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Journal Cover Foot & Ankle International
   [11 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1071-1007
     Published by Sage Publications Homepage  [753 journals]   [SJR: 1.021]   [H-I: 62]
  • Inflammatory Cytokines and Cellular Metabolites as Synovial Fluid
           Biomarkers of Posttraumatic Ankle Arthritis
    • Authors: Adams, S. B; Nettles, D. L, Jones, L. C, Miller, S. D, Guyton, G. P, Schon, L. C.
      Pages: 1241 - 1249
      Abstract: Background: There is a paucity of research on posttraumatic ankle arthritis (PTAA). We aimed to identify synovial fluid PTAA biomarkers using cytokine analysis and metabolic profiling. Methods: Ankle joint synovial fluid was obtained from 20 patients with PTAA and 20 patients with no ankle pain and no radiographic evidence of ankle arthritis (control group). Synovial fluid samples were analyzed for IFN-, TNF-α, MIP-1β, MCP-1, IL-1β, IL-1Ra, IL-4, IL-6, IL-8, IL-10, IL-13, and IL-15 using ELISA and for more than 3000 metabolites using liquid and gas chromatography with mass spectroscopy. To compare presence of cytokines and metabolites between groups, t tests were used. Random forest analysis was performed on metabolites to determine whether control and PTAA samples could be differentiated based on metabolic profile. Results: IL-1Ra, IL-6, IL-8, IL-10, IL-15, and MCP-1 were significantly elevated in the PTAA group. In addition, 107 metabolites in the PTAA group were significantly altered, including derangement in amino acid, carbohydrate, lipid, and energy metabolism, extracellular matrix turnover, and collagen degradation. Random forest analysis yielded a predictive accuracy of 90% when using the metabolic profiles to distinguish between control and PTAA samples. Conclusion: This study identified inflammatory cytokines and metabolites present in the synovial fluid of PTAA. Clinical Relevance: Several of these entities have previously been implicated in rheumatoid arthritis and osteoarthritis of the knee, but many could potentially be used as novel biomarkers of PTAA. Most importantly, the findings suggest that metabolites could be used to distinguish synovial fluid from patients with PTAA.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714550652|hwp:master-id:spfai;1071100714550652
      Issue No: Vol. 35, No. 12 (2014)
       
  • Radiographic and Functional Outcomes Following Bilateral Ankle Fusions
    • Authors: Houdek, M. T; Wilke, B. K, Ryssman, D. B, Turner, N. S.
      Pages: 1250 - 1254
      Abstract: Background: Ankle arthrodesis is considered to be a well-accepted technique for end-stage ankle arthritis. Our purpose was to evaluate outcomes of patients with bilateral ankle arthrodeses with attention to radiographic and functional outcomes. Methods: Medical records of 31 patients were reviewed from 1977 through 2007. All patients had 1 year of clinical follow-up after their contralateral ankle arthrodesis, with an average follow-up of 11.2 years following the initial arthrodesis. Pertinent patient demographics and information pertaining to the operative procedure, complications, and subsequent adjacent joint fusions was collected. Radiographs were reviewed for time to fusion and adjacent joint arthritis. Functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot scale. Results: Ten females and 21 males underwent bilateral ankle fusions at an average age of 57 years at the time of the initial fusion. The contralateral fusion occurred on average 3.1 years following the initial fusion. Radiographic fusion occurred 12 weeks following the initial fusion and 14 weeks following the contralateral fusion. There was a significant increase (P = .0001) in the average AOFAS score postoperatively in both ankles. The average FAAM score at last follow-up was 70. Adjacent joint arthritis developed in the majority of patients; however, most of the patients were free from adjacent fusions and reported their function as "normal" or "nearly normal" at last follow-up. Conclusion: Bilateral ankle arthrodesis was an acceptable treatment option for patients with bilateral, end-stage ankle arthritis. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714551947|hwp:master-id:spfai;1071100714551947
      Issue No: Vol. 35, No. 12 (2014)
       
