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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  [850 journals]
  • Effectiveness of Allograft Reconstruction vs Tenodesis for Irreparable
           Peroneus Brevis Tears: A Cadaveric Model
    • Authors: Pellegrini, M. J; Glisson, R. R, Matsumoto, T, Schiff, A, Laver, L, Easley, M. E, Nunley, J. A.
      Pages: 803 - 808
      Abstract: Background: Irreparable peroneus brevis tendon tears are uncommon, and there is scant evidence on which to base operative treatment. Options include tendon transfer, segmental resection with tenodesis to the peroneus longus tendon, and allograft reconstruction. However, the relative effectiveness of the latter 2 procedures in restoring peroneus brevis function has not been established. Methods: Custom-made strain gage–based tension transducers were implanted into the peroneus longus and brevis tendons near their distal insertions in 10 fresh-frozen cadaver feet. Axial load was applied to the foot, and the peroneal tendons and antagonistic tibialis anterior and posterior tendons were tensioned to 50% and 100% of physiologic load. Distal tendon tension was recorded in this normal condition and after sequential peroneus brevis-to-longus tenodesis and peroneus brevis allograft reconstruction. Measurements were made in 5 foot inversion/eversion and plantarflexion/dorsiflexion positions. Results: Distal peroneus brevis tendon tension after allograft reconstruction significantly exceeded that measured after tenodesis in all tested loading conditions (P ≤ 0.022). With 50% of physiologic load applied, peroneus brevis tension was 1% to 28% of normal (depending on foot position) after tenodesis and 73% to 101% of normal after allograft reconstruction. Under the 100% loading condition, peroneus brevis tension was 6% to 43% of normal after tenodesis and 88% to 99% of normal after reconstruction with allograft. Distal peroneus longus tension remained within 20% of normal under all operative and loading conditions. Conclusion: Allograft reconstruction of a peroneus brevis tendon tear in this model substantially restored distal tension when the peroneal tendons and their antagonists were loaded to 50% and 100% of physiologic load. Tenodesis to the peroneus longus tendon did not effectively restore peroneus brevis tension under the tested conditions. Clinical Relevance: Because tenodesis was demonstrated to be ineffective for restoration of peroneus brevis function, this procedure may result in an imbalanced foot clinically.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716658469
      Issue No: Vol. 37, No. 8 (2016)
  • Clinical and Operative Factors Related to Successful Revision Arthrodesis
           in the Foot and Ankle
    • Authors: OConnor, K. M; Johnson, J. E, McCormick, J. J, Klein, S. E.
      Pages: 809 - 815
      Abstract: Background: Arthrodesis is a common operative procedure used to manage arthritis and deformity in the foot and ankle. Nonunion is a possible and undesirable outcome in any arthrodesis surgery. Rates of nonunion in the foot and ankle literature range from 0% to 47% depending on the patient population and joint involved. Multiple factors can contribute to developing a nonunion including location, fixation method, tobacco use, diabetes, infection, and others. Methods: The case logs of 3 foot and ankle surgeons were reviewed from January 2007 to September 2014 to identify nonunion arthrodesis revision cases. The patient factors reviewed included diabetes, inflammatory arthropathy, tobacco use, history of infection, nonunion elsewhere, neuropathy, Charcot arthropathy, posttraumatic arthritis, and prior attempt at revision arthrodesis at the same site. Operative records were reviewed to identify location of the nonunion, instrumention, use of allograft or autograft bone, use of iliac crest bone marrow aspirate (ICBMA) and use of orthobiologics such as bone morphogenetic protein (BMP) during the revision arthrodesis. Successful revision was defined as radiographic union on the final radiograph during follow-up. Eighty-two cases of revision arthrodesis were identified with an average follow-up of 16 months. Results: The overall nonunion rate was 23%. Neuropathy and prior attempts at revision were identified as significant risks (P
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716642845
      Issue No: Vol. 37, No. 8 (2016)
  • Depression, Anxiety, and Stress in People With and Without Plantar Heel
    • Authors: Cotchett, M; Munteanu, S. E, Landorf, K. B.
