourniquet control were included in the study. A total of 454 limbs were operated on: 8 patients underwent bilateral surgical procedures. The patients comprised 172 men and 274 women. The average age was 48.9 (±16.0 SD) years. Surgery was completed in one tourniquet period in 435 cases (95.8%) and in two periods of tourniquet inflation in 19 cases (4.2%). The average duration of tourniquet ischemia was 49.2 minutes (±30.7 SD) for one tourniquet period and 131.1 minutes (±46.0 SD) for two tourniquet periods. No postoperative compromise to either neurologic or vascular function was detected. Specifically, no alteration in peroneal nerve function was seen. We conclude that a calf tourniquet placed proximally with adequate cast padding is a safe and effective method to achieve a bloodless surgical field for foot and ankle surgery.
Triple Arthrodesis: A Biomechanical Evaluation of Screw Versus Staple Fixation
Authors: Meyer Mark S. , Alvarez Brian E. , Njus Glen O. , Bennett Gordon L. 
Published: March 2013

The subtalar, talonavicular, and calcaneocuboid joints were internally fixed to simulate triple arthrodesis was performed on eight matched pairs of human cadaver feet. Feet were randomly assigned such that one specimen in each pair was internally fixed with cobalt-chrome staples and one specimen with stainless steel screws. Liquid metal strain gauges were placed in a perpendicular fashion across the three joints of each specimen. Each foot was then secured to the Shore Western Materials Test System where a series of 10 increasing eversion stresses across the foot was created. Displacement was measured at each joint with every increase in eversion stress. Our results show that there is no statistical difference in fixation strength between screws and staples at the talonavicular, calcaneocuboid, or subtalar joints ( P = 0.862). Although many studies determining the strength to failure of different implants have been performed, shear stress and micromotion at the joint surfaces have not been evaluated, to our knowledge, and no single implant in this study has shown superior immobilization characteristics to recommend its use as the implant of choice in triple arthrodesis.
Achilles Tendon Insertion: An In Vitro Anatomic Study
Authors: Chao Wen , Deland Jonathan T. , Bates James E. , Kenneally Sharon M. 
Published: March 2013

Seventeen adult fresh-frozen below-knee amputation cadaver specimens were studied. Calcific Achilles tendinitis was present in three specimens. After exposing the Achilles tendon insertion on the calcaneus, the insertion was outlined with waterproof paint. The specimens were photographed on a special plexiglass apparatus to highlight important findings. For the purpose of showing the length of insertion on lateral radiographs, lead beads were placed on the most superior and most inferior aspects of the insertion. All specimens showed that the tendon terminated at the medial and lateral bone borders of the calcaneus without significant extension around the medial or lateral wall. All specimens revealed a greater distance of insertion on the medial calcaneus than on the lateral side. In the specimens that had calcific Achilles tendinitis, the posterior bone surface of the spurs was devoid of tendinous insertion. Instead, the insertion occurred between the spur and the posterior wall of the calcaneus. All spurs were located laterally at the most inferior border of the tendon insertion.
Chronic Ankle Pain Caused by Osteoid Osteoma of the Neck of the Talus
Authors: Snow Stephen W. , Sobel Mark , DiCarlo Edward F. , Thompson Francesca M. , Deland Johnathan T. 
Published: March 2013

Five patients with osteoid osteomas of the talar neck were treated at the Hospital for Special Surgery between 1981 and 1992. The course of care leading to definitive diagnosis and treatment was reviewed. All five of the patients had night pain relieved by aspirin or nonsteroidal anti-inflammatory drugs. One of the five reported associated trauma. The average time from onset of symptoms to correct diagnosis was 2.5 years. Juxta-articular osteoid osteoma can cause a small spur that resembles a traction spur on the neck of the talus. Anterior ankle impingement was the most common misdiagnosis. Initial treatments included arthroscopic spur debridement or synovectomy, casting for fracture, and repeated nerve blocks for reflex sympathetic dystrophy. The five patients were cured by en bloc excision of the lesion. In the diagnosis of osteoid osteoma, a history of relief of pain with aspirin is important. Plain radiographs and a bone scan are useful. Fine cut computed tomography scanning or magnetic resonance imaging are the best studies for making a definitive diagnosis. Localization by computed tomography guided needle placement or intraoperative radionuclide scanning are recommended to find the lesion for excision. Intraoperative radiographs of the excised lesion should be used to confirm complete removal.
The Chevron Osteotomy: A Clinical and Radiographic Analysis
Authors: Mann Roger A. , Donatto Keith C. 
Published: March 2013