  • The Prognostic Value of the Hawkins Sign and Diagnostic Value of MRI After
           Talar Neck Fractures
    • Authors: Chen, H; Liu, W, Deng, L, Song, W.
      Pages: 1255 - 1261
      Abstract: Background: The early diagnosis of avascular necrosis of the talus (AVN) and prediction of ankle function for talar fractures are important. The Hawkins sign, as a radiographic predictor, could exclude the possibility of developing ischemic bone necrosis after talar neck fractures, but its relationship with ankle function remains unclear. The purpose of this study was to illustrate the prognostic effect of the Hawkins sign on ankle function after talar neck fractures and to study the value of early MRI in detecting the AVN changes after talus fractures. Methods: Cases of talar neck fractures between November 2008 and November 2013 were evaluated. The occurrences of the Hawkins sign and AVN were studied. X-ray imaging was performed at multiple time points from the 4th to the 12th week after the fractures, and MRI examinations were used in the Hawkins sign negative group, with the time span ranging from 1.5 to 12 months. AOFAS scores of the Hawkins sign positive and negative groups were compared during the follow-up. Forty-four cases (48 feet) were evaluated. Results: The occurrence of positive Hawkins sign was 50%, 30%, and 33.3%, the incidence of AVN was 0%, 10%, and 50%, respectively, in type I, type II, and type III and IV talus fractures, respectively. The AOFAS scores showed no statistically significant difference between Hawkins sign positive group and negative group in type I and II fractures. The Hawkins sign positive group had better AOFAS scores than the negative group in type III and IV fractures. However, there was no statistically significant difference between Hawkins sign positive and negative groups when AVN cases were excluded in type III and IV fractures. Conclusion: The Hawkins sign was a reliable predictor excluding the possibility of AVN. It did not have predictive value on the ankle function in low-energy fractures and may predict better ankle function in high-energy fractures. MRI can diagnose AVN during an earlier period, and we believe Hawkins sign negative patients should undergo MRI examinations 12 weeks after the fractures, especially in high-energy traumatic cases. Level of Evidence: Level III, comparative case series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714547219|hwp:master-id:spfai;1071100714547219
      Issue No: Vol. 35, No. 12 (2014)
       
  • Preoperative Radiological Factors Correlated to Long-Term Recurrence of
           Hallux Valgus Following Distal Chevron Osteotomy
    • Authors: Pentikainen, I; Ojala, R, Ohtonen, P, Piippo, J, Leppilahti, J.
      Pages: 1262 - 1267
      Abstract: Background: The purpose of this article was to analyze the long-term radiologic results after distal chevron osteotomy for hallux valgus treatment and to determine the preoperative radiographic factors correlating with radiological recurrence of the deformity. Methods: The study included 100 consecutive patients who received distal chevron osteotomy for hallux valgus. The osteotomy included fixation with an absorbable pin in 50 cases, and no fixation in the other 50. For 6 weeks postoperatively, half of each group used a soft cast and half had a traditional elastic bandage. Weight-bearing radiographs were evaluated at 6 weeks, 6 months, 1 year, and a mean of 7.9 (range, 5.8-9.4) years postoperatively. Results: At the final follow-up, radiological recurrence of hallux valgus deformity (HVA > 15 degrees) was observed in 56 feet (73%). Eleven feet (14%) had mild recurrence (HVA < 20 degrees), 44 (57%) moderate (20 degrees ≥ HVA < 40 degrees), and 1 (1%) severe (HVA ≥ 40 degrees). All recurrences were painless, and thus no revision surgery was required. Long-term hallux valgus recurrence was significantly affected by preoperative congruence, DMAA, sesamoid position, HVA, and I/II IMA. Conclusions: Radiological recurrence of hallux valgus deformity of 15 degrees or more was very common at long-term follow-up after distal chevron osteotomy. Preoperative congruence, DMAA, sesamoid position (LaPorta), HVA, and I/II IMA significantly affected recurrence. Level of Evidence: Level III, comparative case series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714548703|hwp:master-id:spfai;1071100714548703
      Issue No: Vol. 35, No. 12 (2014)
       
  • Prospective Randomized Study of Chevron Osteotomy Versus Mitchell's
           Osteotomy in Hallux Valgus
    • Authors: Buciuto R.
      Pages: 1268 - 1276
      Abstract: Background: We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell’s osteotomy (MO) and chevron osteotomy (CO). Methods: One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis. The follow-up period was 3 years. Clinical results were rated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System (CRS). Results: HV in the MO group was reduced from 30 (range, 20 to 44) to 15 (range, 8 to 24) degrees and IM angle from 11 (range, 6 to 14) to 7 (range, 4 to 11) degrees. HV in the CO group was reduced from 31 (range, 22 to 42) to 16 (range, 6 to 24) degrees and IM angle from 14 (range, 8 to 20) to 6 (range, 2 to 10) degrees. Transfer metatarsalgia occurred in 36 (60%) patients and hammertoe in 6 (10%) patients in the MO group. In the CO group, metatarsalgia occurred in 5 patients. The median loss of postoperative HV correction was 4 (range, 2 to 10) degrees in mild deformity and 6 (6 to 10) degrees in moderate deformity. Conclusion: Patients treated with CO had significantly better results for AOFAS CRS, number of postoperative complications, patient satisfaction, and length of sick leave for the employed patients. Based on our results, we consider that in female patients CO should be regarded as the first-line procedure for treatment of mild and moderate HV. Level of Evidence: Level I, prospective randomized study.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714550647|hwp:master-id:spfai;1071100714550647
      Issue No: Vol. 35, No. 12 (2014)
       