      Pages: 816 - 821
      Abstract: Background: Depression, anxiety, and stress are prevalent in patients with musculoskeletal pain, but the impact of these emotional states has not been evaluated in people with plantar heel pain. The aim of this study was to evaluate the association between depression, anxiety, and stress with plantar heel pain. Methods: Forty-five participants with plantar heel pain were matched by sex and age (±2 years) to 45 participants without plantar heel pain. Levels of depression, anxiety, and stress were measured using the Depression, Anxiety and Stress Scale (short version) in participants with and without plantar heel pain. Logistic regression was conducted to determine if levels of depression, anxiety, or stress were associated with having plantar heel pain. Results: Univariate analysis indicated that participants with plantar heel pain had greater levels of depression (mean difference = 4.4, 95% CI 2.3 to 6.5), anxiety (mean difference = 2.6, 95% CI 0.9 to 4.3), and stress (mean difference = 4.8, 95% CI 1.9 to 7.8). After adjusting for age, sex, BMI, and education, for every 1 unit increase in depression, anxiety, or stress (in the DASS subscales), the odds ratios for having plantar heel pain were increased by 1.3 (95% CI 1.1 to 1.6), 1.3 (95% CI 1.1 to 1.5), and 1.2 (95% CI 1.1 to 1.3), respectively. Conclusion: Symptoms of depression, anxiety, and stress were independently associated with plantar heel pain. Larger prospective studies are necessary to evaluate the temporal association between these emotional states and plantar heel pain. Level of Evidence: Level III, cross sectional, observational.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716646630
      Issue No: Vol. 37, No. 8 (2016)
  • Etiology and Treatment of Delayed-Onset Medial Malleolar Pain Following
           Total Ankle Arthroplasty
    • Authors: Lundeen, G. A; Dunaway, L. J.
      Pages: 822 - 828
      Abstract: Background: Total ankle arthroplasty (TAA) has become a successful treatment for end-stage ankle arthritis. Some patients may still have pain or may present with new pain. Suggested sources of medial pain include tibialis posterior tendonitis, impingement, or medial malleolar stress fracture. Etiology and treatment remain unclear. The objective of our study was to evaluate patients with delayed-onset medial malleolar pain following TAA who underwent treatment with percutaneous medial malleolar screw placement and propose an etiology. Materials and Methods: Patients who had undergone TAA at our institution were reviewed and those with medial malleolar pain were identified. Clinical and radiographic examinations were performed pre- and postoperatively. Radiographs were compared with those from a cohort of controls without a history of medial pain. All affected patients failed conservative therapy and were treated with percutaneous placement of medial malleolar screws positioned from the malleolar tip and extending proximally beyond the tibial component. Postoperatively, patients were placed in an ace wrap and allowed to be weightbearing to tolerance, except for 1 patient initially restricted to partial weightbearing. Visual analog scale (VAS) scores were recorded. Seventy-four (74) patients underwent TAA by the corresponding author. All (100%) were female with an average age of 66 (range, 57-73) years. Average follow-up since screw placement was 21.4 (range, 10-41) months. Results: Six (8.1%) underwent placement of 2 percutaneous medial malleolar screws. Patients presented with pain an average of 12 (range, 4-24) months postoperatively and underwent screw placement an average of 2.8 (range, 1-6) months after presentation. At the time of TAA, none had a coronal plane deformity and none underwent a deltoid ligament release as part of balancing. All (100%) patients had pain and swelling directly over the medial malleolus prior to screw placement. Postoperatively, 1 (17%) had mild pain clinically at this site and 2 (33%) had occasional pain medially with activity. Average VAS scores improved from 5.7 (range, 4-6) preoperatively to 1.3 (range, 0-3) postoperatively (P < .05). Three (50%) patients had a bone density test and all were normal. Prior to screw placement, radiographs demonstrated no signs of stress fracture or misalignment. Average minimum width of the medial malleolus at the level of the tibial component was 10.2 mm (range, 9.2-11.0), which was significantly less (P < .05) than the control group of 19 patients whose distance measured 12.2 mm (range, 8.5-14.8). Discussion: Patients who present with new-onset medial malleolar pain with normal radiographs following TAA may have medial malleolar insufficiency fracture. These patients can be treated successfully with minimal morbidity by placement of percutaneous medial malleolar screws. Etiology may be related to deltoid traction, subacute stress fracture, and/or impingement of the talus component on the medial malleolus. Medial malleolar pain may be misdiagnosed as tibialis posterior tendonitis, impingement, or implant failure. This diagnosis should be considered in patients who have pain at the medial malleolus, particularly if they are female or have medial malleolus thickness less than 11 mm at the level of the tibial implant. Placement of prophylactic medial malleolar screws may be considered at the time of TAA when these conditions exist. Level of Evidence: Level IV, case series.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716643278
      Issue No: Vol. 37, No. 8 (2016)
  • Prospective Computed Tomographic Analysis of Osteochondral Lesions of the
           Ankle Joint Associated With Ankle Fractures
    • Authors: Nosewicz, T. L; Beerekamp, M. S. H, De Muinck Keizer, R.-J. O, Schepers, T, Maas, M, Niek van Dijk, C, Goslings, J. C.