This is a retrospective study of the chevron osteotomy for hallux valgus. Subjective and objective postoperative results were evaluated. Differences in the postoperative correction of the intermetatarsal 1–2 angle and the first metatarsophalangeal angle were noted using two accepted measurement methods. Seventeen patients (23 feet) with an average age of 39 years (range, 15–51 years) and an average follow-up of 3 years (range, 1–5 years) were studied. The average preoperative intermetatarsal 1–2 angle was 11° (range, 8° to 14°), and the average hallux valgus angle was 23° (range, 7° to 39°). The apparent postoperative correction differed depending on the method of measurement used. One method consistently indicated a greater amount of correction in both the intermetatarsal and metatarsophalangeal angles. The chevron procedure resulted in an overall satisfactory improvement of symptoms, function, and cosmesis. Four feet exhibited postoperative radiographic changes that could be construed as avascular changes, but there was no collapse noted, nor were there clinical symptoms of avascular necrosis. No nonunions, malunions, or infections developed, and no cases of hallux varus occurred.
Arthroscopic Treatment of Anterior Ankle Impingement
Authors: Branca Alberto , Di Palma Luigi , Bucca Carmelo , Visconti Camilla Sagarriga , Di Mille M. 
Published: March 2013

Ankle arthroscopy has recently allowed the elaboration of less invasive techniques for the treatment of anterior impingement. Its indications, advantages, and drawbacks in this application are discussed. Between 1987 and 1994, 133 patients were treated for ankle impingement. Among them, 58 patients, 37 men and 21 women (mean age, 28.5 years), who had failed a trial of conservative treatment were treated by means of tibiotalar arthroscopy. Twenty-seven were athletes engaged in sports with abnormal stressing of the ankle. According to McDermott's radiological classification, there were 15 stage I cases, 23 stage II, 13 stage III, and 7 stage IV. Preoperative evaluation with a modified version of McGuire's scoring system gave 50 cases rated as “poor” (<60 points) and 8 cases rated as “fair” (60–67 points). Treatment consisted of removal of adhesions, cartilage shaving, and removal of the bone impingement with powered instruments, curettes, or small osteotomes. Follow-up was from 8 to 62 months (mean, 21.5 months). The postoperative McGuire ratings were 37 good, 13 fair, and 8 poor. There were no major complications. Recurrence of impingement was observed in four cases of stage III and IV. The conclusion is drawn that ankle arthroscopy is a sound method for the treatment of anterior impingement. Even in cases with severe joint cartilage impairment, it plays a therapeutic role as a means of postponing a possible arthrodesis.
Reconstruction of the Lateral Ankle Ligaments Using an Inferior Extensor Retinaculum Flap
Authors: Saragaglia D. , Fontanel F. , Montbarbon E. , Tourné Y. , Picard F. , Charbel A. 
Published: March 2013

The aim of this study was to assess the results of 32 cases of chronic ankle instability. These were treated by ligament shortening and reinforced with an inferior extensor retinaculum flap. All patients complained of persistent functional instability unrelieved with proprioceptive exercises. Results were assessed clinically (pain, instability, recovery of sports activity, mobility) and radiologically (correction of laxity on stress x-rays). This enabled us to draw up a revision score on a scale of 100 points. We obtained a mean score of 86.7 points (45–100 points), and subjective results showed that 88% of the patients were satisfied with the surgery.
The Effect of Tibiotalar Fixation on Foot Biomechanics
Authors: Wayne Jennifer S. , Lawhorn Keith W. , Davis Kenneth E. , Prakash Karanvir , Adelaar Robert S. 
Published: March 2013

Contact areas and peak pressures in the posterior facet of the subtalar and the talonavicular joints were measured in cadaver lower limbs for both the normal limb and after fixation of the tibiotalar joint. Six joints were fixed in neutral, in 5–7° of varus and of valgus. Ten degrees of equinus angulation was also studied. Each position of fixation was tested independently. Neutral was defined as fixation without coronal or sagittal plane angulation compared with prefixation alignment of the specimen. When compared with normal unfused condition, peak pressures increased, and contact areas decreased in the subtalar joint for specimens fixed in neutral, varus, and valgus. However, the change in peak pressure for neutral fusion compared with normal control was not statistically significant ( P > 0.07). Peak pressures for varus and valgus fixation were significantly different from normal ( P < 0.001). Contact areas for all positions of fixation were significantly different from normal ( P < 0.001). Coronal plane angulation, however, also resulted in significantly lower contact areas compared with neutral fixation ( P < 0.001). Contact areas and peak pressures in the talonavicular joint did not appear to be substantially affected by tibiotalar fixation with coronal plane angulation. Equinus fixation qualitatively increased contact areas and peak pressures in the talonavicular and posterior facet of the subtalar joint. Neutral alignment of the tibiotalar joint in the coronal and sagittal planes altered subtalar and talonavicular joint contact characteristics the least compared with normal controls. Therefore, ankle fusion in the neutral position would be expected to most closely preserve normal joint biomechanics and may limit the progression of degenerative arthrosis of the subtalar joint.
Functional Properties of Adhesive Ankle Taping: Neuromuscular and Mechanical Effects Before and After Exercise
Authors: Alt Wilfried , Lohrer Heinz , Gollhofer Albert 
Published: March 2013

