bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Analysis of Cancellous Bone Graft Available from the Greater Trochanter
Authors: Lindberg Eric J. , Katchis Stuart D. , Smith Ronald W. 
Published: March 2013

To quantify the amount of cancellous bone graft available from the greater trochanteric region, 20 paired iliac crest-proximal femur specimens were harvested and compared in 10 adult pelvises. A 1.3 × 1.3-cm cortical window was made in the lateral aspect of the proximal femur 2 cm distal from the tip of the greater trochanter. Cancellous bone evacuation was performed by curettage. The extent of harvest was mechanically limited by the medial wall of the trochanter and by curette impingement on the margins of the cortical window. The graft was quantitated after maximal digital compression in a 10-ml syringe and compared with cancellous graft obtained from the paired anterior iliac crest. The average compressed volume of cancellous bone harvested from the greater trochanter was 6.5 ml (range, 4.2–9.6 ml). The average iliac crest cancellous bone volume was 6.0 ml (range, 2.7–8.8 ml). Differences in graft volume between the anterior iliac crest and the trochanter were not statistically significant. The resulting defect in the proximal femur remained isolated to the trochanteric region. In this study, we demonstrate that cancellous bone is available from the greater trochanteric region in an amount similar to that available from the anterior iliac crest. We also show that it is obtainable in a reproducible manner. Our clinical experience of over 100 cases has demonstrated acceptable morbidity associated with this technique. The greater trochanteric region may be used as a secondary source of autogenous cancellous bone graft when specific procedures demand more bone graft than available from the iliac crest alone, or in patients who have had previous iliac crest graft harvest.
Plantarflexion Injury to the Metatarsophalangeal Joint (“Sand Toe”)
Authors: Frey Carol , Andersen G. Douglas , Feder Keith S. 
Published: March 2013

This is a retrospective study of 12 cases of hyperplantarflexion injuries to the great toe and the lesser toes sustained in professional beach volleyball players. The hyperplantarflexion injury to the metatarsophalangeal joint, referred to as “sand toe,” can result in significant functional disability. Push-off, forward drive, running, and jumping are compromised. The average player in this series took 6 months to fully recover from the injury, and the most common problem after injury was the loss of dorsiflexion, seen in six players. Five players had residual discomfort in the injured toe, and two demonstrated an unstable toe. Individuals who experience sand toe injuries should be treated conservatively, with taping, anti-inflammatory medications, shoe wear modification, ice, and rest. A toe strengthening program is also presented.
Bridle Transfer for Paresis of the Anterior and Lateral Compartment Musculature
Authors: Prahinski John R. , McHale Kathleen A. , Temple H. Thomas , Jackson Joseph P. 
Published: March 2013

In the Riordan (bridle) transfer, the posterior tibialis muscle as motor is routed through the interosseous membrane and anastomosed into a “bridle” formed by the distal tibialis anterior and peroneus longus muscles. In theory, the bridle provides inversion/eversion balance even if the transfer effects only tenodesis. However, the procedure has been criticized because its insertion is not into bone. This review analyzes the use of bridle transfer in flaccid paresis involving musculature innervated by the peroneal nerve. Surgery was performed 1 to 3 years after injury for patients with traumatic etiology. Ten patients are reviewed at 61 months’ mean follow-up. Eight patients had traumatic peroneal nerve loss. Two had neuromuscular etiology. Evaluation included review of records, telephone interviews, and physical examinations. Data on functional status included walking barefoot, running, need for bracing, return to duty, and patient satisfaction. Physical examination recorded ankle position and motions, gait findings, and results of static electromyograms. All patients were able to walk barefoot, but 6 of 10 had a mild to moderate limp. Five patients returned to running initially; only two were able to keep running. Nine patients were brace-free initially (polio sequela required bracing initially), and four others returned to bracing. Of these, two experienced an acute “tearing” and dorsiflexion loss, one sustained a prolonged gradual loss of dorsiflexion, and one sustained a contralateral cerebrovascular accident. Only three of seven patients returned to active duty, and one is on jump status. All patients were satisfied with their initial result. Only two patients had no detectable swing phase problems (both returned to active duty). Five patients had peroneal nerve exploration with repair or neurolysis; two of them sustained complete transections. Postoperative electromyograms showed insignificant, if any, nerve return. The Riordan transfer works well for neuromuscular flaccid paresis and in patients with peroneal nerve injuries with low demands. It may stretch out over time to the point of acute failure in patients with high demands. Concurrent peroneal nerve exploration and repair did not seem to be beneficial in this small study.
Two-point Discrimination of Vibratory Perception on the Sole of the Human Foot
Authors: Kowalzik R. , Hermann Birgit , Biedermann H. , Peiper U. 
Published: March 2013