      Pages: 829 - 834
      Abstract: Background: Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome. Methods: 100 ankle fractures requiring operative treatment were prospectively included (46 men, 54 women; mean age 44 ± 14 years, range 20-77). All ankle fractures (conventional radiography; 71 Weber B, 22 Weber C, 1 Weber A, 4 isolated medial malleolus and 2 isolated posterior malleolus fractures) were treated by open reduction and internal fixation. Multidetector computed tomography (CT) was performed postoperatively. For each OCL, the location, size, and Loomer OCL classification (CT modified Berndt and Harty classification) were determined. The subjective Foot and Ankle Outcome Scoring (FAOS) was used for clinical outcome at 1 year. Results: OCLs were found in 10/100 ankle fractures (10.0%). All OCLs were solitary talar lesions. Four OCLs were located posteromedial, 4 posterolateral, 1 anterolateral, and 1 anteromedial. There were 2 type I OCLs (subchondral compression), 6 type II OCLs (partial, nondisplaced fracture) and 2 type IV OCLs (displaced fracture). Mean OCL size (largest diameter) was 4.4 ± 1.7 mm (range, 1.7 mm to 6.2 mm). Chi-square analysis showed no significant association between ankle fracture type and occurrence of OCLs. OCLs did occur only in Lauge-Hansen stage III/IV ankle fractures. There were no significant differences in FAOS outcome between patients with or without OCLs. Conclusions: Ten percent of investigated ankle fractures had associated OCLs on CT. Although no significant association between fracture type and OCL was found, OCLs only occurred in Lauge-Hansen stage III/IV ankle fractures. With the numbers available, OCLs did not significantly affect clinical outcome at 1 year according to FAOS. Level of Evidence: Level IV, observational study.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716644470
      Issue No: Vol. 37, No. 8 (2016)
  • Early Complications and Secondary Procedures in Transfibular Total Ankle
    • Authors: Tan, E. W; Maccario, C, Talusan, P. G, Schon, L. C.
      Pages: 835 - 841
      Abstract: Background: A new transfibular total ankle arthroplasty (TAA) system has not been assessed for potential early complications. Methods: We retrospectively assessed prospectively collected data on the initial cohort of patients undergoing TAA with this implant. We evaluated visual analog scale (VAS) pain and function, range of motion, and early radiographic outcomes. Results: Twenty consecutive TAAs (19 patients) were treated with the implant from January 2013 through June 2014. Average patient age was 63.7 (range, 41-80) years, with an average follow-up of 18 (range, 12-27) months. No fibular nonunion or implant failure was found at 12 months postoperatively. One patient had asymptomatic mild tibial lucency. Four of 20 TAAs underwent additional surgery for anterior impingement (1 ankle), deep infection and symptomatic fibular hardware (1 ankle), and symptomatic fibular hardware (2 ankles). Conclusion: Of 20 ankles treated with a new transfibular arthroplasty system, no fibular nonunion, delayed union, or implant failure was noted at 12 months postoperatively. Two complications were resolved with secondary treatment, and 2 other ankles underwent secondary surgery for symptomatic fibular hardware with good outcome. The findings suggest that this total ankle system is safe and effective at short-term follow-up. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716644817
      Issue No: Vol. 37, No. 8 (2016)
  • Influence of Hindfoot Malalignment on Hallux Valgus Operative Outcomes
    • Authors: Gines-Cespedosa, A; Perez-Prieto, D, Muneton, D, Gonzalez-Lucena, G, Millan, A, de Zabala, S, Busquets, R.
