bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment of Advanced Hallux Rigidus by Interpositional Arthroplasty
Authors: Sanhudo Jose A. , Gomes Joao E. , Rodrigo Martini K. 
Published: July 2011

Background: While arthrodesis is the gold-standard for end-stage hallux rigidus, it leads to loss of mobility. The purpose of this paper was to report our clinical results with modified interpositional arthroplasty for the treatment of advanced (Grade III and IV of Coughlin and Shurnas) hallux rigidus. Material and Methods: Twenty-five feet with Grade III and IV hallux rigidus underwent cheilectomy, minimal proximal phalanx resection (modified Keller) and interposition of the dorsal capsule and EHB. Results: At a minimum followup of 15 months, the mean postoperative hallux AOFAS score was 93.6 points with a pain subscore of 36.4 (maximum, 40 points) and functional subscore of 42.5 (maximum, 45 points). Subjectively, patients were completely satisfied with the surgical outcome in 75% of the cases. Conclusion: The modified interpositional arthroplasty was a feasible surgical option to address advanced hallux rigidus in middle aged patients. Level of Evidence: IV, Case Series
Stabilization of Chevron Bunionectomy with a Capsuloperiosteal Flap
Authors: Guclu Berk , Kaya Alper , Akan Burak , Koken Murat , Us Ali Kemal 
Published: July 2011

Background: Distal chevron osteotomy (DCO) for mild to moderate hallux valgus deformity is inherently more stable than the other forms of distal metatarsal osteotomy, but complications such as loss of correction, infection, joint stiffness, delayed union, malunion and nonunion can occur. In this study, we evaluated the use of a capsuloperiosteal flap for stabilization of DCO in the treatment of hallux valgus. Materials and Methods: A retrospective study was conducted on 59 patients (88 feet) that underwent distal Chevron osteotomy stabilized only with a capsuloperiosteal flap for mild and moderate hallux valgus deformity with a mean followup of 11.3 years. Clinical evaluation was calculated using the hallux score of the American Orthopaedic Foot and Ankle Society (AOFAS). Results: The score improved from a preoperative mean of 52 to a mean of 91.5 points at last followup. Average hallux valgus angle changed from 30.3 degrees preoperatively to 14.2 degrees postoperatively at the last followup. Intermetatarsal angle 1–2 changed from 13.6 degrees preoperatively to 10.2 degrees postoperatively. The correction proved to be consistent with only an average of 3.4-degree correction loss and 4.9-degree loss in the range of motion. Eighty-six feet (97.7%) were pain free. Discomfort with shoewear was absent in 84 feet (95.5%) postoperatively and 24 of 25 (96%) patients were satisfied cosmetically. Conclusion: Capsuloperiosteal flap stabilization of distal chevron osteotomy for mild-moderate hallux valgus yielded excellent clinical results at long-term followup.
Analysis of the Proximal Phalanx Size as a Guide for an Akin Closing Wedge Osteotomy
Authors: Shannak Odei , Sehat Khosrow , Dhar Sunil 
Published: July 2011

Background: The Akin closing wedge osteotomy for correction of hallux valgus interphalangeus has experienced a resurgence in popularity. Commonly, the size of the osteotomy is visually judged intraoperatively. We present a means of performing the osteotomy more objectively. Materials and Methods: Radiographs of 101 feet were studied to derive mean values for dimensions of the hallux proximal phalanx in the general population. Based on these we calculated the size of osteotomy required for given corrections. Results: The mean hallux width 5 mm distal to the apex of the articular surface differed between males and females. In males the mean width was 18 mm (95% CI 17.5 to 18.8) and in females 15 mm (95% CI 14.5 to 15.5). For a 10 degree correction, an osteotomy with a 3 mm base would be required. Conclusion: Although the Akin osteotomy dimensions are commonly estimated, a more objective method of planning the osteotomy is presented. The method can also be applied to any closing wedge osteotomy. Clinical Relevance: We believe this method of the Akin osteotomy can improve the accuracy of the surgery.
A Biomechanical Analysis of a Tensioned Suture Device in the Fixation of the Ligamentous Lisfranc Injury
Authors: Pelt Christopher E. , Bachus Kent N. , Vance Richard E. , Beals Timothy C. 
Published: July 2011

