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Journal Cover Foot & Ankle International
  [SJR: 1.544]   [H-I: 80]   [10 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [853 journals]
  • Symptom Resolution and Patient-Perceived Recovery Following Ankle
           Arthroplasty and Arthrodesis
    • Authors: Pinsker, E; Inrig, T, Daniels, T. R, Warmington, K, Beaton, D. E.
      Pages: 1269 - 1276
      Abstract: Background:Patients’ perception of outcomes is not always defined by the absence of limitations/symptoms (resolution), but can also be characterized by behavioral adaptation and cognitive coping arising in cases with residual deficits. Patient-reported outcome measures (PROs) are designed to measure levels of function or symptoms, largely missing whether patients are coping with ongoing limitations. This study aimed to broaden the conventional definition of a "satisfactory" outcome following ankle reconstruction by comparing patient-reported outcomes of patients with and without residual symptoms and limitations.Methods:The study consisted of a cross-sectional survey of ankle arthroplasty (n = 85) and arthrodesis (n = 15) patients. Outcome measures included the Ankle Osteoarthritis Scale, Short Musculoskeletal Function Assessment, Short Form-12, and EuroQol-5 Dimension. Patients also completed measures of pain (0-10), stiffness (0-10), satisfaction (0-3), and ability to complete activities of daily living (ADL) (0-6). Based on a self-reported question regarding recovery and coping, patients were categorized as "Recovered-Resolved" (better with no symptoms or residual effects), "Recovered, not Resolved" (RNR, better with residual effects), or "Not Recovered" (not better). Recovery groups were compared across measures.Results:Only 15% of patients were categorized Recovered-Resolved. Most were RNR (69%), leaving 14% Not Resolved. Recovered-Resolved experienced lower rates of pain (1.4 ± 2.3), stiffness (1.1 ± 2.6), and difficulty performing ADLs (0.9 ± 1.2). Overall, outcome measure scores were high (ie, better health) for Recovered-Resolved patients, midrange for RNR patients, and low for Not Recovered patients, thus confirming predefined hypotheses. Recovered-Resolved and RNR patients had similarly high satisfaction summary scores (3.0 ± 0.0 vs 2.6 ± 0.6).Conclusion:Most patients reported positive outcomes, but few (15%) experienced resolution of all symptoms and limitations. Current PROs focus on achieving low levels of symptoms and limitations, but miss an important achievement when patients are brought to a level of residual deficits with which they can cope. Patients’ perceptions of satisfactory outcomes were not predicated on the resolution of all limitations; thus, the conventional definition of "satisfactory" outcomes should be expanded accordingly.Level of Evidence:Level II, prospective cohort study.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716660820
      Issue No: Vol. 37, No. 12 (2016)
       
  • Development of an Expectations Survey for Patients Undergoing Foot and
           Ankle Surgery
    • Authors: Cody, E. A; Mancuso, C. A, MacMahon, A, Marinescu, A, Burket, J. C, Drakos, M. C, Roberts, M. M, Ellis, S. J.
      Pages: 1277 - 1284
      Abstract: Background:Many authors have reported on patient satisfaction from foot and ankle surgery, but rarely on expectations, which may vary widely between patients and strongly affect satisfaction. In this study, we aimed to develop a patient-derived survey on expectations from foot and ankle surgery.Methods:We developed and tested our survey using a 3-phase process. Patients with a wide spectrum of foot and ankle diagnoses were enrolled. In phase 1, patients were interviewed preoperatively with open-ended questions about their expectations from surgery. Major concepts were grouped into categories that were used to form a draft survey. In phase 2, the survey was administered to preoperative patients on 2 occasions to establish test-retest reliability. In phase 3, the final survey items were selected based on weighted kappa values for response concordance and clinical relevance.Results:In phase 1, 94 preoperative patients volunteered 655 expectations. Twenty-nine representative categories were discerned by qualitative analysis and became the draft survey. In phase 2, another 60 patients completed the draft survey twice preoperatively. In phase 3, 23 items were retained for the final survey. For retained items, the average weighted kappa value was 0.54. An overall score was calculated based on the amount of improvement expected for each item on the survey and ranged from zero to 100, with higher scores indicating more expectations. For patients in phase 2, mean scores for both administrations were 65 and 66 and approximated normal distributions. The intraclass correlation coefficient between scores was 0.78.Conclusion:We developed a patient-derived survey specific to foot and ankle surgery that is valid, reliable, applicable to diverse diagnoses, and includes physical and psychological expectations. The survey generates an overall score that is easy to calculate and interpret, and thus offers a practical and comprehensive way to record patients’ expectations. We believe this survey may be used preoperatively by surgeons to help guide patients’ expectations and facilitate shared decision making.Level of Evidence:Level II, cross-sectional study.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716666260
      Issue No: Vol. 37, No. 12 (2016)
       