The capability for discrimination of vibratory stimuli of the sole of the foot was tested on 12 subjects (6 men, 6 women). Two vibratory stimuli (sinusoidal impulse: frequency, 200 Hz; amplitude, 0.1 mm; duration, 2 sec) were applied at different sites to the sole of the foot. Subjects were asked whether they detected one or two vibratory sensations. The discrimination threshold was defined as the shortest distance at which two vibrations can be differentiated at repeated trials. In addition, the absolute threshold was measured by one plunger (sinusoidal vibration: frequency, 200 Hz; variable amplitude). The values of the absolute threshold (average value, 1.2 μm) were in accordance with the results of other authors. A decrease of discrimination capability was observed along the longitudinal axis of the foot from distal to proximal parts and was about 15 mm at the big toe and 34 mm at the heel. Discrimination at the medial longitudinal arch was inferior to that at the lateral longitudinal arch. This was also true for inverse vibration in which all subjects showed lower thresholds. No relationship was found with respect to thickness of the skin (measured by ultrasound), side of foot, or gender. Determining factors for vibratory threshold might be the density of the Pacinian corpuscles per cm2 as well as their peripheral and central representation. Anatomical or physical factors (e.g., thickness of the skin, impedance of the deeper tissue) can probably be disregarded.
Isolated First Naviculocuneiform Joint Coalition
Authors: Kumai Tsukasa , Tanaka Yasuhito , Takakura Yoshinori , Tamai Susumu 
Published: March 2013

Clinical analysis was performed on 60 feet in 40 patients with isolated first naviculocuneiform coalitions. The most common symptom was a mild pain at the medioplantar site of the first naviculocuneiform joint. Fifteen feet (25%) were asymptomatic. Some cases had been treated erroneously as osteoarthritis or bony cyst before diagnosis. We divided coalitions morphologically into three patterns based on computed tomography findings: irregular, cystic, and combined pattern. Based on the mean age of each pattern, we hypothesized that initial irregular coalitions gradually develop into cystic and, finally, combined patterns. Considering the modest number of reported cases, this condition might easily be overlooked in many patients or may be related to ethnic characteristics. We suggest that the actual incidence of first naviculocuneiform coalitions should be investigated again.
Plantar Fibromatosis: Treatment of Primary and Recurrent Lesions and Factors Associated with Recurrence
Authors: Aluisio Frank V. , Mair Scott D. , Hall Reginald L. 
Published: March 2013

Plantar fibromatosis is a benign but often problematic foot disorder which, when surgically treated, is difficult to eradicate. The purpose of this investigation was to identify epidemiologic factors associated with disease recurrence and to determine which method of treatment most successfully eliminated recurrence. A retrospective review of surgical pathology reports and clinical histories from 1979 to 1993 was performed to identify all patients who underwent surgery for plantar fibromatosis at our institution during that time. Thirty-three feet of 30 patients were identified with a minimum 2-year follow-up. Seventeen feet underwent surgery for primary lesions, and 4 of 10 that had local excision, 1 of 3 that had wide excision, and 2 of 4 that had subtotal fasciectomy (with or without skin grafting) had recurrence. All 16 feet in patients presenting with recurrent lesions had undergone prior local excision at other institutions. When combined with patients from our institution who underwent a second procedure, 21 feet had surgery for recurrent plantar fibromatosis. Of these, three of four had further recurrence when treated with local or wide excision. In feet with recurrences treated with subtotal fasciectomy, only 4 of 17 had recurrence after the first attempt at such treatment. Average follow-up for all patients was 7.7 years, and all patients with postoperative recurrences showed evidence of disease within 14 months after surgery (mean, 6.9 months). Factors identified with an increased risk for recurrence were multiple nodules, bilateral lesions, and positive family history. In treating recurrent disease, subtotal fasciectomy was more effective than local or wide excision. This study identified factors associated with a significant likelihood of postoperative recurrence in treating plantar fibromatosis and found subtotal fasciectomy to provide the most successful treatment in eradicating disease in recurrent cases.
Nonoperative Management of Posterior Tibial Tendon Dysfunction
Authors: Chao Wen , Wapner Keith L. , Lee Thomas H. , Adams Jeffrey , Hecht Paul J. 
Published: March 2013