      Pages: 842 - 847
      Abstract: Background: Hindfoot deformity has been described as a risk factor for poor hallux valgus (HV) surgery outcomes. However, there has been no study that demonstrates it. The purpose of this investigation was to evaluate the influence of hindfoot misalignment in HV surgery results. Methods: All patients operated on for HV during 2010 and 2011 at 3 university hospitals were included. The preoperative and 2-year postoperative radiologic data included the HV and the intermetatarsal (IM) angles, the naviculocuboid overlap (NC), the talonavicular coverage (TN) angle, the talus–first metatarsal (T-1MT) angle, as well as the calcaneal pitch (CP) angle. Additionally, the Short Form–36 questionnaire version 2.0 (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) score, satisfaction and recurrence were also analyzed. A total of 207 met the inclusion criteria. There were 26 patients (12.6%) who could not be assessed at the 2-year follow-up. Patients were allocated to a varus, normal, or a valgus hindfoot tertile using the values for the CP, NC, TN, and T-1MT angles. Results: No significant differences (P > .05) were found between the groups when the HV or IM angles, AOFAS, SF-36 Mental Composite Scale, SF-36 Physical Composite Scale, or satisfaction were compared. Similarly, no significant and strong correlations were observed (P > .05, < 0.3) between any of the mentioned hindfoot measures and the outcomes scales. Conclusion: No influence of hindfoot misalignment on HV surgery outcomes was found in the present study in terms of correction, pain, function, satisfaction, or quality of life. Patients with hindfoot misalignment did not obtain worse outcomes in HV surgery. Level of Evidence: Level II, prognostic, comparative study.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716645403
      Issue No: Vol. 37, No. 8 (2016)
  • Motion at the Tibial and Polyethylene Component Interface in a
           Mobile-Bearing Total Ankle Replacement
    • Authors: Lundeen, G. A; Clanton, T. O, Dunaway, L. J, Lu, M.
      Pages: 848 - 854
      Abstract: Background: Normal biomechanics of the ankle joint includes sagittal as well as axial rotation. Current understanding of mobile-bearing motion at the tibial-polyethylene interface in total ankle arthroplasty (TAA) is limited to anterior-posterior (AP) motion of the polyethylene component. The purpose of our study was to define the motion of the polyethylene component in relation to the tibial component in a mobile-bearing TAA in both the sagittal and axial planes in postoperative patients. Methods: Patients who were a minimum of 12 months postoperative from a third-generation mobile-bearing TAA were identified. AP images were saved at maximum internal and external rotation, and the lateral images were saved in maximum plantarflexion and dorsiflexion. Sagittal range of motion and AP translation of the polyethylene component were measured from the lateral images. Axial rotation was determined by measuring the relative position of the 2 wires within the polyethylene component on AP internal and external rotation imaging. This relationship was compared to a table developed from fluoroscopic images taken at standardized degrees of axial rotation of a nonimplanted polyethylene with the associated length relationship of the 2 imbedded wires. Sixteen patients were included in this investigation, 9 (56%) were male and average age was 68 (range, 49-80) years. Time from surgery averaged 25 (range, 12-38) months. Results: Total sagittal range of motion averaged 23±9 (range, 9-33) degrees. Axial motion for total internal and external rotation of the polyethylene component on the tibial component averaged 6±5 (range, 0-18) degrees. AP translation of the polyethylene component relative to the tibial component averaged 1±1 (range, 0-3) mm. There was no relationship between axial rotation or AP translation of the polyethylene component and ankle joint range of motion (P > .05). Conclusion: To our knowledge, this is the first investigation to measure axial and sagittal motion of the polyethylene component at the tibial implant interface in patients following a mobile-bearing TAA. Based on outcome scores and range-of-motion measurements, we believe the patients in this study are a representative cross section of subjects compared to other TAA research results. The results from this investigation indicate the potential for a mobile-bearing TAA to fall within the parameters of normal polyaxial ankle motion. The multiplanar articulation in a mobile-bearing TAA may reduce excessively high peak pressures during the complex dynamic tibial and talar motion, which may have a positive influence on gait pattern, polyethylene wear, and implant longevity. Level of Evidence: Level IV, case series.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716643308
      Issue No: Vol. 37, No. 8 (2016)
  • Comparison of Removable and Irremovable Walking Boot to Total Contact
           Casting in Offloading the Neuropathic Diabetic Foot Ulceration
    • Authors: Piaggesi, A; Goretti, C, Iacopi, E, Clerici, G, Romagnoli, F, Toscanella, F, Vermigli, C.