  • Outcomes of Osteomyelitis in Patients Hospitalized With Diabetic Foot
           Infections
    • Authors: Wukich, D. K; Hobizal, K. B, Sambenedetto, T. L, Kirby, K, Rosario, B. L.
      Pages: 1285 - 1291
      Abstract: Background:This study was conducted to evaluate the outcomes of patients with diabetic foot osteomyelitis (DFO) compared to diabetic foot soft tissue infections (STIs).Methods:229 patients who were hospitalized with foot infections were retrospectively reviewed, identifying 155 patients with DFO and 74 patients with STI. Primary outcomes evaluated were the rates of amputations and length of hospital stay. DFO was confirmed by the presence of positive bone culture and/or histopathology. Results: Patients with DFO had a 5.6 times higher likelihood of overall amputation (P < .0001), a 3.4 times higher likelihood of major amputation (P = .027) and a 4.2 times higher likelihood of minor amputation (P < .0001) compared to patients without DFO. Major amputation was performed in 16.7% patients diagnosed with DFO and 5.3% of patients diagnosed with STI. Patients with DFO complicated by Charcot neuroarthropathy had a 7 times higher likelihood of undergoing major amputation (odds ratio 6.78, 95% confidence interval 2.70-17.01, P < .0001). The mean hospital stay was 7 days in DFO and 6 days in patients with DFI (P = .0082). Patients with DFO had a higher erythrocyte sedimentation rate (85 vs 71, P = .02) than patients with STI, however the differences in C-reactive protein (13.4 vs 11.8, P = .29) were not significantly different.Conclusion:In this study of moderate and severe DFIs, the presence of osteomyelitis resulted in a higher likelihood of amputation and longer hospital stay. Readers should recognize that the findings of this study may not be applicable to less severe cases of DFO that can be effectively managed in an outpatient setting.Level of Evidence:Level III, retrospective comparative case series.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716664364
      Issue No: Vol. 37, No. 12 (2016)
       
  • Long-term Functional and Radiographic Outcome of a Mobile Bearing Ankle
           Prosthesis
    • Authors: Kerkhoff, Y. R. A; Kosse, N. M, Metsaars, W. P, Louwerens, J. W. K.
      Pages: 1292 - 1302
      Abstract: Background:Total ankle arthroplasty is an accepted alternative to arthrodesis of the ankle. However, complication and failure rates remain high. Long-term results of the Scandinavian Total Ankle Replacement (STAR) are limited, with variable complication and failure rates observed. This prospective study presents the long-term survivorship and postoperative complications of the STAR prosthesis.Methods:Between May 1999 and June 2008, 134 primary total ankle arthroplasties were performed using the STAR prosthesis in 124 patients. The survivorship, postoperative complications, and reoperations were recorded, with a minimum follow-up period of 7.5 years. Clinical results were assessed using the Foot Function Index and the Kofoed score. The presence of component migration, cysts, and radiolucency surrounding the prosthesis components, heterotopic ossification, and progression of osteoarthritis in adjacent joints were determined.Results:The cumulative survival was 78% after the 10-year follow-up period. An ankle arthrodesis was performed in 20 ankles (14.9%) that failed. Fourteen polyethylene insert fractures occurred (10.4%). Other complications occurred in 29 ankles (21.6%), requiring secondary procedures in 21 ankles (15.7%). Nevertheless, the postoperative clinical results improved significantly. Osteolytic cysts were observed in 61 ankles (59.8%) and the surface area of these cysts increased during follow-up, without any association with the prosthesis alignment or clinical outcome. Heterotopic ossification at the medial malleolus was present in 58 cases (56.8%) and at the posterior tibia in 73 cases (71.6%), with no effect on clinical outcome. Osteoarthritis of the subtalar and talonavicular joint developed in 9 (8.8%) and 11 cases (10.8%), respectively.Conclusion:The long-term clinical outcomes for the STAR were found to be satisfactory. Although these results are consistent with previous studies, the survival and complication rates are disappointing compared to knee and hip arthroplasty. Higher rates of successful outcomes following ankle arthroplasty are important, and these results highlight the need for further research to clarify the origin and significance of the reported complications.Level of Evidence:Level II, prospective comparative study.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716661477
      Issue No: Vol. 37, No. 12 (2016)
       