Forty-nine patients with posterior tibial tendon dysfunction (4 patients had bilateral involvement) were treated with orthoses. Forty feet were treated with molded ankle-foot orthoses, and 13 feet were treated with University of California Biomechanics Laboratory shoe inserts with medial posting. A total of 37 women and 12 men were included in the study. The mean follow-up period was 20.3 months (range, 8–60 months). The average age of the patients was 66 years (range, 42–89 years). Sixty-seven percent of patients had good to excellent results, according to a functional scoring system based on pain, function, use of assistive device, distance of ambulation, and patient satisfaction. The average period of orthosis use was 14.9 months (range, 1.5–29 months), with an average length of daily orthosis wear of 12.3 hours. One patient elected to undergo surgical treatment rather than continuing with long-term orthosis use. Thirty-three percent of patients had discountinued using the orthosis at the time of follow-up evaluation. Three patients were unable to wear the orthosis because of concurrent medical conditions. Nine patients stopped wearing the orthosis after experiencing discomfort and inconvenience. Although these patients continued to exhibit signs and symptoms of posterior tibial tendon dysfunction, they were not disabled enough to consider further treatment. Four patients tolerated orthosis treatment poorly and were treated surgically. Patients with posterior tibial tendon dysfunction can be treated by aggressive nonoperative management using molded ankle-foot orthoses or University of California Biomechanics Laboratory shoe inserts with medial posting. Surgical treatment can be reserved for patients who fail to respond to an adequate trial of brace treatment. Nonoperative management using an orthosis is particularly useful for elderly patients with a sedentary lifestyle or for patients at high risk because of medical problems.
The Mayday Distal First Metatarsal Osteotomy for Hallux Valgus: A Review After the Introduction of a New Instrument
Authors: Terzis G.D. , Kashif F. , Mowbray M.A.S. 
Published: March 2013

We present the short-term follow-up of 55 symptomatic hallux valgus deformities in 38 patients, treated operatively with a modification of the spike distal first metatarsal osteotomy, as described by Gibson and Piggott in 1962. The age range of the patients was 17 to 72 years at the time of surgery. The postoperative follow-up period was 12 to 55 months. Excellent and good clinical and radiographic results were recorded in 96.2% of our patients. Two of the patients (3.8%) were dissatisfied; one of them complained of metatarsalgia after the procedure, and the other had stiffness of the metatarsophalangeal joint and metatarsalgia that had been present before surgery. Three others (5.45%) required revision after early postoperative displacement but were asymptomatic subsequently. We concluded that our technique is an effective method of treating mild hallux valgus deformities with the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal tilting of the distal fragment. Hallux valgus (lateral deviation of the great toe) is not a single disorder, as the name implies, but a complex deformity of the first ray that sometimes may involve the lesser toes. More than 130 procedures exist for the surgical correction of hallux valgus, which means that no treatment is unique. No single operation is effective for all bunions. 5 , 22 , 29 The objectives of surgical treatment are to reduce pain, to restore articular congruency, and to narrow the forefoot without impairing function, by transferring weight to the lesser metatarsals either by shortening or by dorsal tilting of the first metatarsal. 5 , 19 , 24 , 27 Patient selection is important for a satisfactory outcome after surgery of any kind, and our criteria were age, degree of deformity, presence of arthrosis, and subluxation of the first metatarsophalangeal joint. 1 , 5 , 13 , 19 – 21 , 24 , 29 In this study, we present a new method of treating hallux valgus that has been used at Mayday University Hospital since 1990. The technique was first described at the British Orthopaedic Foot Surgery Society, Liverpool, November 1990, 7 and we now present the short-term follow-up results. The procedure is essentially a modification of the spike osteotomy of the neck of the first metatarsal, as described by Gibson and Piggott. 9 It has the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal displacement of the distal fragment.
Mechanical Behavior of the Foot and Ankle After Plantar Fascia Release in the Unstable Foot
Authors: Kitaoka Harold B. , Luo Zong Ping , An Kai-Nan 
Published: March 2013

The change in position of the bones of the foot was studied in three dimensions after plantar fascia release in intact and destabilized feet. Fifteen fresh-frozen human foot specimens were used. Physiologic loads of 445 newtons were applied axially to simulate standing at ease, and the three-dimensional position of tarsal bones was determined with a magnetic tracking device. The positions were presented in the form of screw axis displacements, quantitating rotation, and axis of rotation orientation. After fasciotomy in the six intact feet, significant differences in rotation were observed at the talotibial and calcaneotalar levels. After fasciotomy in the four unstable feet with three supporting elements sectioned, significant differences in position were observed at the talotibial joint and a significant decrease in arch height was observed. After fasciotomy in the five unstable feet with five supporting elements sectioned, significant differences in rotation were observed at the talotibial joint (mean, 5.5 ± 1.6° P = 0.001), calcaneotalar joint (mean, 6.1 ± 2.1° P = 0.003), and metatarsotalar level (mean, 9.3 ± 4.1° P = 0.007). The average decrease in arch height was 7.4 ± 4.1 mm ( P = 0.015). Displacement of all joints tested occurred after fasciotomy, with rotation about all three axes. These changes in displacement were more pronounced in unstable or destabilized feet. The data suggest that operations involving fasciotomy affect arch stability and should not be performed in patients with evidence of concomitant pes planus deformity, because of the likelihood of further deformation.
Effect of the Posterior Tibial Tendon on the Arch of the Foot During Simulated Weightbearing: Biomechanical Analysis
Authors: Kitaoka Harold B. , Luo Zong Ping , An Kai-Nan 
Published: March 2013