Background: We hypothesized that using a cadaveric Lisfranc ligamentous injury model, abduction stress would provoke greater post-injury motion than axial weightbearing between the medial cuneiform (MC1) and the base of the second metatarsal (MT2). Second, we hypothesized that both a tensioned suture-button device and a rigid screw fixation method could maintain a reduction and similarly restrain motion to intact (pre-injury) levels. Materials and Methods: Motion was measured between MC1 and MT2 in five matched pairs of human cadaveric feet. Specimens were tested prior to injury, following a transverse ligamentous Lisfranc injury, and then randomized to either screw or tensioned suture-button fixation. Axial then abduction loads were applied. Measurements were repeated after one thousand loading cycles. Results: With both axial and abduction loads, statistically significant differences in motion were detected between the intact and post-injury conditions, although the magnitudes were greater with abduction (6.8 mm versus 2.0 mm, p = 0.000004). With abduction loads, both fixation methods were effective in restraining motion to pre-injury levels (screw fixation: 1.5 mm intact versus 1.1 mm post-fixation, p = 0.487; suture-button fixation: 1.3 mm intact versus 2.1 mm post-fixation, p = 0.063), and similarly, both devices restrained motion to less than post-injury levels (screw fixation: 8.1 mm post-injury versus 1.1 mm post-fixation, p = 0.001; suture-button fixation: mean 5.5 mm post-injury versus 2.1 mm post-fixation, p = 0.0002). No significant differences in these patterns were detected following cyclic loading. Conclusion: Small, though statistically significant, amounts of motion are produced between MC1 and MT2 with axial loading after a ligamentous Lisfranc injury. With abduction stress, we were able to show a significantly greater difference between pre- and post-injury motion and the ability of both fixation methods to restrain motion to pre-injury levels. Clinical Relevance: Abduction stress may be valuable when diagnosing and testing the transverse ligamentous Lisfranc injury. Both suture-button and screw fixation methods restrain motion at the Lisfranc complex.
Biomechanical Evaluation of a Locking and Nonlocking Reconstruction Plate in an Osteoporotic Calcaneal Fracture Model
Authors: Blake Matthew H. , Owen John R. , Sanford Timothy S. , Wayne Jennifer S. , Adelaar Robert S. 
Published: July 2011

Background: This study evaluated the effects of locking vs nonlocking configuration on the biomechanical performance of a calcaneal reconstruction plate in an osteoporotic cadaveric model. Materials and Methods: A Saunders II B type calcaneal fracture was created in ten matched pair of cadaveric calcanei. Each pair was fixed with the Ascension calcaneal reconstruction plate using either locking or nonlocking screws in the same hole pattern. Specimens were axially loaded for 1000 cycles through the talus followed by load to failure. Statistical comparisons were made between the locking and nonlocking constructs on the displacements during cyclic loading as well as construct stiffness and load achieved at selected fragment displacements. Results: No significant difference was detected between the locking and nonlocking constructs in displacement during cyclic loading ( p >0.2) for the numbers available. Similarly no significant difference was found in stiffness of the constructs between the groups: 445.7 ± 148.8 (N/mm ± SD) for the locking plate and 395.2 ± 127.7 for the nonlocking plate ( p >0.14). The load achieved at 2 mm displacement of the posterior fragment for the two groups were not different: locking plate at 744.6 ± 237.2 N and nonlocking plate at 739.3± 269.7 N ( p >0.99). Conclusion: This study did not reveal a mechanical advantage to locking technology for calcaneal fractures with the selected plate and fracture model. Clinical Relevance: While locking plate technology has shown mechanical advantages for fracture management in other osteoporotic models, in our fracture model and plating construct, this was not found. It is still unclear which fixation technique is most beneficial in these calcaneal fractures.
STAR™ Ankle: Long-Term Results
Authors: Mann Jeffrey A. , Mann Roger A. , Horton Eric 
Published: July 2011

