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Journal Cover Foot & Ankle International
  [SJR: 1.202]   [H-I: 68]   [9 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [842 journals]
  • Lesser Toe PIP Joint Resection Versus PIP Joint Fusion: A Randomized
           Clinical Trial
    • Authors: Schrier, J. C; Keijsers, N. L, Matricali, G. A, Louwerens, J. W. K, Verheyen, C. C. P. M.
      Pages: 569 - 575
      Abstract: Background: It is unclear whether proximal interphalangeal joint (PIPJ) resection or fusion leads to superior clinical outcome in patients undergoing hammertoe surgery. The purpose of this study was to prospectively evaluate a series of patients undergoing this surgery. Methods: Patients with one or more toes with rigid PIP flexion deformity were prospectively enrolled. These patients were randomly assigned to undergo either PIPJ resection or PIPJ fusion. In addition to the PIPJ procedure, a metatarsophalangeal joint (MTPJ) release was performed if deemed necessary. Follow-up was up to 1 year postoperatively. Twenty-six patients (39 toes) were included in the PIPJ resection group and 29 (50 toes) in the PIPJ fusion group. Results: Thirty-four underwent an MTPJ release. No significant difference in foot outcome scores (American Orthopaedic Foot & Ankle Society scale, the Foot Function Index, and visual analog scale pain) could be detected after 1-year follow-up. A statistically significant difference was found regarding the toe alignment in the sagittal plane in favor of PIPJ fusion. Conclusions: Our randomized controlled study did not show any clinical outcome difference between PIPJ fusion and PIPJ resection. Both procedures resulted in good to excellent outcome in pain and activity scores. Level of Evidence: Level II, lesser quality RCT or prospective comparative study.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716629776
      Issue No: Vol. 37, No. 6 (2016)
  • Outcome of Lateral Transfer of the FHL or FDL for Concomitant Peroneal
           Tendon Tears
    • Authors: Seybold, J. D; Campbell, J. T, Jeng, C. L, Short, K. W, Myerson, M. S.
      Pages: 576 - 581
      Abstract: Background: Concomitant tears of the peroneus longus and brevis tendons are rare injuries, with literature limited to case reports and small patient series. Only 1 recent study directly compared the results of single-stage lateral deep flexor transfer, and no previous series objectively evaluated power and balance following transfer. The purpose of this study was to evaluate clinical outcomes, patient satisfaction, and objective power and balance data following single-stage flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon transfers for treatment of concomitant peroneus longus and brevis tears. Methods: Over an 8-year period (2005-2012), 9 patients underwent lateral transfer of the FHL or FDL tendon for treatment of concomitant peroneus longus and brevis tears. All but 1 patient underwent additional procedures to address hindfoot malalignment or other contributing deformity at the time of surgery. Mean age was 56.9 years, and average body mass index was 27.9. Lateral transfer of the FHL was performed in 5 patients, and FDL transfer performed in 4 with mean follow-up 35.7 months (range: 11-94). Eight of 9 patients completed SF-12 and Foot Function Index (FFI) scores, and 7 returned for range of motion (ROM) and manual strength testing of the involved and normal extremities. These 7 patients also completed force plate balance tests, in addition to peak force and power testing on a PrimusRS machine with a certified physical therapist. Results: All patients were satisfied with the results of the procedure. Mean SF-12 physical and mental scores were 32 and 55, respectively; mean FFI total score was 56.7. No postoperative infections were noted. Two patients continued to utilize orthotics or braces, and 2 patients reported occasional pain with weightbearing activity. Three patients noted mild paresthesias in the distribution of the sural nerve and 2 demonstrated tibial neuritis. All patients demonstrated 4/5 eversion strength in the involved extremity. Average loss of inversion and eversion ROM were 24.7% and 27.2% of normal, respectively. Mean postoperative eversion peak force and power were decreased greater than 55% relative to the normal extremity. Patients demonstrated nearly 50% increases in both center-of-pressure tracing length and velocity during balance testing. There were no statistically significant differences between the FHL and FDL transfer groups with regards to clinical examination or objective power and balance tests. Conclusion: The FHL and FDL tendons were both successful options for lateral transfer in cases of concomitant peroneus longus and brevis tears. Objective measurements of strength and balance demonstrated significant deficits in the operative extremity, even years following the procedure. These differences, however, did not appear to alter or inhibit patient activity levels or high satisfaction rates with the procedure. Although anatomic studies have demonstrated benefits of FHL transfer over the FDL tendon, further studies with increased patient numbers are needed to determine if these differences are clinically significant. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716634762
      Issue No: Vol. 37, No. 6 (2016)
  • Association of Metatarsalgia After Hallux Valgus Correction With Relative
           First Metatarsal Length
    • Authors: Nakagawa, S; Fukushi, J.-i, Nakagawa, T, Mizu-uchi, H, Iwamoto, Y.