  • Radiological Prevalence of Degenerative Arthritis of the First
           Metatarsophalangeal Joint
    • Authors: Howard, N; Cowen, C, Caplan, M, Platt, S.
      Pages: 1277 - 1281
      Abstract: Background: The prevalence of osteoarthritis of the first metatarsophalangeal joint (MTPJ) has not been completely determined in a population-based study. The aim of the study was to determine the age- and gender-related prevalence of radiological first MTPJ arthritis. Methods: We analyzed 517 consecutive radiographs of adult patients who presented with acute foot injuries to the accident and emergency department over a 6-month period. Radiographs were assessed independently by 2 authors using the Hattrup and Johnson grading system for osteoarthritic changes in the first MTPJ. Results: The radiographic prevalence of MTPJ arthritis in our population was 25% (127/517). Overall incidence was higher in females, with 32% (85/269) of females affected in comparison to 18% (44/248) of males. Variance between the sexes was insignificant until the age of 60, at which point the prevalence rose to 66% (53/80) in females compared with 47% (18/38) in males of the same age. Conclusions: The development of first MTPJ arthritis follows a typical pattern of degenerative arthritis, as shown in other joints, with increasing age being an important factor. The results of this study suggest that first MTPJ arthritis begins to appear in most cases in middle age and is significantly more apparent in females. Level of Evidence: Level III, comparative case series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714554451|hwp:master-id:spfai;1071100714554451
      Issue No: Vol. 35, No. 12 (2014)
       
  • Improving the Readability of Online Foot and Ankle Patient Education
           Materials
    • Authors: Sheppard, E. D; Hyde, Z, Florence, M. N, McGwin, G, Kirchner, J. S, Ponce, B. A.
      Pages: 1282 - 1286
      Abstract: Background: Previous studies have shown the need for improving the readability of many patient education materials to increase patient comprehension. This study’s purpose was to determine the readability of foot and ankle patient education materials and to determine the extent readability can be improved. We hypothesized that the reading levels would be above the recommended guidelines and that decreasing the sentence length would also decrease the reading level of these patient educational materials. Methods: Patient education materials from online public sources were collected. The readability of these articles was assessed by a readability software program. The detailed instructions provided by the National Institutes of Health (NIH) were then used as a guideline for performing edits to help improve the readability of selected articles. The most quantitative guideline, lowering all sentences to less than 15 words, was chosen to show the effect of following the NIH recommendations. Results: The reading levels of the sampled articles were above the sixth to seventh grade recommendations of the NIH. The MedlinePlus website, which is a part of the NIH website, had the lowest reading level (8.1). The articles edited had an average reduction of 1.41 grade levels, with the lowest reduction in the Medline articles of 0.65. Conclusion: Providing detailed instructions to the authors writing these patient education articles and implementing editing techniques based on previous recommendations could lead to an improvement in the readability of patient education materials. Clinical Relevance: This study provides authors of patient education materials with simple editing techniques that will allow for the improvement in the readability of online patient educational materials. The improvement in readability will provide patients with more comprehendible education materials that can strengthen patient awareness of medical problems and treatments.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714550650|hwp:master-id:spfai;1071100714550650
      Issue No: Vol. 35, No. 12 (2014)
       