      Pages: 855 - 861
      Abstract: Background: Despite its efficacy in healing neuropathic diabetic foot ulcers (DFUs), total contact cast (TCC) is often underused because of technical limitations and poor patient acceptance. We compared TCC to irremovable and removable commercially available walking boots for DFU offloading. Methods: We prospectively studied 60 patients with DFUs, randomly assigned to 3 different offloading modalities: TCC (group A), walking boot rendered irremovable (i-RWD; group B), and removable walking boot (RWD; group C). Patients were followed up weekly for 90 days or up to complete re-epithelization; ulcer survival, healing time, and ulcer size reduction (USR) were considered for efficacy, whereas number of adverse events was considered for safety. Patients’ acceptance and costs were also evaluated. Results: Mean healing time in the 3 groups did not differ (P = .5579), and survival analysis showed no difference between the groups (logrank test P = .8270). USR from baseline to the end of follow-up was significant (P < .01) in all groups without differences between the groups. Seven patients in group A (35%), 2 in group B (10%), and 1 in group C (5%) (Fisher exact test P = .0436 group A vs group C) reported nonsevere adverse events. Patients’ acceptance and costs were significantly better in group C (P < .05). Conclusions: Our results suggest that a walking boot was as effective and safe as TCC in offloading the neuropathic DFUs, irrespective of removability. The better acceptability and lesser costs of a removable device may actually extend the possibilities of providing adequate offloading. Level of Evidence: Level II, prospective comparative study.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716643429
      Issue No: Vol. 37, No. 8 (2016)
  • Accessory Navicular Syndrome in Athlete vs General Population
    • Authors: Jegal, H; Park, Y. U, Kim, J. S, Choo, H. S, Seo, Y. U, Lee, K. T.
      Pages: 862 - 867
      Abstract: Background: Symptomatic accessory navicular syndrome (ANS) typically develops in young athletes. The symptoms are exacerbated during exercise or while walking, affecting the sports performance of athletes. The purpose of this study was to evaluate the radiologic findings and clinical course in athletes with accessory navicular syndrome (ANS) in comparison with a nonathletic population. Methods: Seventy-nine patients with ANS between August 2012 and August 2013 were included. Overall, 29 were athletes and 50 were not athletes, and 19 (2 athletes and 17 nonathletes) of them improved after at least 6 months of conservative treatment. The records of 60 patients (64 consecutive feet) of ANS treated by modified Kidner operation were evaluated retrospectively. The study population included 27 athletes (31 feet) and 33 nonathletes (33 feet). Clinical features and radiologic findings were compared between them. Results: Overall, 34% of the nonathletes improved after conservative treatment, but only 6.9% of athletes improved (P < .001). Mean age at surgery in the athlete group was 16.1 years (range, 12-26), and 24.3 years (range, 12-52) in the nonathlete group (P < .001). There was a history of trauma in 23 feet (74%) of the athlete group and in 13 feet (39%) of the nonathlete group (P = .006). Eighteen feet (58%) in the athlete group and 11 feet (32%) in the nonathlete group showed movement between the 2 bones (P = .047). Bone marrow edema was observed in both navicular and accessory navicular in all of the athletes (27/27, 100%). But it was only present in 80% (16/20) for nonathletes (P = .012). Conclusion: The radiologic findings and clinical course of athletes were different from that of the general population. Their symptoms were more refractory to conservative treatment than the nonathletes group. Therefore, early operative treatment could be considered in cases of symptomatic ANS especially for athletes. Level of Evidence: Level III, retrospective comparative case series.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716644791
      Issue No: Vol. 37, No. 8 (2016)
  • Validated Method for Measuring Functional Range of Motion in Patients With
           Ankle Arthritis
    • Authors: Thornton, J; Sabah, S, Segaren, N, Cullen, N, Singh, D, Goldberg, A.