Background: There has been a resurgence of interest in total ankle replacement (TAR) due to improved results with newer prostheses. However, long-term survivorship data has been limited. The STAR™ Ankle prosthesis is the first three-part prosthesis approved for use in the United States. Materials and Methods: Eighty-four total ankle replacements were performed in 80 patients using the STAR™ Ankle prosthesis and followed prospectively. Postoperatively, patients were evaluated with the AOFAS score for pain and function, and serial radiographs were evaluated for stability and alignment of the prosthesis. Implant failure, secondary procedures, and complications were recorded. Results: Ninety-one percent of prostheses remain implanted at an average followup of 9.1 years. The probability of implant survival was 96% at 5 years and 90% at 10 years. An average 39-point improvement in the AOFAS ankle-hindfoot score was noted, from a mean of 43 to a mean of 82 points. We noted a statistically significant increase in both average pain and function sub-scores. Postoperative range of motion averaged 4.5 degrees of dorsiflexion and 35 degrees of plantarflexion. Ninety-two percent of the patients were satisfied with their outcome. Ten patients (13%) developed concerning osteolytic lesions. Change in prosthetic alignment and adjacent joint arthritis were similar to previous reports. We report 21 complications, which included 14 additional surgical procedures. Conclusion: The first U.S. prospective long-term survivorship data with the STAR™ Ankle prosthesis found it to be an excellent long-term option for the treatment of ankle arthritis. Level of Evidence: IV, Case Series
Transient Bone Marrow Edema of the Foot and Ankle and its Association with Reduced Systemic Bone Mineral Density
Authors: Sprinchorn Anna E. , O'Sullivan Richard , Beischer Andrew D. 
Published: July 2011

Background: Transient bone marrow edema in the foot and ankle is an uncommon condition that should be distinguished from early avascular necrosis, stress fracture, or bone bruise. The diagnosis is based on the clinical presentation of pain with weightbearing without a history of trauma, combined with typical findings on magnetic resonance imaging. The etiology is not known, but recent case reports have suggested a possible link to systemic osteoporosis. This study examined the relationship between transient bone marrow edema of the foot and ankle and low systemic bone mineral density. Material and Methods: Over a period of 2 years, ten patients (eight women and two men) who were referred to our foot and ankle clinic were diagnosed as having transient bone marrow edema. Their mean age was 59 years. All underwent dual energy X-ray absorptiometry (DEXA) scan and were tested for serum vitamin D levels. The patients were treated with either a controlled ankle motion (CAM) walker or a stiff-soled postoperative shoe and all recovered in 5 to 10 months. Results: Four patients were found to have osteoporosis and five had osteopenia. Only one patient had normal bone density. Serum vitamin D levels were low in nine patients, and normal in one. Conclusion: Our study found a strong association with transient bone marrow edema in the foot and ankle and low systemic bone mineral density, which appears to be due to a vitamin D deficiency. We recommend that, when TBME is diagnosed, patients should be referred for assessment and treatment of their bone mineral density. Level of Evidence: IV, Retrospective Case Series
First Metatarsal Length Change after Basilar Closing Wedge Osteotomy for Hallux Valgus
Authors: Day Thomas , Charlton Timothy P. , Thordarson David B. 
Published: July 2011

Background: Hallux valgus deformities with large intermetatar-sal angles require a more proximal metatarsal procedure to adequately correct the deformity. Due to the relative ease of a closing wedge osteotomy, this technique was adopted but with concern over first metatarsal shortening. In this study, we primarily evaluated angular correction and first metatarsal shortening. Materials and Methods: We evaluated 70 feet in 57 patients (average age, 54 years) with 52 female and five male. The average followup was 14 (range, 6 to 45) months. The charts were reviewed for the presence of metatarsalgia. Digital radiographic measurements were made for pre- and postoperative hallux valgus and intermetatarsal angles, dorsiflexion angle of the first metatarsal, and absolute and relative shortening of the first metatarsal. Results: The average hallux valgus angle improved from 31 to 11 degrees ( p < 00001) and intermetatarsal angle from 13.2 to 4.4 angles ( p < 00001). The absolute shortening of the first metatarsal was 2.2 mm and relative shortening was 0.6 mm. There was 1.3 degrees of dorsiflexion on average. Conclusion: Excellent correction of the deformity with minimal dorsiflexion or new complaints of metatarsalgia was found with this technique. The new method of assessing the relative shortening found to be less than the absolute shortening, which we feel more accurately reflects the functional length of the first metatarsal. Level of Evidence: IV, Retrospective Case Series
Extremely Proximal Fractures of the Fifth Metatarsal in the Developmental Age
Authors: Riccardi Giovanni , Riccardi Domenico , Marcarelli Marco , Regno Nicola Del , Riccio Vincenzo 
Published: July 2011