  • Staged Treatment of High Energy Midfoot Fracture Dislocations
    • Authors: Kadow, T. R; Siska, P. A, Evans, A. R, Sands, S. S, Tarkin, I. S.
      Pages: 1287 - 1291
      Abstract: Background: Staged care with interval external fixation is a successful established treatment strategy for high energy periarticular fractures with often extensive soft tissue damage such as the tibial plateau and plafond. The aim of the current study was to determine whether staged care of high energy midfoot fracture/dislocation with interval external fixation prior to definitive open reconstruction in the polytraumatized patient was both safe and efficacious. Methods: One hundred twenty-three patients were operated on for high energy midfoot fracture/dislocation during the 8-year study period. Eighteen polytrauma patients were selectively treated with a staged protocol. Radiographic assessment was utilized to determine if the fixator achieved gross skeletal alignment. Further, final alignment after definitive reconstruction and postoperative complications were analyzed. Results: The fixator improved both length and alignment of all high energy midfoot fracture/dislocations. Loss of acceptable reduction while in the temporary frame occurred in only 1 case. Final alignment after definitive reconstruction was anatomic in all cases. No cases of wound-related complication and/or deep infection occurred. Conclusion: Delayed reconstruction of high energy midfoot fracture/dislocation using interval external fixation should be an accepted care paradigm in selected polytrauma patients. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714552077|hwp:master-id:spfai;1071100714552077
      Issue No: Vol. 35, No. 12 (2014)
       
  • Prevalence of Metatarsus Adductus in Patients Undergoing Hallux Valgus
           Surgery
    • Authors: Aiyer, A. A; Shariff, R, Ying, L, Shub, J, Myerson, M. S.
      Pages: 1292 - 1297
      Abstract: Background: Metatarsus adductus (MA) is a congenital condition in which there is adduction of the metatarsals in conjunction with supination of the hindfoot through the subtalar joint. It is generally believed that MA precedes the development of hallux valgus. Historically, studies have demonstrated that patients with a history of MA were ~3.5 times more likely to develop hallux valgus. The purpose of this study was to identify the relative prevalence of MA in patients undergoing surgery for symptomatic hallux valgus. Methods: Between 2002 and 2012, 587 patients who underwent hallux valgus surgery were retrospectively identified following IRB approval and parameters including the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the metatarsus adductus angle (MAA) were recorded. The MAA was considered abnormal if the value was greater than 20 degrees. Interobserver and intraobserver reliability studies for the measurement of the MAA were completed as well. Results: Using the modified Sgarlato technique for measurement of the MAA, there was a high interobserver and intraobserver reliability. The interclass and intraclass coefficients were greater than .90. The prevalence of MA in this patient population was found to be 29.5%. Of those patients with MA, 23 males and 150 females were identified. This gave a male to female ratio of 1:6.5 (P < .00001). Lesser toe deformities (claw toes, hammertoes) were the most commonly associated diagnoses identified. When stratified by severity, 113 (65%) patients had an MAA between 21 and 25 degrees, 41 (23.7%) had an MAA between 26 and 30 degrees, 8 (4.6%) patients had an MAA between 31 and 35 degrees, and 11 (6.3%) patients had an MAA greater than 36 degrees. Conclusion: Historically the prevalence of MA in patients with hallux valgus has been reported to be 35%. The data in this study indicate a comparable prevalence at 29.4%. The presence of concomitant MA may portend different outcomes for operative treatment of hallux valgus. Further research needs to delineate rates of persistence of deformity in this patient population to guide operative management. Level of Evidence: Level IV, case series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714551022|hwp:master-id:spfai;1071100714551022
      Issue No: Vol. 35, No. 12 (2014)
       
  • Comparison of Nonlocking Plates and Locking Plates for Intraarticular
           Calcaneal Fracture
    • Authors: Chen, K; Zhang, H, Wang, G, Cheng, Y, Qian, Z, Yang, H.
      Pages: 1298 - 1302
      Abstract: Background: The optimal treatment of displaced intraarticular calcaneal fractures remains challenging. Currently, there is no uniform method to treat such fractures. The purpose of this study was to compare the radiographic and clinical outcome of nonlocking plates and locking plates in the treatment of intraarticular calcaneal fractures. Methods: A retrospective comparative study was performed including 42 patients with intraarticular calcaneal fractures that were treated by nonlocking plate (n = 18) or locking plates (n = 24) between January 2010 and June 2012. Radiological and functional outcomes were compared between the 2 groups. Results: At the final follow-up, all fractures were healed, and the patients with a locking plate had a significantly better Bohler’s angle and Gissane’s angle compared with the nonlocking plate group (P < .05). No complications occurred for the patients in the locking plate group, and 3 patients in the nonlocking plate group had implant loosening that led to loss of reduction (P < .05). The average American Orthopaedic Foot and Ankle Society hindfoot score in the locking plate group was significantly higher than that in the nonlocking plate group (P < .05). No statistically significant difference between the 2 groups was found regarding SF-36 (P > .05). Conclusion: This study supports the view that locking plates may provide better stability and functional recovery in the treatment of intraarticular calcaneal fractures. Level of Evidence: Level III, comparative case series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714547520|hwp:master-id:spfai;1071100714547520
      Issue No: Vol. 35, No. 12 (2014)
       
