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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  [839 journals]
  • Prospective, Randomized, Multi-centered Clinical Trial Assessing Safety
           and Efficacy of a Synthetic Cartilage Implant Versus First
           Metatarsophalangeal Arthrodesis in Advanced Hallux Rigidus
    • Authors: Baumhauer; J. F., Singh, D., Glazebrook, M., Blundell, C., De Vries, G., Le, I. L. D., Nielsen, D., Pedersen, M. E., Sakellariou, A., Solan, M., Wansbrough, G., Younger, A. S. E., Daniels, T., for on behalf of the CARTIVA Motion Study Group
      Pages: 457 - 469
      Abstract: Background: Although a variety of great toe implants have been tried in an attempt to maintain toe motion, the majority have failed with loosening, malalignment/dislocation, implant fragmentation and bone loss. In these cases, salvage to arthrodesis is more complicated and results in shortening of the ray or requires structural bone graft to reestablish length. This prospective study compared the efficacy and safety of this small (8/10 mm) hydrogel implant to the gold standard of a great toe arthrodesis for advanced-stage hallux rigidus. Methods: In this prospective, randomized non-inferiority study, patients from 12 centers in Canada and the United Kingdom were randomized (2:1) to a synthetic cartilage implant or first metatarsophalangeal (MTP) joint arthrodesis. VAS pain scale, validated outcome measures (Foot and Ankle Ability Measure [FAAM] sport scale), great toe active dorsiflexion motion, secondary procedures, radiographic assessment, and safety parameters were evaluated. Analysis was performed using intent-to-treat (ITT) and modified ITT (mITT) methodology. The primary endpoint for the study consisted of a single composite endpoint using the 3 primary study outcomes (pain, function, and safety). The individual subject’s outcome was considered a success if all of the following criteria were met: (1) improvement (decrease) from baseline in VAS pain of ≥30% at 12 months; (2) maintenance of function from baseline in FAAM sports subscore at 12 months; and (3) absence of major safety events at 2 years. The proportion of successes in each group was determined and 1-sided 95% confidence interval for the difference between treatment groups was calculated. Noninferiority of the implant to arthrodesis was considered statistically significant if the 1-sided 95% lower confidence interval was greater than the equivalence limit (
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100716635560
      Issue No: Vol. 37, No. 5 (2016)
  • Prospective Randomized Evaluation of Intraoperative Application of
           Autologous Platelet-Rich Plasma on Surgical Site Infection or Delayed
           Wound Healing
    • Authors: SanGiovanni, T. P; Kiebzak, G. M.
      Pages: 470 - 477
      Abstract: Background: Prevention of surgical site infections and the reduction of wound-related complication rates have become increasingly emphasized by hospital task groups and government agencies given the degree of economic burden it places on the health care system. Platelet-rich plasma (PRP) contains growth factors and other biomolecules that promote endogenous microbicidal activity. We hypothesized that PRP would help prevent postoperative infection and delayed wound healing (DWH). Methods: We randomized patients having foot or ankle surgery to the treatment group receiving intraoperative PRP (applied to operative field) and platelet-poor plasma at closing (PPP, on the sutured skin) or the control group (no PRP/PPP). The incidence of deep surgical site infection and DWH (collectively called endpoints) was compared between groups (n = 250/group). PRP had a mean 5.3-fold platelet concentration compared to whole blood, with concentrated white blood cells. Mean age (±SD) of patients was 52 years (±15), 65% were women. Minor and major operative procedures were included. Patients were followed for 60 days. Seventy controls had PRP prepared for assay of growth factors. Procedure mix, ASA scores, mean operative times, and comorbidity mix were similar between groups. Results: The primary result was no difference in number of endpoints between groups: 19 patients in the PRP group (7.6%) versus 18 controls (7.2%). Endpoints were deep surgical site infections in 2 PRP/PPP patients and 1 control, and DWH in 17 PRP/PPP patients and 17 controls. Analysis of PRP samples revealed a large variation in growth factor concentrations between patients. Conclusions: Intraoperative application of PRP/PPP did not reduce the incidence of postoperative infection or DWH. Growth factor profiles varied greatly between patients, suggesting that the potentially therapeutic treatment delivered was not consistent from patient-to-patient. Level of Evidence: Level I, prospective randomized trial.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715623994
      Issue No: Vol. 37, No. 5 (2016)
  • Randomized, Prospective Study of the Order of Preoperative Preparation
           Solutions for Patients Undergoing Foot and Ankle Orthopedic Surgery
    • Authors: Hunter, J. G; Dawson, L. K, Soin, S. P, Baumhauer, J. F.