Background: Numerous studies document the high incidence of this type of fracture of the foot in childhood due to the presence of the growth plate of the apophysis of the fifth metatarsal. Our aim in this study was to evaluate the presence and morphology of the growth nucleus and correlate its presence with fractures of the apophysis of the fifth metatarsal. Materials and Methods: Between 2001 and 2003, we reviewed the radiographs of 481 patients (558 feet) between 6 months and 16 years that were diagnosed with a fracture. We evaluated for the presence and morphology of the growth nucleus of the base of the fifth metatarsal in the 7- to 16-year age group because this is the time interval in which the nucleus becomes visible radiographically. Results: We identified the nucleus of the base of the fifth metatarsal in 115 patients for a total of 132 feet. A fracture of the fifth metatarsal was found in 12.8%. A misdiagnosis had been made in 47%. Misdiagnosis was strictly related to the presence of the growth nucleus of the apophysis except two cases where an accessory bone was present. Conclusions: Our study demonstrated a much higher incidence of the presence of the growth nucleus than documented in previous reports and that its morphology varied widely in relation to the stage of maturity of the patient and the radiographic technique. Its presence led to a high rate of misdiagnosis of a fracture. Level of Evidence: IV, Retrospective Case Series
Relationship of the Scarf Valgus-Inducing Osteotomy of the Calcaneus to the Medial Neurovascular Structures
Authors: Vermeulen Katrien , Neven Enrico , Vandeputte Geoffroy , Van Glabbeek Francis , Somville Johan 
Published: July 2011

Background: The Scarf valgus inducing osteotomy of the calcaneus is an operative technique to correct varus deformity of the hindfoot. It is versatile with significant corrective power; however, the neurovascular structures are in close proximity on the medial side and thus may be harmed during the osteotomy. Moreover, because this type of osteotomy can cause a great lateral translation, traction of the medial neurovascular structures is possible. We performed an anatomic study to evaluate the medial soft tissues after a lateralizing Scarf-type calcaneal osteotomy. Materials and Methods: The osteotomies were carried out on ten fresh-frozen cadaver specimens. We performed the osteotomy and induced valgus. Then we performed a medial dissection to identify the important medial structures: the medial and lateral plantar nerve (MPN, LPN) and the posterior tibial artery (PTA). We noted their relation to the osteotomy and their integrity. Results: In several cases, one or more of the structures were sectioned. In five cases, all the structures crossed the osteotomy, four of which even a transection of one or both of the plantar nerves occurred. Although the PTA crossed the osteotomy in eight specimens, there was no transection of this structure. Conclusion: Scarf osteotomy of the calcaneus is a highly corrective osteotomy. However, caution must be exercised when performing as the medial neurovascular structures cross the osteotomy lines and transection can occur. Clinical Relevance: When performing the osteotomy one should keep in mind that vigorous sawing and large displacement can cause damage to the medial neurovascular structures.
Deep Peroneal Nerve Injury following External Fixation of the Ankle: Case Report and Anatomic Study
Authors: Lui T. H. , Chan Lap Ki 
Published: July 2011

Background: We present a case of deep peroneal nerve injury after application of external fixator and conducted a cadaveric study of the relationship of the deep peroneal nerve to the lateral tibial cortex. Materials and Methods: A case of toe drop after application of the external fixator is reported. Twelve cadaveric lower legs were dissected to identify the course of the deep peroneal nerve. The tibia were divided into four Zones with equal length. The course of the nerve through each Zone of the tibia was studied Result: In Zone 1, the deep peroneal nerve went around the fibular neck and was found on the interosseous membrane at the distal portion of Zone 1. In Zone 2, the nerve still lay on the interosseous membrane in all specimens at the posterior edge of the lateral tibia. In Zone 3, the nerve moved away from the interosseous membrane and had direct contact with the tibia in nine specimens. In Zone 4, the nerve was on the anterior surface of the distal tibia. Conclusion: The deep peroneal nerve can be injured during the application of a unilateral frame ankle external fixator. The nerve is particularly at risk in Zone 2 and 3. Clinical Relevance: The study provided an anatomic basis for the safe application of a unilateral external fixator of the tibia. Level of Evidence: V, Expert Opinion
Efficacy of Paracetamol versus Diclofenac for Grade II Ankle Sprains
Authors: Lyrtzis Christos , Natsis Konstantinos , Papadopoulos Christos , Noussios Georgios , Papathanasiou Efthymia 
Published: July 2011