  • Achilles Tendons Hypertrophy in Response to High Loading Training
    • Authors: Milgrom, Y; Milgrom, C, Altaras, T, Globus, O, Zeltzer, E, Finestone, A. S.
      Pages: 1303 - 1308
      Abstract: Background: Whether the human Achilles tendon undergoes hypertrophic changes as measured by an increase in cross-sectional area, in response to endurance training exercise remains in question. We investigated the hypothesis that transition from civilian life through 6 months of elite infantry training would induce adaptive Achilles tendon hypertrophy. Methods: Seventy-two new elite infantry recruits had the cross-sectional area of their Achilles tendons measured at a point 2.5 cm proximal to the Achilles insertion by ultrasound before beginning elite infantry training. Measurements were repeated by the same ultrasonographer for those recruits who were still in the training program at 6 months. Prior to beginning the study the intraobserver reliability of the ultrasonographer’s Achilles tendon measurements was calculated (intraclass correlation coefficient = .96). Fifty-five recruits completed 6 months of training. Results: The mean cross-sectional area of their right Achilles tendon increased from 47.0 ± 11.2 to 50.2 ± 9.6 mm2 (P = .037) and the left Achilles tendon from 47.2 ± 8.9 to 51.1 ± 8.3 mm2 (P = .013). The change in cross-sectional area did not correlate with subject height, weight, prior sport history, or jumping and running abilities. Conclusions: An abrupt stimulus of 6 months of elite infantry training was adequate to induce hypertrophic changes in the Achilles tendon. This is the first human prospective study showing an increase in the Achilles tendon cross-sectional area in response to rigorous endurance type training. The finding supports the hypothesis that the Achilles tendon in response to sufficiently high and sustained loading can remodel its morphological properties and thereby strengthen itself. Level of Evidence: Level II, etiology study.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714550651|hwp:master-id:spfai;1071100714550651
      Issue No: Vol. 35, No. 12 (2014)
       
  • Availability of Consumer Prices for Bunion Surgery
    • Authors: Willey, J. C; Reuter, L. S, Belatti, D. A, Phisitkul, P, Amendola, N.
      Pages: 1309 - 1315
      Abstract: Background: Today, insurance insulates most patients from the true costs of the health care services they consume. Economists believe that the absence of price signals incentivizes patients to pursue more extensive care than they would otherwise. Reformers propose restoring price consciousness to patients as a way to tame the soaring costs of American health care. To test this idea, we decided to gauge the availability and variability of price quotes for a common elective surgery—bunion repair. Methods: Orthopedic clinics were sorted by state and randomly selected from an online directory maintained by the American Orthopaedic Foot and Ankle Society. Each selected clinic was contacted up to 3 times in an attempt to get a full, bundled price quote using a standardized patient script. If this was unavailable, an isolated quote for the physician fee alone was solicited. Results: Of the 141 clinics contacted, 56 (39.7%) could provide a physician price estimate and 12 (8.5%) could give a complete bundled estimate, including hospital fees. The overall mean bundled price quoted was $18 332, while the overall mean physician fee quoted was $2487. There was no statistically significant difference in the mean price quoted by academic and private clinics, nor was regional variation observed. Conclusion: We found low price availability for elective bunion procedures. Clinical Relevance: However, the wide variation observed in the prices that were quoted suggests that a very determined patient may be able to spend substantially less on an elective surgery if they were willing to select a provider carefully.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714549045|hwp:master-id:spfai;1071100714549045
      Issue No: Vol. 35, No. 12 (2014)
       