      Pages: 868 - 873
      Abstract: Background: Total range of motion between the tibia and the floor is an important outcome measure following ankle surgery. However, there is wide variation in its measurement: from clinical evaluation, to radiographic metrics, and gait analysis. The purpose of this study was to present and validate a simple, standardized technique for measurement of functional total range of motion between the tibia and the floor using a digital goniometer. Methods: Institutional review board approval was obtained. Forty-six ankles from 33 participants were recruited into 2 groups: Group 1 (healthy controls) comprised 20 ankles from 10 participants. None had any musculoskeletal or neurologic pathology. Group 2 (ankle osteoarthritis) comprised 25 ankles from 23 patients. Ankle pathology had been treated with ankle arthrodesis (n = 5), total ankle replacement (n = 6), and nonoperative treatment (n = 14). Measurement was performed by 2 testers according to a standardized protocol developed for the Total Ankle Replacement Versus Arthrodesis (TARVA) randomized controlled trial. Intra- and interrater reliability was calculated using intraclass correlation coefficients (ICCs). Results: Group 1 (healthy controls): the median difference for all measurements within an observer was 1.5 (interquartile range [IQR] 0.7-2.5) degrees, and the intraclass coefficients (ICCs) for inter- and intrarater total ankle range of motion were excellent: 0.95 (95% confidence interval [CI] 0.91-0.97, P < .001) and 0.942 (95% CI 0.859-0.977, P < .001), respectively. Group 2 (ankle osteoarthritis): the median difference for all measurements within an observer was 0.6 (IQR 0.2-1.3) degrees, and the ICCs for inter- and intrarater total ankle range of motion were excellent: 0.99 (95% CI 0.97-1.0), P < .001) and 0.99 (95% CI 0.96-1.0), P < .001), respectively. Conclusion: This technique provided a reliable, standardized method for measurement of total functional range of motion between the tibia and the floor. The technique required no special equipment or training. It provided a valid functional assessment for patients with or without ankle osteoarthritis, including those who had undergone operative treatment. Level of Evidence: Level II, prospective comparative study.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716645391
      Issue No: Vol. 37, No. 8 (2016)
  • Correlation of Talar Anatomy and Subtalar Joint Alignment on Weightbearing
           Computed Tomography With Radiographic Flatfoot Parameters
    • Authors: Cody, E. A; Williamson, E. R, Burket, J. C, Deland, J. T, Ellis, S. J.