      Pages: 582 - 588
      Abstract: Background: Metatarsalgia is frequently associated with hallux valgus. The aim of this study was to evaluate how the relative length and position of the first metatarsal head influenced metatarsalgia and plantar callosities beneath the lesser metatarsal heads. Methods: A retrospective analysis of the clinical data and radiographs of 102 cases was performed at a mean follow-up of 16 months after biplane interlocking osteotomies. Clinical evaluation was made using the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Radiologic evaluation was made with standard weight-bearing anteroposterior radiographs, and the hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA), distal metatarsal articular angulation (DMAA), and the sesamoid position were evaluated. Relative first metatarsal length (RML) was determined according to Nilsonne/Morton’s technique. Results: The mean preoperative HVA decreased from 37 to 3 degrees, and the mean IMA from 17 to 4 degrees. The mean JSSF-hallux score improved from 56 to 96 points. The mean preoperative area of plantar callosities decreased from 3.1 to 1.5 mm2. Sixty percent of metatarsalgia cases improved, and 85% of painless callosities disappeared postoperatively. Among radiologic parameters, postoperative RML was most significantly associated with JSSF score (P < .0001) and the presence of postoperative metatarsalgia (P < .0001). Receiver operating characteristic analysis revealed that the RML cut-off point was –3 mm for avoiding metatarsalgia, with an area under the curve of 0.88, a specificity of 88%, and a sensitivity of 85%. Conclusion: Preservation of relative first metatarsal length during first metatarsal osteotomy was important to prevent postoperative metatarsalgia. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716634792
      Issue No: Vol. 37, No. 6 (2016)
  • Second Metatarsal Transfer Lesions Due to First Metatarsal Shortening
           After Distal Chevron Metatarsal Osteotomy for Hallux Valgus
    • Authors: Ahn, J; Lee, H. S, Seo, J. H, Kim, J. Y.
      Pages: 589 - 595
      Abstract: Background: The first metatarsal bone can shorten after a distal chevron metatarsal osteotomy (DCMO). This shortening can result in a postoperative second metatarsal transfer lesion. The aim of the present study was to investigate the occurrence of second metatarsal transfer lesions after DCMO. Methods: This study involved 185 feet (138 patients), with hallux valgus (HV) deformity, treated with DCMO with Akin osteotomy. The mean patient age was 51.7 years (range, 21 to 74). Patients were followed for an average of 28 months, between June 2004 and June 2010. We measured the length of first metatarsal relative to second metatarsal preoperatively and postoperatively, using Morton’s and Hardy-Clapham’s methods. A second metatarsal transfer lesion was defined as a newly developed lesion, including metatarsalgia, a painful callosity, or a painless callosity, which was not present prior to the DCMO. The relation of the shortened first metatarsal after DCMO with the occurrence of second metatarsal transfer lesion was evaluated. Results: Second metatarsal transfer lesions (painless callosity) developed in 5 feet (2.7%) of 185 feet. Twenty-four preoperative second metatarsal lesions were improved postoperatively. The median shortening of the first metatarsal bone after DCMO was 0.6 mm according to Morton’s method (range, –6.4 to 6.4), and 1.9 according to Hardy-Clapham’s method (range, –5.8 to 5.8). According to the extent of first metatarsal shortening after DCMO by Hardy-Clapham’s method and Morton’s method, there was no significant difference of the occurrence of second transfer metatarsal lesions (P = .259 and P = .176, respectively). Conclusions: In our study, second metatarsal transfer lesions developed in 2.7% of feet after DCMO. The occurrence of second metatarsal transfer lesions did not appear to be correlated with the degree of first metatarsal shortening in cases with less than 5.8 mm shortening. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100715627350
      Issue No: Vol. 37, No. 6 (2016)
  • Characterization and Surgical Management of Achilles Tendon Sleeve
    • Authors: Huh, J; Easley, M. E, Nunley, J. A.