  • Isolated Talonavicular Fusion With Tension Band for Muller-Weiss Syndrome
    • Authors: Fornaciari, P; Gilgen, A, Zwicky, L, Horn Lang, T, Hintermann, B.
      Pages: 1316 - 1322
      Abstract: Background: There are still controversies with regard to the operative treatment in advanced Müller-Weiss syndrome (MWS), where the navicular undergoes avascular necrosis and the talonavicular (TN) joint becomes arthritic. Most authors advocate extended fusion, sacrificing hindfoot mobility. To restore TN alignment and to achieve stable fixation, we developed a new isolated TN fusion technique applying the principles of a static tension band. The aim of the present study was to report the midterm results of a preliminary series of patients and their clinical and radiographic outcomes. Methods: Ten feet (10 patients; 8 females, 2 males; age 63 ± 16.7 [range, 34-83] years) with advanced deformity of MWS (3 Maceira’s stage III and 7 stage IV) were treated with isolated TN arthrodesis using the tension band technique. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the functional outcome. Standard angles were measured to determine the amount of correction achieved through the operative treatment. The minimum follow-up was 24 (range, 24-43) months. Results: Trabeculation was seen to cross the fusion site on radiographs in 8 patients after 2 and in 1 patient after 3 months. One case needed revision after 13 months due to implant failure; after additional screw fixation, bony healing was achieved 2 months later. At last follow-up, all cases described a high level of satisfaction. Postoperatively, the AOFAS score improved from 33 (range, 18-48) to 88.3 (range, 79-100) (P < .0001) points, the AP talocalcaneal angle increased from 14.2 (range, 1-22) to 22.7 (range, 12-30) degrees (P = .0007), and the calcaneal pitch increased from 10.3 (range, 3-22) to 14.7 (range, 8-22) degrees (P = .0006). Conclusion: The static tension band technique is a new, promising technique to treat MWS patients, providing stability against the counteracting deforming forces. Therefore, we consider this technique as our treatment of choice in patients with stage III and stage IV MWS. Level of Evidence: Level IV, prospective case series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714548197|hwp:master-id:spfai;1071100714548197
      Issue No: Vol. 35, No. 12 (2014)
       
  • Predictors of a Persistent Dislocation After Reduction of Syndesmotic
           Injuries Detected With Intraoperative Three-Dimensional Imaging
    • Authors: Franke, J; von Recum, J, Suda, A. J, Vetter, S, Grutzner, P. A, Wendl, K.
      Pages: 1323 - 1328
      Abstract: Background: In about 25% of cases, reduction of acute unstable syndesmotic injuries and stabilization with syndesmotic screws leads to an inadequate reduction. Conventional fluoroscopy does not provide reliable information about the reduction outcome. However, use of intraoperative 3D imaging can be more accurate. The purpose of this study was to identify predictors of inadequate reduction so that the need for intra- or postoperative 3D imaging could be assessed. Our hypothesis was that complex injuries of the syndesmosis present a higher risk of malreduction than simpler ankle fractures. Methods: From August 2001 to February 2011, 251 unstable syndesmotic injuries were treated from a total of 2286 ankle fractures. In 61 of these cases, malreduction of the fibula into the fibular notch was detected by intraoperative 3D imaging. The influence of all possible concomitant and combination injuries of the ankle joint, surgeon’s experience, and potential implant-related effects was analyzed. Results: Thirty-seven Weber C fractures (60.7%), 13 Maisonneuve fractures (21.3%), 10 Weber B fractures (16.4%), and 1 syndesmotic injury without fracture (1.6%) were included. In 14 cases (23%) there was involvement of the posterior malleolus, in 10 cases of the medial malleolus (16.4%), and in 12 cases both (19.7%). The Weber C fractures included 10 bimalleolar fractures with involvement of the posterior malleolus. In neither this combination nor in any other possible injury configuration was it possible to identify a statistically significant correlation with malreduction of the fibula into the fibular notch. The surgeon’s experience or an implant-related effect had no detectable influence either. Conclusion: Based on the factors studied, it is not possible to conclude whether a patient has an increased risk of malreduction. Therefore we still recommend verifying all reduction outcomes by intraoperative 3D imaging or postoperative computed tomography. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714549047|hwp:master-id:spfai;1071100714549047
      Issue No: Vol. 35, No. 12 (2014)
       