      Pages: 478 - 482
      Abstract: Background: Surgical site infection is routinely cited as the most common complication following orthopedic foot and ankle surgery. Our institution uses 4% chlorhexidine gluconate followed by 70% isopropyl alcohol to reduce skin bacterial loads prior to surgery. These solutions have potential synergistic qualities to prevent a postoperative infection. The purpose of this study was to determine if the order of these solutions has a significant effect on the residual bacterial pathogens load following operative site preparation for foot and ankle surgery, as evidenced by positive culture swabs. Methods: A total of 95 consecutive patients, undergoing surgery of the foot and ankle with a single surgeon, were prospectively randomized to 1 of 2 operative preparation groups: isopropyl alcohol (IPA) group, whose operative site preparation consisted of a 4% chlorhexidine application followed by alcohol rinse (49 patients), and chlorhexidine gluconate (CHG) group, which had 46 patients undergo operative site preparation using alcohol followed by chlorhexidine. A total of 4 aerobic culture specimens were obtained from the third web space of the operative foot on each patient: (1) prior to operative site preparation, (2) after the prep was completed, (3) after completion of the procedure, and (4) after the incision was closed. Each patient was then followed for 6 months postoperatively to monitor the operative site. Medical comorbidities were also analyzed. Results: The average time for IPA procedures was 52 minutes vs 54 for CHG (ns). There was no difference between groups with respect to diabetes, tobacco use, obesity, race, or immunosuppression. Both groups had 100% bacterial growth from specimens obtained prior to operative site preparation (P > .05). For all postpreparation swabs, 19.0% (28/147) of the IPA cultures were positive compared to 10.9% (15/138) from the CHG group cultures (P = .07). The amount of patients with positive culture results favored the CHG group at each collection point: 6.5% (3/46) versus 25% (12/49) after draping (P = .02); 15% (7/46) versus 33% (16/49) after completion of the surgery (P = .05); and 20% (9/46) versus 35% (17/49) after skin closure (P = .07). One operative site infection was seen in the first 30 days following surgery for each treatment group, each treated with oral antibiotics. No additional skin or wound complications were encountered during the 6-month study follow-up. Conclusion: Postoperative infection rates following foot and ankle orthopedic surgery was low. Both chlorhexidine and isopropyl alcohol solutions were effective methods in reducing operative site bacterial colonization when combined. In this study, applying isopropyl alcohol solution followed by the chlorhexidine solution was more effective in reducing positive bacterial cultures taken after operative site preparation. No difference in clinical wound infection rate was seen. Level of Evidence: Level I, prospective randomized study.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715623037
      Issue No: Vol. 37, No. 5 (2016)
  • Effect of Obesity on Outcomes of Forefoot Surgery
    • Authors: Stewart, M. S; Bettin, C. C, Ramsey, M. T, Ishikawa, S. N, Murphy, G. A, Richardson, D. R, Tolley, E. A.
      Pages: 483 - 487
      Abstract: Background: Forefoot surgery typically is elective, so it is important to define risk factors to educate patients on potential complications. The purpose of this study was to determine if obesity is an independent risk factor that contributes to increased complication rates after forefoot surgery. Methods: Through a retrospective review of records, 633 patients were identified who had forefoot surgery at one institution between 2008 and 2010. All patients who currently smoked or smoked in the past were excluded to eliminate a confounding factor, as smoking is known to increase complication rates, leaving 427 patients for inclusion, 299 nonobese (BMI less than 30) and 128 obese (BMI more than 30). Medical records were reviewed for the occurrence of complications, including nonunion, delayed union, delayed wound healing, infection, and persistent pain. Results: The overall complication rate was 9%, with similar rates between obese (10%) and nonobese patients (9%). The only specific complication approaching significance (P = .13) was a higher rate of infection in obese patients (4 % compared to 1%), which could be attributed to the higher percentage of diabetic patients in the obese group. Diabetic patients, regardless of weight, had significantly higher rates of infection (P = .03), with a trend toward higher rates of overall complications and delayed wound healing (P = .08 and P < .06, respectively). Conclusion: Obesity was not shown to lead to more frequent complications after forefoot surgery. Diabetes was associated with significantly higher rates of infection, regardless of weight. Though not significant, there was a trend toward higher rates of overall complications and delayed wound healing in diabetic patients as well. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715624209
      Issue No: Vol. 37, No. 5 (2016)
  • Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III)
           in the NBA
    • Authors: OMalley, M; DeSandis, B, Allen, A, Levitsky, M, OMalley, Q, Williams, R.