  • Relationship Between Displacement and Degenerative Changes of the
           Sesamoids in Hallux Valgus
    • Authors: Katsui, R; Samoto, N, Taniguchi, A, Akahane, M, Isomoto, S, Sugimoto, K, Tanaka, Y.
      Pages: 1303 - 1309
      Abstract: Background:Although the tangential sesamoid view is used to visualize the sesamoid position relative to the first metatarsal head, correctly evaluating patients with severe varus of the first metatarsal is difficult. Computed tomography (CT) can be helpful due to its cross-sectional images in any plane. The purposes of this study were to evaluate the alignment of the tibial sesamoid and investigate the relationship between malalignment and degenerative change in the sesamoid metatarsal joint (SMJ) using simulated weight-bearing CT imaging in patients with hallux valgus.Methods:In total, 269 feet from 142 patients with hallux valgus were included. The mean age was 63.7 years (range, 33-87 years). An anteroposterior weight-bearing radiograph was assessed for sesamoid position into 3 grades: grade 1, the tibial sesamoid was medial to the axis of the first metatarsal; grade 2, the tibial sesamoid was located below the first metatarsal axis; and grade 3, the tibial sesamoid was lateral to the first metatarsal axis. The hallux valgus and intermetatarsal angles (HVA and IMA, respectively) were measured. The lateral shift of the tibial sesamoid relative to the first metatarsal was classified into 3 grades on simulated weight-bearing CT classification: grade 1, tibial sesamoid was entirely medial to the intersesamoid ridge; grade 2, tibial sesamoid was subluxated laterally but located below the intersesamoid ridge; and grade 3, tibial sesamoid was located entirely lateral to the intersesamoid ridge. The differences of HVA and IMA in each grade were confirmed by using 1-way analysis of variance with Bonferroni post hoc corrections. Furthermore, multiple linear regression analysis was used to predict the degenerative change in the SMJ for age, sex, sesamoid position determined by CT or plain radiography, HVA, and IMA. The 2 test was used for descriptive statistics to analyze the agreement between radiography or CT classifications of sesamoid position against degenerative change in the SMJ.Results:Based on the radiographic classification of the tibial sesamoid position, 7 feet were classified as grade 1, 72 were grade 2, and 190 were grade 3, respectively. Based on the CT classification, 34 feet were classified as grade 1, 116 were grade 2, and 119 were grade 3. Degenerative change in SMJ progressed according to the sesamoid shift relative to the first metatarsal using either radiography or CT. In radiography, statistically significant differences were found except for the difference in HVA between grades 1 and 2. In addition, statistically significant differences were found between HVA and IMA, along with the grades in CT.In multiple linear regression, degenerative change was correlated with age and sesamoid position in CT and radiographic classifications.Conclusion:Our study showed that lateral shift of the tibial sesamoid increased in association with progression of the hallux valgus deformity. Furthermore, increasing lateral shift of the tibial sesamoid was associated with worsening degenerative change within the SMJ.Level of Evidence:Level III, retrospective comparative study.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716661827
      Issue No: Vol. 37, No. 12 (2016)
       
  • Ankle Fusion Combined With Calcaneal Sliding Osteotomy for Severe
           Arthritic Ball and Socket Ankle Deformity
    • Authors: Cho, B.-K; Park, K.-J, Choi, S.-M, Kang, S.-W, Lee, H.-K.
      Pages: 1310 - 1316
      Abstract: Background:Although a ball and socket ankle deformity is usually congenital and asymptomatic, abnormal inversion and eversion mobility can result in recurrent ankle sprain and osteoarthritis. This retrospective study was performed to evaluate the clinical and radiologic outcomes of ankle fusion combined with calcaneal sliding osteotomy for severe arthritic ball and socket ankle deformity.Methods:Fourteen patients with severe arthritic ball and socket ankle deformity were followed for more than 3 years after operation. The clinical evaluation consisted of American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS) for pain, and subjective satisfaction score. The period to fusion and union of osteotomy, the change of hindfoot alignment angle, and complications were evaluated radiologically.Results:AOFAS and FAAM scores were significantly improved from an average of 37.4 and 34.5 points to 74.6 and 78.5 points, respectively. VAS for pain with walking over 20 minutes was significantly improved from an average of 8.4 points to 1.9 points. The average satisfaction score of patients was 88.9 points. The difference in heel alignment angle (compared to contralateral side) was significantly improved from an average of 34.8 to 5.4 degrees. There were 2 cases of progressive arthritis in an adjacent joint and 1 case of failed fusion.Conclusions:Ankle fusion combined with calcaneal sliding osteotomy can be an effective operative option for ball and socket ankle deformity with advanced arthritis. In spite of increased complication rate, reliable pain relief, and restoration of gait ability through correcting hindfoot malalignment could improve the quality of life.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716661382
      Issue No: Vol. 37, No. 12 (2016)
       
  • Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation
           Techniques for Syndesmotic Injuries
    • Authors: Kocadal, O; Yucel, M, Pepe, M, Aksahin, E, Aktekin, C. N.
      Pages: 1317 - 1325
      Abstract: Background:Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans.Methods:Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2.Results:There was a statistically significant decrease in the degree of fibular rotation (P = .03) and an increase in the upper syndesmotic area (P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area (P = .02) and distal tibiofibular volumes (P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups.Conclusion:Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique.Level of Evidence:Level III, retrospective comparative study.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716661221
      Issue No: Vol. 37, No. 12 (2016)
       
  • Preemptive Local Anesthesia in Ankle Arthroscopy
    • Authors: Liszka, H; Gadek, A.
      Pages: 1326 - 1332
      Abstract: Background:Complex anesthesia is increasingly used in order to reduce postoperative pain and accelerate rehabilitation. The aim of this study was to evaluate the efficacy and safety of preemptive local anesthesia combined with general or spinal anesthesia in ankle arthroscopy.Methods:From January 2014 to February 2016, 80 ankle anterior arthroscopies were performed. Patients were randomly assigned to one of 4 groups, depending on the type of anesthesia: A, general and local preemptive; B, spinal and local preemptive; C, general and placebo; D, spinal and placebo. After general or spinal anesthesia, each patient randomly received an injection of 7 mL of a mixture of local anesthetics or the same amount of normal saline. After 2, 4, 8, 12, 16, 24, 48, and 72 hours following the release of the tourniquet, the pain intensity level was measured with a visual analog scale (VAS). The use of additional analgesics and any adverse effects were also noted.Results:Preemptive local anesthesia (groups A and B) resulted in a significantly lower level of pain intensity during the first 24 hours after surgery. Until 8 hours after the release of the tourniquet, the pain intensity level was statistically lower in the groups A, B, and D in comparison to C. During hospitalization, none of the patients from groups A and B received on-demand ketoprofen intravenously. No side effects of local anesthetic agents were observed. Two patients had transient numbness and paresthesia in the field of sensory nerve innervation of the dorsal intermediate cutaneous nerve of the foot.Conclusion:Preemptive operative site infiltration with a mixture of local anesthetics performed in ankle arthroscopy was a safe procedure. It reduced the level of intensity of postoperative pain and the amount of analgesics used.Level of Evidence:Level I, prospective randomized study.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716665354
      Issue No: Vol. 37, No. 12 (2016)
       
  • Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown
           Flap and Semitendinosus Augmentation
    • Authors: Gedam, P. N; Rushnaiwala, F. M.
      Pages: 1333 - 1342
      Abstract: Background:The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results.Methods:Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion.Results:The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage.Conclusion:All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications.Level of Evidence:Level III, retrospective comparative study.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716666365
      Issue No: Vol. 37, No. 12 (2016)
       