  • Osteoarthritis of the Second Metatarsophalangeal Joint Associated With
           Hallux Valgus Deformity
    • Authors: Lee, K. T; Park, Y. U, Jegal, H, Young, K. W, Kim, J. S, Lim, S. Y.
      Pages: 1329 - 1333
      Abstract: Background: Hallux valgus is speculated to increase the load on the second metatarsophalangeal (MTP) joint, possibly inducing degenerative osteoarthritis. In addition, the severity of arthritis may be correlated with the severity of hallux valgus. This study evaluated the association of arthritis of the second MTP joint in hallux valgus patients and the relationship between arthritis of the second MTP joint and hallux valgus deformity. Methods: A total of 382 patients (509 feet) underwent surgery for symptomatic hallux valgus deformities by the 2 senior authors (KTL, YUP) from November 2011 to December 2012. A total of 54 patients (61 feet), all female, were included in the osteoarthritis (OA) group. The rest were assigned to the nonosteoarthritis (NOA) group. There were 328 patients (448 feet) consisting of 16 men and 432 women. Osteoarthritis patients were then evaluated and classified according to joint space narrowing (JSN) and osteophyte (OP) formation. A statistical analysis was conducted to compare the 2 groups in terms of their hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), hypermobility of the first metatarsal ray, the length of the second metatarsal bone, and the length ratio of the first and second metatarsal bones. Correlation coefficients were calculated to compare the severity of hallux valgus and the degree of osteoarthritis of the second MTP joint. Results: The IMA of the OA group was 16.2 ± 2.9 degrees, and that of the NOA group was 15.4 ± 3.3 degrees (P = .034, Mann-Whitney U test). The DMAA of the OA group was 18.2 ± 8.3 degrees, and that of the NOA group was 16.1 ± 8.0 degrees (P = .029, Mann-Whitney U test). There were no significant differences between the 2 groups in terms of the HVA, hypermobility, the length of the second metatarsal bone, and the length ratio of the second and first metatarsal bones. In the OA group, there was a positive correlation between the HVA and the degree of osteoarthritis (osteophyte formation) ( = 0.278, P = .030). In addition, there was a positive correlation between the IMA and the degree of osteoarthritis ( = 0.284 [JSN], 0.327 [OP] for the HVA, P = .026 [JSN], .010 [OP]). However, there was no significant difference between hypermobility and the degree of osteoarthritis (P = .356 [JSN], .635 [OP], Mann-Whitney U test). Furthermore, there were no positive correlations between the DMAA, the length of the second metatarsal bone, and the metatarsal length ratio. Conclusion: Our study demonstrated a positive correlation between HVA, IMA, and osteoarthritis of the second MTP joint. Other studies will be needed to determine the factors that are responsible for this correlation. Level of Evidence: Level III, retrospective comparative series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714552478|hwp:master-id:spfai;1071100714552478
      Issue No: Vol. 35, No. 12 (2014)
       
  • The Sensitivity of Standard Radiographic Foot Measures to Misalignment
    • Authors: Willauer, P; Sangeorzan, B. J, Whittaker, E. C, Shofer, J. B, Ledoux, W. R.
      Pages: 1334 - 1340
      Abstract: Background: The purpose of this study was to identify the effects that X-ray source misalignment has on common measurements made from anterior-poster (AP) and medial-lateral (ML) view foot radiographs. Methods: A cadaveric foot model was used to obtain ML radiographs with ±25 degree transverse plane misalignment. From these images the calcaneal pitch angle (CPA) and lateral talometatarsal angle (LTMA) were measured. AP images were captured with up to 30 degree sagittal plane misalignment as well as ±15 degree misalignment in the transverse plane at each sagittal angle. From these images the talonavicular coverage angle (TNCA) and talometatarsal angle (TMA) were measured. Results: On the ML images, the CPA was sensitive to transverse plane misalignment from –10 to –25 degrees and from 15 to 25 degrees (P < .005). The LTMA was a more reliable measurement than the CPA and did not demonstrate sensitivity to transverse plane misalignment. On the AP images, the TNCA and TMA were not sensitive to sagittal plane misalignment alone. However, at 0, 10, and 15 degrees sagittal misalignment the TNCA showed sensitivity to transverse plane misalignment (P < .0083). Conclusion: Misalignment of an X-ray source can lead to errors in the measurement of foot radiographic parameters, especially the CPA when there is transverse plane misalignment and the TNCA when there is both sagittal and transverse plane misalignment. The LTMA and TMA can be measured reliably, even with significant misalignment present. Clinical Relevance: If a researcher or clinician is interested in measuring the CPA or TNCA, the current best practices guidelines for obtaining ML and AP images should be closely followed.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714549188|hwp:master-id:spfai;1071100714549188
      Issue No: Vol. 35, No. 12 (2014)
       