      Pages: 488 - 500
      Abstract: Background: Proximal fractures of the fifth metatarsal (zone II and III) are common in the elite athlete and can be difficult to treat because of a tendency toward delayed union, nonunion, or refracture. The purpose of this case series was to report our experience in treating 10 NBA players, determine the healing rate, return to play, refracture rate, and role of foot type in these athletes. Methods: The records of 10 professional basketball players were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) whereas the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features evaluated included fourth-fifth intermetatarsal, fifth metatarsal lateral deviation, calcaneal pitch, and metatarsus adductus angles. Results: Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. There were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest metatatarsus adductus angles. Most athletes were pes planus and 9 of 10 had a bony prominence under the fifth metatarsal styloid. Conclusion: This is the largest published series of operatively treated professional basketball players who exemplify a specific patient population at high risk for fifth metatarsal fracture. These players were large and possessed a unique foot type that seemed to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type had forefoot metatarsus adductus and a fifth metatarsal that was curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high fourth-to-fifth intermetatarsal, fifth metatarsal lateral deviation, and metatarsus adductus angles as well as prominent fifth metatarsal styloids in order to improve fracture healing and potentially decrease the risk of refracture. Level of Evidence: Level IV, case series.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715625290
      Issue No: Vol. 37, No. 5 (2016)
  • Operative Treatment of Acute Fractures of the Tarsal Navicular Body:
           Midterm Results With a New Classification
    • Authors: Schmid, T; Krause, F, Gebel, P, Weber, M.
      Pages: 501 - 507
      Abstract: Background: Treatment of displaced tarsal navicular body fractures usually consists of open reduction and internal fixation. However, there is little literature reporting results of this treatment and correlation to fracture severity. Methods: We report the results of 24 patients treated in our institution over a 12-year period. Primary outcome measurements were Visual-Analogue-Scale Foot and Ankle score (VAS-FA), AOFAS midfoot score, and talonavicular osteoarthritis at final follow-up. According to a new classification system reflecting talonavicular joint damage, 2-part fractures were classified as type I, multifragmentary fractures as type II, and fractures with talonavicular joint dislocation and/or concomitant talar head fractures as type III. Spearman’s coefficients tested this classification’s correlation with the primary outcome measurements. Mean patient age was 33 (range 16-61) years and mean follow-up duration 73 (range 24-159) months. Results: Average VAS-FA score was 74.7 (standard deviation [SD] 16.9), and average AOFAS midfoot score was 83.8 (SD = 12.8). Final radiographs showed no talonavicular arthritis in 5 patients, grade 1 in 7, grade 2 in 3, grade 3 in 6, and grade 4 in 1 patient. Two patients had secondary or spontaneous talonavicular fusion. Spearman coefficients showed strong correlation of the classification system with VAS-FA score (r = –0.663, P < .005) and talonavicular arthritis (r = 0.600, P = .003), and moderate correlation with AOFAS score (r = –.509, P = .011). Conclusion: At midterm follow-up, open reduction and internal fixation of navicular body fractures led to good clinical outcome but was closely related to fracture severity. A new classification based on the degree of talonavicular joint damage showed close correlation to clinical and radiologic outcome. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715624208
      Issue No: Vol. 37, No. 5 (2016)
  • Radiographic Correction Following Reconstruction of Adult Acquired Flat
           Foot Deformity Using the Cotton Medial Cuneiform Osteotomy
    • Authors: Aiyer, A; Dall, G. F, Shub, J, Myerson, M. S.