      Pages: 874 - 881
      Abstract: Background: Underlying bony deformity may be related to development of adult-acquired flatfoot deformity (AAFD). Multiplanar weightbearing (MP-WB) computed tomography can be used to identify subtalar deformity which may contribute to valgus hindfoot alignment. On coronal MP-WB images, 2 angles reliably evaluate the subtalar joint axis: the angle between the inferior facet of the talus and the horizontal (inftal-hor) and the angle between the inferior and superior facets of the talus (inftal-suptal). Although these angles have been shown to differ significantly between flatfoot patients and controls, no study has investigated their relationships with other components of AAFD. We hypothesized that these angles would correlate strongly with commonly used radiographic measures of AAFD. Methods: Forty-five patients with stage II AAFD and 17 control patients underwent MP-WB imaging and standard weightbearing radiographs. MP-WB measurements were correlated with standard radiographic measurements of AAFD. Differences between AAFD and control patients were assessed using independent samples t tests and Mann-Whitney U tests. To assess correlations between each MP-WB measurement and radiographic measurement, factorial generalized linear models (GLMs) were constructed. Results: Patients with AAFD differed from the controls in all measured angles (P ≤ .001 for each). After accounting for differences between flatfoot and control patients, inftal-hor was not significantly correlated with any of the radiographic angles. Inftal-suptal, however, correlated with the AP coverage angle, AP talar–first metatarsal angle, calcaneal pitch, Meary’s angle, medial column height, and hindfoot alignment after accounting for differences between flatfoot patients and controls. Meary’s angle alone explained 48% of the variation in inftal-suptal angles. Conclusion: As measured on coronal MP-WB images, patients with stage II AAFD had more innate valgus in their talar anatomy as well as more valgus alignment of their subtalar joints than did control patients. It is possible that this information could be used to identify patients likely to have progression of deformity and may ultimately guide the approach to operative reconstruction. Level of Evidence: Level III, case-control study.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716646629
      Issue No: Vol. 37, No. 8 (2016)
  • Cadaveric Analysis of the Distal Tibiofibular Syndesmosis
    • Authors: Lilyquist, M; Shaw, A, Latz, K, Bogener, J, Wentz, B.
      Pages: 882 - 890
      Abstract: Background: Unstable ankle fractures with syndesmotic injuries commonly occur and can result in significant morbidity. Although the need for an anatomic reduction is clear, there is still debate surrounding the optimal operative treatment. Recent literature shows an increasing interest in anatomic ligament repair or reconstruction in the acute and chronic syndesmosis injury. Despite this trend, there is insufficient literature detailing anatomy of the distal tibiofibular syndesmosis. In the literature that does exist, there is controversy regarding the ligamentous anatomy of the syndesmosis. None of the current literature describes an anatomic constant that may be used as an intraoperative reference for anatomic ligament reconstructions. Methods: Ten sets of tibia and fibula free of all soft tissue were used to analyze osseous structures. Another 10 nonpaired, fresh-frozen specimens were used to study the distal tibiofibular syndesmosis. These were measured using a 3-dimensional tracking system. Measurement of each ligament width at origin and insertion, length, and distance from the tibial articular cartilage was performed. Results: The superior and inferior insertions of the anterior inferior tibiofibular ligament measured 22.7 mm and 3.4 mm proximal to the distal articular cartilage of the tibia, respectively. The superior insertion of the posterior inferior tibiofibular ligament measured 15.2 mm proximal to the articular cartilage. The superior and inferior insertions of the interosseous ligament measured 31.8 mm and 9.2 mm proximal to the distal articular cartilage, respectively. The inferior transverse ligament was a prominent identifiable structure in 70% of specimens. Conclusions: The superior margin of the distal articular cartilage could serve as a consistent anatomic landmark for reconstruction. The inferior transverse ligament is an identifiable structure in 70% of the specimens studied. Clinical Relevance: This article clarifies the anatomy and provides measurements from an anatomic constant that can guide reconstruction and intraoperative evaluation of the syndesmosis.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716643083
      Issue No: Vol. 37, No. 8 (2016)
  • Interlocking Nailing Versus Interlocking Plating in Intra-articular
           Calcaneal Fractures: A Biomechanical Study
    • Pages: 891 - 897