  • The Role of Fluid Dynamics in Distributing Ankle Stresses in Anatomic and
           Injured States
    • Authors: Hamid, K. S; Scott, A. T, Nwachukwu, B. U, Danelson, K. A.
      Pages: 1343 - 1349
      Abstract: Background:In 1976, Ramsey and Hamilton published a landmark cadaveric study demonstrating a dramatic 42% decrease in tibiotalar contact area with only 1 mm of lateral talar shift. An increase in maximum principal stress of at least 72% is predicted based on these findings though the delayed development of arthritis in minimally misaligned ankles does not appear to be commensurate with the results found in dry cadaveric models. We hypothesized that synovial fluid could be a previously unrecognized factor that contributes significantly to stress distribution in the tibiotalar joint in anatomic and injured states.Methods:As it is not possible to directly measure contact stresses with and without fluid in a cadaveric model, finite element analysis (FEA) was employed for this study. FEA is a modeling technique used to calculate stresses in complex geometric structures by dividing them into small, simple components called elements. Four test configurations were investigated using a finite element model (FEM): baseline ankle alignment, 1 mm laterally translated talus and fibula, and the previous 2 bone orientations with fluid added. The FEM selected for this study was the Global Human Body Models Consortium–owned GHBMC model, M50 version 4.2, a model of an average-sized male (distributed by Elemance, LLC, Winston-Salem, NC). The ankle was loaded at the proximal tibia with a distributed load equal to the GHBMC body weight, and the maximum principal stress was computed.Results:All numerical simulations were stable and completed with no errors. In the baseline anatomic configuration, the addition of fluid between the tibia, fibula, and talus reduced the maximum principal stress computed in the distal tibia at maximum load from 31.3 N/mm2 to 11.5 N/mm2. Following 1 mm lateral translation of the talus and fibula, there was a modest 30% increase in the maximum stress in fluid cases. Qualitatively, translation created less high stress locations on the tibial plafond when fluid was incorporated into the model.Conclusions:The findings in this study demonstrate a meaningful role for synovial fluid in distributing stresses within the ankle that has not been considered in historical dry cadaveric studies. The increase in maximum stress predicted by simulation of an ankle with fluid was less than half that projected by cadaveric data, indicating a protective effect of fluid in the injured state. The trends demonstrated by these simulations suggest that bony alignment and fluid in the ankle joint change loading patterns on the tibia and should be accounted for in future experiments.Clinical Relevance:Synovial fluid may play a protective role in ankle injuries, thus delaying the onset of arthritis. Reactive joint effusions may also function to additionally redistribute stresses with higher volumes of viscous fluid.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716660823
      Issue No: Vol. 37, No. 12 (2016)
       
  • Three-Dimensional Analysis of Fibular Motion After Fixation of Syndesmotic
           Injuries With a Screw or Suture-Button Construct
    • Authors: LaMothe, J. M; Baxter, J. R, Murphy, C, Gilbert, S, DeSandis, B, Drakos, M. C.
      Pages: 1350 - 1356
      Abstract: Background:Suture-button constructs are an alternative to screw fixation for syndesmotic injuries, and proponents advocate that suture-button constructs may allow physiological motion of the syndesmosis. Recent biomechanical data suggest that fibular instability with syndesmotic injuries is greatest in the sagittal plane, but the design of a suture-button construct, being a rope and 2 retention washers, is most effective along the axis of the rope (in the coronal plane). Some studies report that suture-button constructs are able to constrain fibular motion in the coronal plane, but the ability of a tightrope to constrain sagittal fibular motion is unknown. The purpose of this study was to assess fibular motion in response to an external rotation stress test in a syndesmotic injury model after fixation with a screw or suture-button constructs.Methods:Eleven fresh-frozen cadaver whole legs with intact tibia-fibula articulations were secured to a custom fixture. Fibular motion (coronal, sagittal, and rotational planes) in response to a 6.5-Nm external rotation moment applied to the foot was recorded with fluoroscopy and a high-resolution motion capture system. Measures were taken for the following syndesmotic conditions: intact, complete lateral injury, complete lateral and deltoid injury, repair with a tetracortical 4.0-mm screw, and repair with a suture button construct (Tightrope; Arthrex, Naples, FL) aimed from the lateral fibula to the anterior medial malleolus.Results:The suture-button construct allowed significantly more sagittal plane motion than the syndesmotic screw. Measurements acquired with mortise imaging did not detect differences between the intact, lateral injury, and 2 repair conditions. External rotation of the fibula was significantly increased in both injury conditions and was not restored to intact levels with the screw or the suture-button construct.Conclusion:A single suture-button placed from the lateral fibula to the anterior medial malleolus was unable to replicate the motion observed in the intact specimen when subjected to an external rotation stress test and allowed significantly more posterior motion of the fibula than when fixed with a screw in simulated highly unstable injuries.Clinical Relevance:Fixation of a syndesmotic injury with a single suture-button construct did not restore physiological fibular motion, which may have implications for postoperative care and clinical outcomes.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716666865
      Issue No: Vol. 37, No. 12 (2016)
       