Background: Ankle sprains are usually treated with the RICE protocol often with nonsteroidal anti-inflammatory drugs (NSAID) for pain reduction. We evaluated the effect of diclofenac, an NSAID, versus paracematol in the reduction of pain and acute edema of severe ankle sprains. Materials and Methods: Ninety patients, 18 to 60 years old, with Grade II acute ankle sprains were randomized into two groups. Group A (45 patients) received for the first 10 days diclofenac 75 mg orally twice per day. Group B (45 patients) received paracetamol 500 mg orally three times per day for the same period. We evaluated ankle joint edema with the Figure-of-Eight method and with the volumetric method, as well as pain with the Visual Analogue Scale (VAS) in both groups. Results: The patients had no significant differences concerning their baseline values ( p > 0.05). The ankle joint edema was decreased in both groups ( p < 0.001) but there was more edema in group A than in group B at the third post-traumatic day with both measurement methods (p = 0.028/0.025). By the tenth post-traumatic day no difference was found. Pain decreased in both groups at the third day and at the tenth day ( p < 0.001). Conclusion: According to these results, diclofenac and paracetamol had the same effect on pain reduction of ankle sprains but more acute ankle edema was present in patients who were treated with diclofenac than in patients who were treated with paracetamol. Level of Evidence: I, Prospective, Randomized Study
Ankle Tourniquet Pain Control in Forefoot Surgery: A Randomized Study
Authors: Burg Alon , Tytiun Yehezkel , Velkes Steven , Heller Snir , Haviv Barak , Dudkiewicz Israel 
Published: July 2011

Background: Forefoot surgery is often performed under regional anesthesia in awake patients, using tourniquet or Esmarch bandage to obtain a bloodless field. The purpose of this study was to examine the value and need for local tourniquet pain control using local subcutaneous analgesic mixture in patients undergoing forefoot surgery under ankle block anesthesia. Materials and Methods: We prospectively randomized 56 patients who underwent forefoot surgery under ankle block to receive either subcutaneous local anesthetic mixture under the tourniquet or no additional anesthetic. We checked for local tourniquet pain score (VAS 0 to 100) and skin condition during and after the procedure. Results: The tourniquet was quite tolerable in both groups, with an average VAS score of 7 to 21. No difference was observed between groups throughout most of the procedure. No correlation between VAS scores and procedure length or patient's age or gender was found. Conclusion: An ankle tourniquet was well-tolerated by patients without need for local anesthetic beneath the cuff. Level of Evidence: II, Prospective Comparative Study
Closed Intramedullary Screw Fixation for Nonunion of Fifth Metatarsal Jones Fracture
Authors: Habbu Rohan A. , Marsh Robert S. , Anderson John G. , Bohay Donald R. 
Published: July 2011

Background: Nonunion following a proximal fifth metatarsal metaphyseal-diaphyseal or Jones fracture can cause considerable pain with high morbidity and loss of work. Treatment should aim for early union, thus allowing early return to activity. The present study evaluated the outcomes and the time required for union following closed intramedullary screw fixation for this condition. Materials and Methods: Between January 2005 to August 2009, 14 patients were diagnosed with nonunion following a Jones fracture. Mean age at surgery was 49 years. Mean duration from injury to surgery was 28 weeks. All nonunions were fixed with a single intramedullary screw inserted from the base of the fifth metatarsal without opening the nonunion site. Serial postoperative radiographs were evaluated to determine union. Time required for return to activity was determined. Outcome was assessed with help of pain scores. Mean followup was 27 months. Results: Union was achieved in all 14 patients with one delayed union. Mean time to union was 13.3 (range, 8 to 20) weeks. All patients were able to start unassisted full weightbearing without pain at mean 10.2 weeks. Overall pain score improved from a preoperative mean of 5.4 to postoperative mean of 1.0. Complications included one deep infection, one delayed wound healing and one sural neuroma. Conclusion: Closed intramedullary screw fixation achieved an excellent union rate when used in the treatment of nonunion of a Jones fractures. Level of Evidence: IV, Retrospective Case Series