      Pages: 596 - 604
      Abstract: Background: An Achilles sleeve avulsion occurs when the tendon ruptures distally from its calcaneal insertion as a continuous "sleeve." This relatively rare injury pattern may not be appreciated until the time of surgery and can be challenging to treat because, unlike a midsubstance rupture, insufficient tendon remains on the calcaneus to allow for end-to-end repair, and unlike a tuberosity avulsion fracture, any bony element avulsed with the tendon is inadequate for internal fixation. This study aimed to highlight the characteristics of Achilles sleeve avulsions and present the outcomes of operative repair using suture anchor fixation. Methods: A retrospective analysis was conducted on 11 consecutive Achilles tendon sleeve avulsions (10 males, 1 female; mean age 44 years) that underwent operative repair between 2008 and 2014. Patient demographics, injury presentation, and operative details were reviewed. Postoperative outcomes were collected at a mean follow-up of 38.4 (range, 12-83.5) months, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, visual analog scale (VAS) for pain, plantarflexion strength, patient satisfaction, and complications. Results: Eight patients (72.7%) had preexisting symptoms of insertional Achilles disease. Ten of 11 (90.9%) injuries were sustained during recreational athletic activity. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. All patients healed after suture anchor repair. The average AOFAS score was 92.8 and VAS score was 0.9. Ten patients (90.9%) were completely satisfied. One complication occurred, consisting of delayed wound healing. Conclusions: Achilles tendon sleeve avulsions predominantly occurred in middle-aged men with preexisting insertional disease, while engaged in athletic activity. Suture anchor fixation, combined with addressing concomitant insertional pathology, was a reliable and safe technique for the operative management of Achilles tendon sleeve avulsions. The majority of patients returned to their preinjury levels of work and recreational activity. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716629778
      Issue No: Vol. 37, No. 6 (2016)
  • Combined Anterior and Dual Posterolateral Approaches for Ankle Arthroscopy
           for Posterior and Anterior Ankle Impingement Syndrome
    • Authors: Song, B; Li, C, Chen, Z, Yang, R, Hou, J, Tan, W, Li, W.