  • Compressive Force With 2-Screw and 3-Screw Subtalar Joint Arthrodesis With
           Headless Compression Screws
    • Authors: Matsumoto, T; Glisson, R. R, Reidl, M, Easley, M. E.
      Pages: 1357 - 1363
      Abstract: Background:Joint compression is an essential element of successful arthrodesis. Although subtalar joint compression generated by conventional screws has been quantified in the laboratory, compression obtainable with headless screws that rely on variable thread pitch to achieve bony contact has not been assessed. This study measured subtalar joint compression achieved by 2 posteriorly placed contemporary headless, variable-pitch screws, and quantified additional compression gained by placing a third screw anteriorly.Methods:Ten, unpaired fresh-frozen cadaveric subtalar joints were fixed sequentially using 2 diverging posterior screws (one directed into the talar dome, the other into the talar neck), 2 parallel posterior screws (both ending in the talar dome), and 2 parallel screws with an additional anterior screw inserted from the plantar calcaneus into the talar neck. Joint compression was quantified directly during screw insertion using a novel custom-built measuring device.Results:The mean compression generated by 2 diverging posterior screws was 246 N. Two parallel posterior screws produced 294 N of compression, and augmentation of that construct with a third, anterior screw increased compression to 345 N (P < .05). Compression subsequent to 2-screw fixation was slightly less than that reported previously for subtalar joint fixation with 2 conventional lag screws, but was comparable when a third screw was added.Conclusions:Under controlled testing conditions, 2 tapered, variable-pitch screws generated somewhat less compression than previously reported for 2-screw fixation with conventional headed screws. A third screw placed anteriorly increased compression significantly.Clinical relevance:Because headless screws are advantageous where prominent screw heads are problematic, such as the load-bearing surface of the foot, their effectiveness compared to other screws should be established to provide an objective basis for screw selection. Augmenting fixation with an anterior screw may be desirable when conditions for fusion are suboptimal.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716666275
      Issue No: Vol. 37, No. 12 (2016)
       
  • Bone Marrow Edema Syndrome in the Foot and Ankle
    • Authors: Mirghasemi, S. A; Trepman, E, Sadeghi, M. S, Rahimi, N, Rashidinia, S.
      Pages: 1364 - 1373
      Abstract: Bone marrow edema syndrome (BMES) is an uncommon and self-limited syndrome characterized by extremity pain of unknown etiology. Symptoms may include sudden or gradual onset of swelling and pain at rest or during activity, usually at night. This syndrome mostly affects middle-aged men and younger women who have pain in the lower extremities. The most common sites involved with BMES, in decreasing order of frequency, are the bones about the hip, knee, ankle, and foot. The diagnosis of BMES is confirmed with magnetic resonance imaging to exclude other causes of bone marrow edema. The correct diagnosis in the foot and ankle often is delayed because of the low prevalence and nonspecific signs. This delay may intensify bone pain and impair patient function and quality of life. The goal of BMES treatment is to relieve pain and shorten disease duration. Treatment options are limited and may include symptomatic treatment, pharmacologic treatment, and surgery.Level of Evidence: Level V, expert opinion.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716664783
      Issue No: Vol. 37, No. 12 (2016)
       
  • Lisfranc Injuries in the Athlete
    • Authors: Lewis, J. S; Anderson, R. B.
      Pages: 1374 - 1380
      Abstract: Lisfranc injuries to the tarsometatarsal complex of the midfoot have become increasingly recognized in the athletic population. Regardless of mechanism, any injury that results in instability in the midfoot requires operative stabilization to preserve function and enable return to sport. In this manuscript, the anatomy, etiology, prevalence, current treatment modalities, and clinical outcomes of patients who suffer Lisfranc injuries are reviewed, with a special focus on the unique characteristics surrounding such an injury in an athlete.Level of Evidence: Level V, expert opinion.
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716675293
      Issue No: Vol. 37, No. 12 (2016)
       
  • Angus McBryde Jr, MD (1937-2016)
    • Authors: Anderson R. B.
      Pages: 1381 - 1382
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716679649
      Issue No: Vol. 37, No. 12 (2016)
       
  • Education Calendar
    • Pages: 1383 - 1383
      PubDate: 2016-11-29T16:48:58-08:00
      DOI: 10.1177/1071100716680603
      Issue No: Vol. 37, No. 12 (2016)
       
 
 
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