      Pages: 508 - 513
      Abstract: Background: The Cotton osteotomy has been used to correct residual forefoot supination in flexible flatfoot deformity reconstruction. The purpose of this study was to delineate the radiographic effects of the Cotton osteotomy by controlling for concomitant procedures used for deformity correction. Methods: We retrospectively analyzed 67 patients who underwent a Cotton osteotomy as part of a flatfoot reconstructive procedure. We evaluated 12 radiographic parameters including the articular surface angles of the foot, Meary angle, and a newly defined medial arch sag angle (MASA). Twenty-eight of these patients were matched to a cohort that did not undergo a Cotton osteotomy. Results: In all patients who underwent a Cotton osteotomy, there were statistically significant changes in the articular surface angles and medial arch height (P < .05). No radiographic secondary sag of the medial column was seen at final follow-up. Compared to 28 matched controls, the Cotton osteotomy did not improve Meary angle but provided an additional 6.5 degrees correction of the MASA (P = .002). After reliability testing, the intraclass correlation coefficient was found to be substantial for the MASA compared to Meary angle. Discussion: The data suggest that the MASA was a useful radiographic tool for assessing midfoot collapse in the setting of pes planovalgus. The current study demonstrated the corrective capacity of the Cotton osteotomy on the MASA; at final follow-up, there was no evidence of radiographic instability. This is suggestive that a naviculocuneiform arthrodesis may not be warranted for medial column stabilization in the setting of flatfoot reconstruction. Level of Evidence: Level III, case control study.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715620894
      Issue No: Vol. 37, No. 5 (2016)
  • Muscle and Joint Factors Associated With Forefoot Deformity in the
           Diabetic Neuropathic Foot
    • Authors: Cheuy, V. A; Hastings, M. K, Commean, P. K, Mueller, M. J.
      Pages: 514 - 521
      Abstract: Background: Diabetic forefoot joint deformities are a known risk factor for skin breakdown and amputation, but the causes of deformity are not well understood. The purposes of this study were to determine the effects of intrinsic foot muscle deterioration and limited ankle joint mobility on the severity of metatarsophalangeal joint (MTPJ) deformity, and determine the relationships between these potential contributing factors and indicators of diabetic complications (peripheral neuropathy and advanced glycation end products). Methods: A total of 34 participants with diabetic neuropathy (average age, 59 years; range 41-73) were studied. MTPJ angle and intrinsic foot muscle deterioration were measured with computed tomography and magnetic resonance imaging, respectively. Maximum ankle dorsiflexion was measured using kinematics. Skin intrinsic fluorescence served as a proxy measure for advanced glycation end product accumulation. Results: Total forefoot lean muscle volume (r = –0.52, P < .01) and maximum ankle dorsiflexion (r = –0.42, P < .05) were correlated with severity of MTPJ deformity. Together they explained 35% of the variance of MTPJ angle. Neuropathy was correlated with forefoot muscle deterioration ( = 0.53, P < .01). Skin intrinsic fluorescence was correlated to severity of neuropathy (r = 0.50, P < .01) but not maximum ankle dorsiflexion, or forefoot deterioration when controlling for neuropathy. Conclusion: These results suggest that the interplay of intrinsic foot muscle deterioration and limited ankle mobility may be the primary contributor to the development of MTPJ deformity. Identifying these muscle and ankle motion impairments as risk factors for MTPJ deformity supports the need for targeted interventions early in the disease process to slow, or possibly stop the progression of deformity over time and reduce the risk of amputation. Level of Evidence: Level IV, case series.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715621544
      Issue No: Vol. 37, No. 5 (2016)
  • Soft Tissue Reconstruction After Total Ankle Arthroplasty
    • Authors: Gross, C. E; Garcia, R, Adams, S. B, DeOrio, J. K, Easley, M. E, Nunley, J. A.