      Pages: 605 - 610
      Abstract: Background: We introduce a novel method of combining the standard anteromedial and anterolateral approaches and dual posterolateral approaches in the arthroscopic treatment of posterior and anterior ankle impingement syndrome and compare the postoperative outcomes with conventional anteromedial/anterolateral and posteromedial/posterolateral approaches. Methods: From January 2013 to January 2015, we treated 28 patients with posterior and anterior ankle impingement syndrome by arthroscopy. The patients were divided into the conventional group (n = 13) and the modified group (n = 15) according to the surgical approaches used in the operation. Preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) score, range of ankle motion, and operation time were recorded. The average follow-up was 16 months (range 6-24 months). Results: Posterior and anterior ankle impingement syndrome was confirmed arthroscopically in all patients. After the operation, the range of ankle motion in all patients was restored. There was no significant difference in postoperative AOFAS score, VAS score, dorsiflexion, and plantarflexion between the conventional group and the modified group. Moreover, the operation time was significantly reduced in the modified group compared with the conventional group. There was no recurrence of osteophyte and no complications such as infection, neurovascular injury, or delayed healing of surgical incision in the modified group. Conclusions: Dual posterolateral approaches combined with standard anteromedial and anterolateral approaches was a novel method for arthroscopic treatment of posterior and anterior ankle impingement syndrome. It proved to be safe and effective, and significantly reduced the operation time. Reposition, repeated prep and drape, and limb distraction were avoided. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716632042
      Issue No: Vol. 37, No. 6 (2016)
  • Minimally Invasive Versus Open Distal Fibular Plating for AO/OTA 44-B
           Ankle Fractures
    • Authors: Chiang, C.-C; Tzeng, Y.-H, Lin, C.-C, Huang, C.-K, Chang, M.-C.
      Pages: 611 - 619
      Abstract: Background: Open reduction and internal fixation (ORIF), the standard treatment for unstable ankle fractures, has well-known wound complications. Minimally invasive surgery (MIS) has been proposed to decrease these complications. The objectives of this study were to describe an algorithm of MIS for fibular plating and compare the radiographic restoration of fibular anatomy, functional outcomes, and complications between ORIF and MIS for ankle fractures. Methods: This retrospective study included 71 patients with AO/OTA 44-B ankle fractures treated by a single surgeon. ORIF group consisted of 34 patients (54.5-month follow-up) and MIS group was composed of 37 patients (55.9-month follow-up). Among 37 MIS patients, 13 patients were treated with minimally invasive percutaneous plate osteosynthesis and 24 patients with minimally invasive trans-fracture approach according to our MIS algorithm. Operative outcomes were evaluated and compared between the 2 groups by radiographic measurements, functional assessment, and complications. Results: The MIS group had less blood loss but longer operative time and greater exposure to fluoroscopy. Radiographic measurements revealed similar union time, fibular length, talocrural angle, medial clear space, and tibiofibular clear space in both groups. Lower visual analogue pain score was observed in the MIS group in the early postoperative period. At last follow-up, there were no significant differences regarding pain score, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, and range of motion between the 2 groups. Total complication rate was significantly higher in the ORIF group. Conclusion: Patients with AO/OTA 44-B fractures treated with MIS fibular plating achieved similar radiographic and functional outcomes but had less pain in the early postoperative period and fewer wound complications compared with those treated with ORIF. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100715625292
      Issue No: Vol. 37, No. 6 (2016)
  • Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy
    • Authors: Bull, P. E; Berlet, G. C, Canini, C, Hyer, C. F.
      Pages: 620 - 626
      Abstract: Background: Access to the medial half of the talus can be challenging even with an osteotomy. Although several techniques are presented in the literature, critical evaluation of fixation, union, and alignment is lacking. The chevron medial malleolar osteotomy provides advantages of perpendicular instrumentation access and wide exposure to the medial talus. Postoperative displacement resulting in malunion, and possibly provoking ankle osteoarthritis, is a known complication. The present study describes our experience with the osteotomy. Methods: A consecutive series cohort of 50 bi-plane chevron osteotomies performed from 2004 to 2013 were evaluated. Forty-six were secured using 2 lag screws, and 4 were secured using 2 lag screws and a medial buttress plate. Radiographic studies performed at 2, 6, and 12 weeks and at final follow-up were analyzed for postoperative displacement, malunion, non-union, and hardware-related complications. Results: At initial postoperative follow-up, 47 of 50 had adequate radiographs for review, and 18 of 47 (38.3%) showed some displacement when compared to the initial osteotomy fixation position. By final follow-up, 15 of 50 (30.0%) had measurable incongruence. Hardware removal was performed in 13 (26.0%) cases at an average of 2.4 years postoperation. Conclusion: Bi-plane medial malleolar chevron osteotomy fixed with 2 lag screws showed a 30.0% malunion rate with an average of 2 mm of incongruence on final follow-up radiographs, which is higher than what has been reported in the literature. In our practice, we now use a buttress plate and more recently have eliminated postoperative osteotomy displacement. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716628912