      Abstract: Background: Open reduction and internal fixation with a plate is deemed to represent the gold standard of surgical treatment for displaced intra-articular calcaneal fractures. Standard plate fixation is usually placed through an extended lateral approach with high risk for wound complications. Minimally invasive techniques might avoid wound complications but provide limited construct stability. Therefore, 2 different types of locking nails were developed to allow for minimally invasive technique with sufficient stability. The aim of this study was to quantify primary stability of minimally invasive calcaneal interlocking nail systems in comparison to a variable-angle interlocking plate. Material and Methods: After quantitative CT analysis, a standardized Sanders type IIB fracture model was created in 21 fresh-frozen cadavers. For osteosynthesis, 2 different interlocking nail systems (C-Nail; Medin, Nov. Město n. Moravě, Czech Republic; Calcanail; FH Orthopedics SAS; Heimsbrunn, France) as well as a polyaxial interlocking plate (Rimbus; Intercus GmbH; Rudolstadt, Germany) were used. Biomechanical testing consisted of a dynamic load sequence (preload 20 N, 1000 N up to 2500 N, stepwise increase of 100 N every 100 cycles, 0.5 mm/s) and a load to failure sequence (max. load 5000 N, 0.5 mm/s). Interfragmentary movement was detected via a 3-D optical measurement system. Boehler angle was measured after osteosynthesis and after failure occurred. Results: No significant difference regarding load to failure, stiffness, Boehler angle, or interfragmentary motion was found between the different fixation systems. A significant difference was found with the dynamic failure testing sequence where 87.5% of the Calcanail implants failed in contrast to 14% of the C-Nail group (P < .01) and 66% of the Rimbus plate. The highest load to failure was observed for the C-Nail. Boehler angle showed physiologic range with all implants before and after the biomechanical tests. Conclusion: Both minimally invasive interlocking nail systems displayed a high primary stability that was not inferior to an interlocking plate. Clinical relevance: Based on our results, both interlocking nails appear to represent a viable option for treating displaced intra-articular calcaneal fractures.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716643586
      Issue No: Vol. 37, No. 8 (2016)
  • Variable Volumes of Resected Bone Resulting From Different Total Ankle
           Arthroplasty Systems
    • Authors: Goetz, J. E; Rungprai, C, Tennant, J. N, Huber, E, Uribe, B, Femino, J, Phisitkul, P, Amendola, A.
      Pages: 898 - 904
      Abstract: Background: The increased popularity and success of total ankle arthroplasty (TAA) has resulted in the development of varying TAA hardware designs, many of which include specific bone-sparing or bone-sacrificing features. The goal of this work was to determine differences in the volume of bone removed for implantation of different total ankle arthroplasty hardware systems. Methods: Sixteen cadaveric specimens were computed tomography–scanned preoperatively and after total ankle arthroplasty using either an INBONE II, Salto Talaris, STAR, or Zimmer TMTA implant. Geometries of the talus and the distal tibia were manually segmented and converted to 3D bony surface models. The volume of bone removed for each implant was calculated as the difference in volume between the preoperative and postoperative bone models. To account for differences in specimen size, volume was expressed as a percentage of the intact bone. Results: There was a significant difference (P = .049) in the average percent of talar bone removed, with the STAR and INBONE II systems requiring removal of greater volumes of bone. The INBONE II system required significantly (P < .004) more tibial bone resection than the other 3 implants when evaluating a long span of the distal tibia. However, most of this increased bone resection was medullary bone. Close to the articular surface, bone volumes removed for the various tibial components were not significantly different (P = .056). Conclusion: Volume and location of bone removed for different implant systems varied with implant design. Clinical Relevance: Primary bone resection associated with different implant hardware systems varied more on the talar side of the articulation, and the stemmed prosthesis did not result in dramatic increases in periarticular bone resection. Clinicians should weigh the effects of greater or lesser bone resection associated with various implant designs against other factors used for hardware selection.
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716645404
      Issue No: Vol. 37, No. 8 (2016)
  • Isolated Talonavicular Arthrodesis
    • Authors: Ma, S; Jin, D.
      Pages: 905 - 908
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716641731
      Issue No: Vol. 37, No. 8 (2016)
  • Personal Responsibility
    • Authors: Pedowitz; W. J.
      Pages: 909 - 909
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716634349
      Issue No: Vol. 37, No. 8 (2016)
  • Education Calendar
    • Pages: 910 - 910
      PubDate: 2016-08-01T17:11:45-07:00
      DOI: 10.1177/1071100716661548
      Issue No: Vol. 37, No. 8 (2016)
School of Mathematical and Computer Sciences
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