      Pages: 522 - 527
      Abstract: Background: Wound complications following total ankle replacement (TAR) may potentially lead to devastating consequences. Soft tissue coverage of the prosthesis and tendons with a flap potentially prevent a catastrophic cascade leading to infection and implant failure. The aim of this study was to investigate the success and complications of flaps following soft tissue defects as a result of total ankle arthroplasty. Methods: We retrospectively identified a consecutive series of 1001 primary TARs performed between January 1998 and December 2014 whose data were prospectively collected. We then identified patients who required a secondary surgery to treat soft tissue defects that were not amenable to split-thickness skin grafting. Clinical outcomes including secondary procedures, wound healing failure, complications, and implant failure rate were recorded. Nineteen patients had a total of 44 operative procedures to treat wound issues (1.9% of all prostheses). The follow-up time from the flap procedure is 24.1 months. Results: More than two-thirds (13/19) of patients had 1 or more previous surgeries on the ankle, for an average of 1.2 procedures. The mean time to the flap procedure was 13.1 weeks after the index TAR. The most common reason for flap coverage was a non-healing anterior wound. Thirteen of 19 patients (68.4%) underwent formal operative wound exploration and debridement prior to their definitive flap coverage. The average size of the wound was 5.4 x 3.8 cm with an average area of 24.9 cm2. The most common type of flap performed was a sural pedicle flap followed by a propeller flap. There were 4 flap failures (21.1%), with 2 subsequent below-the-knee amputations. No TAR patients developed a deep infection following a flap unless they had a preexisting infection. In patients who had a successful flap, there were significant improvements in their American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, visual analog scale (VAS), and Short Musculoskeletal Function Assessment bother index, but not their Short Form-36 scores. Conclusion: Ankle wounds that occur after TAR can result in a devastating outcome, but management with a coordinated effort with surgeons with microvascular experience can help achieve salvage of the prosthesis. A variety of flap reconstruction options are available and should be employed to improve the rate of implant survival and retention. Level of Evidence: Level IV, case series.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715624206
      Issue No: Vol. 37, No. 5 (2016)
  • Multiplanar CT Analysis of Fifth Metatarsal Morphology: Implications for
           Operative Management of Zone II Fractures
    • Authors: DeSandis, B; Murphy, C, Rosenbaum, A, Levitsky, M, OMalley, Q, Konin, G, Drakos, M.
      Pages: 528 - 536
      Abstract: Background: Percutaneous internal fixation is currently the method of choice treating proximal zone II fifth metatarsal fractures. Complications have been reported due to poor screw placement and inadequate screw sizing. The purpose of this study was to define the morphology of the fifth metatarsal to help guide surgeons in selecting the appropriate screw size preoperatively. Methods: Multiplanar analysis of fifth metatarsal morphology was completed using computed tomographic (CT) scans from 241 patients. Specific parameters were analyzed and defined in anteroposterior (AP), lateral, and oblique views including metatarsal length, distance from the base to apex of curvature, apex medullary canal width, apex height, and fifth metatarsal angle. Results: The average metatarsal length in the AP view was 71.4 ± 6.1 mm and in the lateral view 70.4 ± 6.0 mm, with 95% of patients having lengths between 59.3 and 83.5 mm and 58.4 and 82.4 mm, respectively. The average canal width at the apex of curvature was 4.1 ± 0.9 mm in the AP view and 5.3 ± 1.1 mm in the lateral view, with 95% of patients having widths between 2.2 and 5.9 mm and 3.2 and 7.5 mm, respectively. Average distance from apex to base was 42.6 ± 5.8 mm in the AP and 40.4 ± 6.4 mm in the lateral views. Every measurement taken in all 3 views had a significant correlation with height. Conclusions: When determining screw length, we believe lateral radiographs should be used since the distance from the base of the metatarsal to the apex was smaller in the lateral view. On average, the screw should be 40 mm or less to reduce risk of distraction. For screw diameter, the AP view should be used because canal shape is elliptical, and width was found to be significantly smaller in the AP view. Most canals can accommodate a 4.0- or 4.5-mm-diameter screw, and one should use the largest diameter screw possible. Larger individuals were likely to have more bowing in their metatarsal shaft, which may lead to a higher tendency to distract. Level of Evidence: Level III, comparative series.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715623041
      Issue No: Vol. 37, No. 5 (2016)
  • Accurate Measurement of First Metatarsophalangeal Range of Motion in
           Patients With Hallux Rigidus
    • Authors: Vulcano, E; Tracey, J. A, Myerson, M. S.