      Issue No: Vol. 37, No. 6 (2016)
  • Rotational Dynamics of the Normal Distal Tibiofibular Joint With
           Weight-Bearing Computed Tomography
    • Pages: 627 - 635
      Abstract: Background: The normal distal tibiofibular joint is strongly stabilized by the syndesmosis, where previous cadaveric, biomechanical studies demonstrated only minimal widening and posterior translation of the fibula in external rotation of the ankle. However, little is known about normal rotational dynamics of the distal tibiofibular joint in upright weight-bearing conditions. The purpose of this study was to investigate the normal anatomy and rotational dynamics of the distal tibiofibular joint under physiological conditions on weight-bearing cone beam computed tomography (WBCT). Methods: In a cross-sectional study of 32 subjects, low-dose WBCT scans of uninjured bilateral ankles were performed. Normal intersubject and intrasubject variation in neutral position and changes in maximal internal and external rotation of the ankle were studied. Sagittal translation of the fibula, anterior and posterior widths of the distal tibiofibular syndesmosis, tibiofibular clear space (TFCS), and rotation of the fibula were measured. Results: In the neutrally loaded ankle, the fibula was located anteriorly in the tibial incisura in 88% of the subjects. When the ankle was rotated, mean anteroposterior motion was 1.5 mm and mean rotation of the fibula was 3 degrees. There was no significant change in TFCS between internal and external rotation. Large intersubject variation was detected, but intrasubject variation between ankles was less than 1 mm and 1 degree. Conclusions: This study provides reference values to evaluate the dynamics of the normal distal tibiofibular joint. The internal control of the contralateral ankle seemed to be a better reference than the population-based normal values. Clinical Relevance: The current study provides the reference values to evaluate the rotational dynamics of a normal distal tibiofibular joint.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716634757
      Issue No: Vol. 37, No. 6 (2016)
  • MRI Evaluation of Achilles Tendon Rotation and Sural Nerve Anatomy:
           Implications for Percutaneous and Limited-Open Achilles Tendon Repair
    • Authors: MacMahon, A; Deland, J. T, Do, H, Soukup, D. S, Sofka, C. M, Demetracopolous, C. A, DeBlis, R.
      Pages: 636 - 643
      Abstract: Background: Limited-open and percutaneous Achilles tendon (AT) repair techniques have limited visibility, which may result in sural nerve violation and poor tendon targeting. The goal of this study was to assess the in vivo rotation of the AT and its distance to the sural nerve in ruptured and nonruptured ATs to develop guidelines to aid in limited-open and percutaneous repair techniques. Methods: A retrospective review was conducted to identify magnetic resonance imaging (MRI) studies of patients with ruptured and healthy (nonruptured) ATs. AT rotation and distance to the sural nerve in the anterior-posterior (A-P) and medial-lateral (M-L) planes were measured at the level of and proximal to the ankle. Results: The AT was externally rotated in both ruptured and nonruptured cohorts. Ruptured ATs showed greater external rotation than nonruptured ATs at the ankle (15.8 ± 16.2 degrees vs 5.9 ± 9.0 degrees, P = .008) but not at 10 cm proximal to the tendon’s insertion (10.9 ± 10.9 degrees vs 6.1 ± 8.4 degrees, P = .139). Proximal AT rotation was negatively correlated with rupture height (r = –0.477, P = .029). At 4 cm proximal to the AT insertion, the sural nerve was closer anteriorly to and farther laterally from the AT in ruptures than in nonruptures (P < .001). At 10 cm proximal to the AT insertion, the sural nerve was farther posteriorly and laterally from the AT in ruptures than in nonruptures (P = .027 and P < .001, respectively). Conclusion: We found that the AT was more externally rotated in ruptured than in nonruptured tendons at the ankle and that its distance to the sural nerve differed between the 2 cohorts in the A-P and M-L planes, likely due to increased AT rotation and swelling with ruptures. To minimize sural nerve injury and improve tendon targeting, we suggest an external rotation of 11 degrees at the proximal end of the rupture and 16 degrees at the distal end when using percutaneous and limited-open AT repair devices to try to minimize sural nerve violation and increase tendon capture, which can decrease rates of complication and rerupture. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716628915
      Issue No: Vol. 37, No. 6 (2016)
  • Computed Tomographic Evaluation of Joint Geometry in Patients With
           End-Stage Ankle Osteoarthritis
    • Authors: Wiewiorski, M; Hoechel, S, Anderson, A. E, Nowakowski, A. M, DeOrio, J. K, Easley, M. E, Nunley, J. A, Valderrabano, V, Barg, A.