The purpose of the study was to investigate effects of adhesive ankle taping. Using electromyographic, gonio-metric, and thermologic methods, different ankle tapes were tested before and after athletic exercise in simulated inversion trauma. Twelve subjects with stable ankle joints performed five trials: with two different materials, with two taping techniques, and one trial without tape as control. After the simulated inversion trauma, approximately 35% of the initial maximum inversion amplitude was decreased by ankle taping. Depending on the technique, there was a loss of tape stability £14% after 30 min of athletic exercise. Thermologic analysis revealed a postexercise 6°C temperature increase in the foot, especially under the tape. Initially, interpreted as the primary effect, the improved joint stabilization is based on mechanical stiffness caused by the adhesive tape. Joint stability was influenced positively by neuromuscular proprioceptive and physiological processes, characterized by relatively increased electromyographic activation.
Clinical Evaluation of the Modified Brostrom-Evans Procedure to Restore Ankle Stability
Authors: Girard Pierre , Anderson Robert B. , Davis W. Hodges , Isear Jerome A. , Kiebzak Gary M. 
Published: March 2013

The modified Brostrom procedure has become the standard for anatomic repair of symptomatic chronic lateral instability. However, it was our perception that this local tissue repair may fail eventually, particularly in patients that are overweight, hyperflexible, or are involved in strenuous work or athletic activity. This is a retrospective review of 21 lateral ankle reconstructions (20 patients) in which the modified Brostrom technique was augmented with a portion of the peroneus brevis tendon. All patients were interviewed at an average of 29.5 months (range, 14–56 months postsurgery). Fourteen patients also agreed to be evaluated by a physical therapist. No surgical complications were identified. American Orthopaedic Foot and Ankle Society ankle-hindfoot scores averaged 98.2. There was no significant difference in passive or active range of motion of plantarflex-ion or dorsiflexion when compared to the contralateral ankle. However, a statistically significant loss of inversion (passive, P = 0.011; active, P = 0.018) and eversion (passive, P = 0.004; active, P = 0.007) was noted when compared to the contralateral ankle. Measurement of isometric eversion strength, using a Cybex 340 Isoki-netic device, and functional testing, using a lateral lunge test, revealed no significant loss of peroneal strength. The authors conclude that chronic lateral ankle instability in the general population can be successfully managed with a modified Brostrom procedure augmented with a portion of the peroneus brevis. The procedure remains technically simple and provides a greater static restraint for inversion stress without evidence of dramatic overtightening or loss of peroneal strength.
Posterior Calcaneal Osteotomy with Wedge: Cadaver Testing of a New Procedure for Insufficiency of the Posterior Tibial Tendon
Authors: Deland Jonathan T. , Page Alexandra E. , Kenneally Sharon M. 
Published: March 2013

Insufficiency of the posterior tibial tendon is challenging to treat. When the deformity is flexible, treatment options have included tendon transfer, often combined with a medial slide calcaneal osteotomy and/or a lengthening of the lateral column. Posterior calcaneal osteotomy has been shown to give correction, although not full correction. Lengthening of the lateral column also has been shown to give correction and has been used in the more severe flexible deformities, but it involves either fusion of the calcaneocuboid joint or risk of arthritis at this joint. An osteotomy combining the calcaneal medial slide with a lengthening of the lateral column at the same osteotomy site has been tested in the laboratory. This combined osteotomy provides a lengthening of the lateral column, but it is positioned away from the calcaneocuboid joint. In this study, the osteotomy was compared with a medial slide calcaneal osteotomy and an Evans lengthening of the lateral column, using a cadaver flatfoot model. Radiographic measurements were made to evaluate correction of the planovalgus deformity after each of these procedures. There was statistically significant improved correction with the new osteotomy compared with that in a standard medial slide, and correction was comparable to that in the lengthening of the lateral column. This combined osteotomy may be a reasonable alternative when more correction is desired than can be obtained from a medial slide alone and when the surgeon wishes to avoid an osteotomy near the calcaneocuboid joint.
Plantar Fascia Release Through a Transverse Plantar Incision
Authors: Brown Jeremy N. , Roberts Simon , Taylor Mark , Paterson Roger S. 
Published: March 2013

A transverse plantar incision for plantar fascial release was assessed for pain relief, numbness, and subsequent heel pad symptoms. Twenty-seven feet in 26 patients who underwent plantar fascia release were reviewed with a minimum follow-up of 2 years after surgery (average, 37.6 months). Comprehensive data were obtained on 25 feet (24 patients) (93% response rate). The plantar fascia origin was completely transected in all cases. This led to complete resolution of symptoms in 19 feet and residual minor symptoms in six feet. After 2 years, four patients had developed recurrent symptoms, two in the area of surgery and two on the dorsum of the foot, in association with a pes planus foot. Two patients had some continued persistence of heel pain after surgery, although significantly less pain than preoperatively. Thus, 76% of patients had complete relieve of there symptoms, 12% of patients had mild symptoms not affecting daily activities, and 12% of patients had moderate symptoms that limited some activities. No patient suffered heel pad symptoms or numbness after surgery. It is concluded that plantar fascia release through a transverse plantar incision is a successful procedure for long-term relief of symptoms which avoids unnecessary heel pad numbness and scar morbidity. The benefits of a transverse incision include greater intraoperative vision, to ensure adequate release and spur excision, and an incision parallel to the medial calcaneal branches of the tibial nerve.