      Pages: 537 - 541
      Abstract: Background: The reliability of range of motion (ROM) measurements has not been established for the hallux metatarsophalangeal (MTP) joint in patients with hallux rigidus. The aim of the present study was to prospectively assess the clinical versus radiographic difference in ROM of the arthritic hallux MTP joint. Method: One hundred consecutive patients who presented with any grade of hallux rigidus were included in this prospective study to determine the hallux MTP range of motion. Clinical range of motion using a goniometer and radiographic range of motion on dynamic x-rays was recorded. Results: The mean difference between clinical and radiographic dorsiflexion was 13 degrees (P < .001). For all measurements, clinical dorsiflexion was equal to or less than radiographically measured dorsiflexion. The difference was significantly greater in patients with a clinical dorsiflexion of less than 30 degrees than in patients with 30 degrees or more. Radiographic measurement of hallux dorsiflexion had an excellent intra- and interobserver reliability. Conclusion: We describe a reliable, reproducible, and straightforward method of measuring hallux MTP ROM that improved upon measuring clinical ROM. Level of Evidence: Level II, prospective comparative study.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715621508
      Issue No: Vol. 37, No. 5 (2016)
  • Radiographic Indicators of Surgery and Functional Outcome in
           Ponseti-Treated Clubfeet
    • Authors: Shabtai, L; Hemo, Y, Yavor, A, Gigi, R, Wientroub, S, Segev, E.
      Pages: 542 - 547
      Abstract: Background: Evaluation of the results of treatment for clubfoot by the Ponseti technique is based on clinical and functional parameters. There is a need to establish universally recognized quantitative measurements to compare, better understand, and more precisely evaluate therapeutic outcome. Methods: Nine angles were measured on standard radiographs of 145 children with idiopathic clubfeet treated between 2000 and 2010 with the Ponseti method. The average follow-up was 6.3 years. The need for additional surgery and the functional outcome was correlated to the radiologic measurements. Results: Three radiologic parameters were identified as having significant (P ≤ .001) predictive value. The lateral tibiocalcaneal angle with the ankle at maximal dorsiflexion measuring fixed equinus was larger in the preoperated group (77 ± 12 degrees) compared to the nonoperated group (67 ± 14 degrees). Functional outcome was better with smaller angles. The lateral talocalcaneal angle with the ankle at maximal dorsiflexion measuring hindfoot rigidity was smaller (29 ± 8 degrees) in the preoperated group compared to the nonoperated group (35 ± 9 degrees). Functional outcome was better with larger angles. The lateral talo-first metatarsal angle with the ankle at maximal plantarflexion measuring foot cavus was larger in the preoperated group (31 ± 10 degrees) compared to the nonoperated group (22 ± 11 degrees), whereas functional outcome did not correlate with this angle. Conclusions: The lateral view with the foot in maximal dorsiflexion was found to be the most significant and useful view to detect abnormality in Ponseti-treated clubfeet. In our practice now, we are using only this view in order to reduce the radiation exposure to the child. Level of Evidence: Level III, retrospective case series.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715623036
      Issue No: Vol. 37, No. 5 (2016)
  • Torsional Failure of Carbon Fiber Composite Plates Versus Stainless Steel
           Plates for Comminuted Distal Fibula Fractures
    • Authors: Wilson, W. K; Morris, R. P, Ward, A. J, Carayannopoulos, N. L, Panchbhavi, V. K.
      Pages: 548 - 553
      Abstract: Background: Carbon fiber composite implants are gaining popularity in orthopedics, but with few independent studies of their failure characteristics under supra-physiologic loads. The objective of this cadaveric study was to compare torsional failure properties of bridge plating a comminuted distal fibula fracture with carbon fiber polyetheretherketone (PEEK) composite and stainless steel one-third tubular plates. Methods: Comminuted fractures were simulated in 12 matched pairs of fresh-frozen human fibulas with 2-mm osteotomies located 3 cm proximal to the tibiotalar joint. Each fibula pair was randomized for fixation and implanted with carbon fiber and stainless steel 5-hole one-third tubular plates. The constructs were loaded in external rotation at a rate of 1-degree/sec until failure with a materials testing system. Torsional stiffness and mode of failure, as well as displacement, torque, and energy absorption for the first instance of failure and peak failure, were determined. Statistical analysis was performed with paired t tests and chi-square. Results: There were no significant differences among the 12 pairs for torsional stiffness, first failure torque, peak failure displacement, peak failure torque, or peak failure energy. Stainless steel plates exhibited significantly higher displacement (P < .001) and energy absorption (P = .001) at the first indication of failure than the carbon fiber plates. Stainless steel plates permanently deformed significantly more often than the carbon fiber plates (P = .035). Carbon fiber plates exhibited no plastic deformation with delamination of the composite, and brittle catastrophic failure in 1 specimen. Conclusions: In a comminuted human fibula fracture fixation model, carbon fiber implants exhibited multiple pre-peak failures at significantly lower angles than the first failure for the stainless steel implants, with some delamination of composite layers and brittle catastrophic failure rather than plastic deformation. Clinical relevance: The torsional failure properties of carbon fiber composite one-third tubular plates determined in this independent study provide novel in vitro data for this alternative implant material.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715625291
      Issue No: Vol. 37, No. 5 (2016)
  • Arthroscopically Assisted Versus Standard Open Reduction and Internal
           Fixation Techniques for the Acute Ankle Fracture
    • Authors: Gonzalez, T. A; Macaulay, A. A, Ehrlichman, L. K, Drummond, R, Mittal, V, DiGiovanni, C. W.