      Pages: 644 - 651
      Abstract: Background: Deformation of the talus and the distal tibia can be frequently observed during ankle joint osteoarthritis (OA). The aim of this study was to objectify these morphologic changes. We hypothesized that a flattening of the talus and a broadening of the distal tibia surface occurs in end-stage OA of the ankle joint. Methods: Twenty-seven computed tomography (CT) ankle joint examinations of unilateral ankle OA were matched by sex and age with 27 CT examinations of healthy ankle joints. Three-dimensional reformatting and measurements were performed with geometry analysis software. The following parameters were assessed: sagittal radius of the talus, talus height, and mediolateral and anteroposterior width of the distal tibial joint surface. Results: Medial, midsagittal, and lateral sagittal arc radii of osteoarthritic tali were significantly larger compared to tali of controls. There was a statistically significant difference in the height of the osteoarthritic talar dome in the medial and in the lateral frontal segment and in the medial central segment compared to tali of controls. The anteroposterior width and the sagittal curvature of the distal tibia was significantly larger in OA ankles than in the control group. The mediolateral measurements were comparable across both groups. Conclusion: Flattening of the talus appears to be more pronounced in the frontal aspect of the talus. The distal tibia broadens anteroposteriorly. These findings may contribute to better understanding of ankle OA development. Level of Evidence: Level III, retrospective comparative cohort study.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716629777
      Issue No: Vol. 37, No. 6 (2016)
  • Early Weightbearing After Operatively Treated Ankle Fractures: A
           Biomechanical Analysis
    • Authors: Tan, E. W; Sirisreetreerux, N, Paez, A. G, Parks, B. G, Schon, L. C, Hasenboehler, E. A.
      Pages: 652 - 658
      Abstract: Background: No consensus exists regarding the timing of weightbearing after surgical fixation of unstable traumatic ankle fractures. We evaluated fracture displacement and timing of displacement with simulated early weightbearing in a cadaveric model. Methods: Twenty-four fresh-frozen lower extremities were assigned to Group 1, bimalleolar ankle fracture (n=6); Group 2, trimalleolar ankle fracture with unfixed small posterior malleolar fracture (n=9); or Group 3, trimalleolar ankle fracture with fixed large posterior malleolar fracture (n=9) and tested with axial compressive load at 3 Hz from 0 to 1000 N for 250 000 cycles to simulate 5 weeks of full weightbearing. Displacement was measured by differential variable reluctance transducer. Results: The average motion at all fracture sites in all groups was significantly less than 1 mm (P < .05). Group 1 displacement of the lateral and medial malleolus fracture was 0.1±0.1 mm and 0.4±0.4 mm, respectively. Group 2 displacement of the lateral, medial, and posterior malleolar fracture was 0.6±0.4 mm, 0.5±0.4 mm, and 0.5±0.6 mm, respectively. Group 3 displacement of the lateral, medial, and posterior malleolar fracture was 0.1±0.1 mm, 0.5±0.7 mm, and 0.5±0.4 mm, respectively. The majority of displacement (64.0% to 92.3%) occurred in the first 50 000 cycles. There was no correlation between fracture displacement and bone mineral density. Conclusion: No significant fracture displacement, no hardware failure, and no new fractures occurred in a cadaveric model of early weightbearing in unstable ankle fracture after open reduction and internal fixation. Clinical Relevance: This study supports further investigation of early weightbearing postoperative protocols after fixation of unstable ankle fractures.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100715627351