  • Correlation Between Subchondral Bone Plate Thickness and Cartilage
           Degeneration in Osteoarthritis of the Ankle
    • Authors: Nakasa, T; Adachi, N, Kato, T, Ochi, M.
      Pages: 1341 - 1349
      Abstract: Background: Osteoarthritis (OA) is characterized not only by cartilage degeneration, but also subchondral bone changes. The subchondral bone plate (SBP) plays an important role in cartilage metabolism, and elucidation of the relationship between the SBP and cartilage degeneration would be helpful to determine the most appropriate treatment strategy for ankle OA. The purpose of this study was to evaluate the SBP and to compare it with cartilage degeneration with arthroscopic findings. Methods: Computed tomography (CT) was used to compare the thickness of the SBP of 11 ankle OA patients with that of 11 non–ankle OA patients in 9 areas of the talar dome. The French Society of Arthroscopy (SFA) grading system was used to analyze the relationship between findings on the thickness of SBP and on articular cartilage degeneration in ankle OA. Results: The SBP in ankle OA was significantly thicker than that of the non-OA ankle. The more severe the articular cartilage degeneration, the thicker the SBP became. The SBP on the sclerotic trabecular bone was significantly thicker than that on decreased trabecular bone. The SFA grade for sclerotic subchondral bone was significantly higher than that for decreased trabecular bone. Conclusion: This study shows that the thickness of SBP and the findings of subchondral bone such as decreased trabecular bone and sclerosis in CT are related to the cartilage degeneration of ankle OA, although a small number of patients were analyzed. Level of Evidence: Level III, comparative series.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714548061|hwp:master-id:spfai;1071100714548061
      Issue No: Vol. 35, No. 12 (2014)
       
  • Calcaneal "Z" Osteotomy Effect on Hindfoot Varus After Triple Arthrodesis
           in a Cadaver Model
    • Authors: Zanolli, D. H; Glisson, R. R, Utturkar, G. M, Eckel, T. T, DeOrio, J. K.
      Pages: 1350 - 1357
      Abstract: Background: Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is performed to relieve pain and correct deformity. Complications include malunion resulting in equinovarus and lateral column overload, which can lead to painful callosities and stress fractures. This study quantified the effectiveness of a closing-wedge calcaneal "Z" osteotomy for correction of the varus condition and reduction of abnormal loading of the lateral border of the foot. Methods: Ten fresh-frozen feet were used. Angle meters were attached to the calcaneus and second cuneiform to measure hindfoot and midfoot varus, and pressure sensors were placed under the first and fifth metatarsal heads to document loading of the borders of the foot. Tensile loads were applied to ten extrinsic tendons and the Achilles tendon while an 1187 N axial foot load was applied. Calcaneus and second cuneiform coronal plane angles and medial and lateral plantar pressures were measured initially, after triple fusion-induced varus, and after "Z" osteotomy. Results: The calcaneal "Z" osteotomy had no significant corrective effect, with hindfoot alignment virtually identical before and after the procedure under the described foot loading conditions. Similarly, second cuneiform inclination, representative of midfoot alignment, showed no change from the osteotomy. Medial and lateral peak plantar pressures after calcaneal "Z" osteotomy did not differ from those measured after varus triple fusion. Conclusion: In this cadaver model of varus malunited triple arthrodesis, the closing-wedge calcaneal "Z" osteotomy was ineffective for correction of bone alignment and lateral forefoot overloading under the tested conditions. Clinical Relevance: The results provide additional information on which to base treatment after triple arthrodesis with varus malunion.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714547364|hwp:master-id:spfai;1071100714547364
      Issue No: Vol. 35, No. 12 (2014)
       
  • Snapping Plantaris Tendon: Case Report
    • Authors: Han, F; Gartner, L, Pearce, C. J.
      Pages: 1358 - 1361
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714549048|hwp:master-id:spfai;1071100714549048
      Issue No: Vol. 35, No. 12 (2014)
       
  • Point-of-Care Ultrasonography in the Diagnosis and Management of
           Superficial Peroneal Nerve Entrapment: Case Series
    • Authors: Luz, J; Johnson, A. H, Kohler, M. J.
      Pages: 1362 - 1366
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714548198|hwp:master-id:spfai;1071100714548198
      Issue No: Vol. 35, No. 12 (2014)
       
  • Fixation of Distal Fibula Fractures: An Update
    • Authors: Mitchell, J. J; Bailey, J. R, Bozzio, A. E, Fader, R. R, Mauffrey, C.
      Pages: 1367 - 1375
      Abstract: Level of Evidence: Level V, expert opinion.
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714555712|hwp:master-id:spfai;1071100714555712
      Issue No: Vol. 35, No. 12 (2014)
       
  • Education Calendar
    • Pages: 1376 - 1376
      PubDate: 2014-11-24T16:34:30-08:00
      DOI: 10.1177/1071100714561612|hwp:resource-id:spfai;35/12/1376
      Issue No: Vol. 35, No. 12 (2014)
       
 
 
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