      Pages: 554 - 562
      Abstract: Background: Ankle fractures represent one of the most common orthopaedic injuries requiring operative treatment. Although open reduction and internal fixation (ORIF) of ankle fractures leads to good results in most patients, poor functional outcomes continue to be reported in some patients for whom anatomic reduction was achieved. It has been theorized that these lesser outcomes may in part be due to a component of missed intra-articular injury that reportedly ranges between 20% and 79%, although to date the true explanation for this subset of lower functional outcomes remains unknown. Such concerns have recently spawned novel techniques of arthroscopically assisted ankle fracture assessment in hopes of enabling better detection and treatment of concomitant intra-articular ankle injuries. The purpose of this systematic review was to summarize the literature comparing standard ORIF to arthroscopically assisted ORIF (AAORIF) for ankle fractures. Methods: A systematic review of the English literature was performed using the PubMed database to access all studies over the last 50 years that have documented the functional outcomes of acute ankle fracture management using either a traditional ORIF or an AAORIF technique in the adult population. Relevant publications were analyzed for their respective Levels of Evidence as well as any perceived differences reported in operative time, outcomes, and complications. Results: A total of only 14 ORIF and 4 AAORIF papers fit the criteria for review. There is fair quality (grade B) evidence to support good to excellent outcomes following traditional ORIF of malleolar fractures. There is fair-quality (grade B) evidence that ankle arthroscopy can be successfully employed for identification and treatment of intra-articular injuries associated with acute ankle fractures, but insufficient (grade I) evidence examining the functional outcomes and complication rates after treatment of these injuries and little documentation that this approach portends any improvement in patient outcome over historical techniques. There is also insufficient (grade I) evidence from 2 prospective randomized studies and 1 case-control study to provide any direct comparative data on functional outcomes, complication rates or total operative time between AAORIF and ORIF for the treatment of acute ankle fractures. Conclusions: Ankle arthroscopy is a valuable tool in identifying and treating intra-articular lesions associated with ankle fractures. The presence of such intra-articular pathology may lead to the unexpectedly poor outcomes seen in some patients who undergo surgical fixation of ankle fractures with otherwise anatomic reduction on postoperative radiographs; the ability to diagnose and address these lesions therefore has the potential to improve patient outcomes. To date, however, currently available literature has not shown that treatment of these intra-articular injuries provides any improvement in outcomes over standard ORIF, and few prospective randomized controlled studies have been performed comparing these 2 operative techniques—rendering any suggestion that AAORIF improves clinical outcomes over traditional ORIF difficult to justify. Further research is indicated for what may be a potentially promising surgical adjunct before we can advocate its routine use in these patients. Level of Evidence: Level II, systematic review.
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715620455
      Issue No: Vol. 37, No. 5 (2016)
  • Alphabet Soup
    • Authors: Pinzur; M. S.
      Pages: 563 - 564
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100715608786
      Issue No: Vol. 37, No. 5 (2016)
  • Corrigendum
    • Pages: 565 - 565
      Abstract: Jung KJ, Chung CY, Park MS, Chung MK, Lee DY, Koo S, Lee KM. Concomitant ankle injuries associated with tibial shaft fractures. Foot Ankle Int. 2015;36(10):1209-1214. (Original
      DOI : 10.1177/1071100715588381)
      PubDate: 2016-05-03T16:20:03-07:00
      Issue No: Vol. 37, No. 5 (2016)
  • Education Calendar
    • Pages: 566 - 566
      PubDate: 2016-05-03T16:20:03-07:00
      DOI: 10.1177/1071100716646780
      Issue No: Vol. 37, No. 5 (2016)
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