      Issue No: Vol. 37, No. 6 (2016)
  • Percutaneous Ankle Reconstruction of Lateral Ligaments (Perc-Anti RoLL)
    • Authors: Glazebrook, M; Stone, J, Matsui, K, Guillo, S, Takao, M, for the ESSKA AFAS Ankle Instability Group, Batista, Bauer, Calder, Choi, Ghorbani, Glazebrook, Guillo, Kong, Karlsson, Lee, Mangone, Michels, Molloy, Nery, Ozeki, Pearce, Perera, Pereira, Pijnenburg, Raduan, Stone, Takao, Tourne
      Pages: 659 - 664
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716633648
      Issue No: Vol. 37, No. 6 (2016)
  • Triple Tendon Transfer for Correction of Foot Deformity in Common Peroneal
           Nerve Palsy
    • Authors: Movahedi Yeganeh; M.
      Pages: 665 - 669
      Abstract: Background: Anterior transfer of posterior tibial tendon (PTT) is the most common technique to correct foot drop in patients with common peroneal nerve palsy. It does not address the loss of toe extension or "toe drop." This may affect the gait pattern, and patients may not tolerate it. Described here is a technique that addresses toe drop associated with common peroneal nerve palsy. Method: A new technique of tendon transfer using the PTT, flexor hallucis longus (FHL) tendon, and flexor digitorum longus (FDL) tendon was performed on 15 patients (13 males and 2 females) with complete common peroneal nerve palsy from 2009 to 2013. Minimum follow-up was 12 months (range, 12-50 months). The mean age was 37 years (range, 20-52 years). Results: Based on the evaluation criteria of Carayon et al, the postoperative results for foot drop correction were excellent in 9 (60%), good in 5 (33%), and moderate in 1 (7%), and the mean active range of motion of the ankle was 46 degrees. Postoperative extension evaluation of the toes was excellent in 7 (47%), good in 5 (33%), and moderate in 3 (20%). Conclusion: Releasing and transferring of FDL and FHL to the toe extensors along with the anterior transfer of the PTT neutralized the deforming forces and allowed for active toe extension while strengthening ankle dorsiflexion. Movahedi Tendon Transfer was a reliable method to achieve a balanced foot and toe dorsiflexion for complete common peroneal nerve palsy. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716629779
      Issue No: Vol. 37, No. 6 (2016)
  • Developing Performance and Assessment Platforms in Foot and Ankle Surgery
    • Authors: Ferguson, C. M; Rocha, J. L, Lalli, T, Irrgang, J. J, Hurwitz, S, Hogan, M. V.
      Pages: 670 - 679
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716649169
      Issue No: Vol. 37, No. 6 (2016)
  • Letter Regarding: The Internet for Patient Education: A Friend or Foe'
    • Authors: Fakhoury, J; Bitterman, A.
      Pages: 680 - 680
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716649459
      Issue No: Vol. 37, No. 6 (2016)
  • Response to "Letter Regarding: The Internet for Patient Education: A
           Friend or Foe'"
    • Authors: Rosenbaum, A. J; Ellis, S. J.
      Pages: 681 - 681
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716649460
      Issue No: Vol. 37, No. 6 (2016)
  • Education Calendar
    • Pages: 682 - 682
      PubDate: 2016-06-03T16:42:05-07:00
      DOI: 10.1177/1071100716653407
      Issue No: Vol. 37, No. 6 (2016)
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