A cadaver study was performed to determine the effect of the posterior tibial tendon (PTT) on the stability of the foot in simulated midstance phase of gait. Thirteen fresh-frozen human foot specimens were used. Loads were applied axially and to each tendon. Three-dimensional positions of tarsal bones before and after tendon loading were determined with the use of a magnetic tracking device. Significant differences in tarsal bone positions were observed with application of loads to the Achilles, posterior tibial, flexor digitorum longus, peroneus longus, and peroneus brevis tendons at the metatarsotalar, calcaneotalar, and talotibial joints and in overall arch height. These tendon loads caused position changes toward arch flattening or mild pes planus deformity. Significant differences in tarsal bone positions were observed with PTT loading compared with no PTT loading in metatarsotalar, calcaneotalar, and talotibial levels as well as arch height. The PTT caused position changes toward restoring the arch alignment. These data suggest that the PTT is an important stabilizer of the arch of the foot.
Modified Austin Procedure for Correction of Hallux Valgus
Authors: Trnka Hans-Jörg , Zembsch Alexander , Wiesauer Hermann , Hungerford Marc , Salzer Martin , Ritschl Peter 
Published: March 2013

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.
Polyglycolide Bioabsorbable Screws in the Treatment of Ankle Fractures
Authors: Hovis W. David , Bucholz Robert W. 
Published: March 2013

Twenty-one patients with unstable medial malleolar, bimalleolar, or trimalleolar ankle fractures underwent open reduction and internal fixation of the medial malleolus with 4.5-mm polyglycolide screws. All lateral malleolar fractures were internally fixed with standard metallic implants. Radiographic and clinical follow-up results were available on 16 of 21 patients. All fractures healed at an average of 3.4 months (range, 3–6 months), and there were no medial wound infections. Eight of 16 patients developed an inflammatory reaction to the biodegradable polyester at 3 to 4 months after implantation, including one who developed a sterile draining sinus tract. No surgical or nonsurgical treatment was required in those eight patients. We conclude that whereas polyester screws yield union rates and functional results similar to those of metallic screws in the treatment of medial malleolar fractures, the use of polyglycolide screws is associated with an unacceptable rate of inflammatory reactions.
Treatment Algorithm of Chronic Ankle and Subtalar Instability
Authors: Thermann Hajo , Zwipp Hans , Tscherne Harald 
Published: March 2013

From 1981 to 1984, 131 reconstructive procedures and 113 Evans tenodesis procedures (1972–1984) were performed for patients with chronic instability of the ankle joint. From 1981 to 1985, 42 Christman/Snook procedures were performed for patients with isolated or combined subtalar instability. Reevaluation was conducted for 223 patients (102 reconstructive procedures, 87 Evans tenodesis procedures, and 34 Christman/Snook tenodesis procedures). The follow-up protocol comprised standard and stress radiograms, subjective patient evaluation, and objective functional data. No patient in either treatment group had clinically important ankle instability. Patients who had undergone the Evans tenodesis had a 3.3° mean less talar tilt than did patients treated with reconstructive procedure. Of 87 patients who underwent Evans tenodesis, 33 had a mean supination deficit of 7.5°. According to the ±100 points classification, 90% of the patients in both groups achieved good or excellent results. For subtalar instability, the Christman/Snook techniques resulted in a mean supination deficit of 7.2° in 20 patients. Of 34 patients, 31 were rated good or excellent.
Kinematics and Contact Characteristics of the First Metatarsophalangeal Joint
Authors: Ahn Tae-Kun , Kitaoka Harold B. , Luo Zong-Ping , An Kai-Nan 
Published: March 2013

We studied six fresh frozen cadaver feet to define the three-dimensional motion of the hallux proximal phalanx in relation to the first metatarsal and to describe the contact features of the first metatarsophalangeal joint. Six tendons to the hallux were loaded to simulate dynamic loading of the hallux. A magnetic tracking system was used to monitor the three-dimensional movement of the proximal phalanx while the toe position was changed from a neutral position to full extension by adjusting the tendon loads. The average surface area was 0.38 ± 0.08 cm2 in the neutral position; it decreased with toe extension and was the lowest (0.04 ± 0.03 cm2) at the full extension position. Contact distribution of the proximal phalanx did not change substantially throughout the arc of motion. However, for the metatarsal articular surface, the contact distribution shifted dorsally with increasing degrees of extension. These data are consistent with the observation that chondral erosions associated with hallux rigidus and degenerative arthritis initially affect the dorsal articular surface of the metatarsal, and implant arthroplasty often fails from component loading dorsally. The current technique of determining joint contact characteristics is applicable not only for the first metatarsophalangeal joint but also other joints that have not been studied because of shortcomings with more conventional methods.