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Ankle arthrodesis (AA) provides reliable pain relief, good patient satisfaction scores, and improved overall function. However, this procedure has been associated with numerous complications and sequelae, such as pseudoarthrosis, malunion, gait abnormalities, increased demand on surrounding joints, and a long period of convalescence. Conversion to total ankle arthroplasty (TAA) is a potential option in the management of these complex and challenging situations. The purpose of this study is to investigate the outcomes of AA conversion to TAA. A systematic review of electronic databases was performed. Six studies involving 172 ankles met inclusion criteria. The weighted mean preoperative Visual Analogue Scale (VAS) score at the time of TAA conversion was 7.8 and the weighted mean postoperative VAS score at the time of final follow-up was 2.5. The weighted mean preoperative AOFAS score at the time of TAA conversion was 32 and the weighted mean postoperative AOFAS score at the time of final follow-up was 72.4. The rate of salvage tibiotalocalcaneal arthrodesis was 2.3% and rate of transtibial amputation was also 2.3% after attempted conversion from initial AA to TAA. Conversion of AA to TAA appears to be a viable option to improve patient outcomes and prevent extensive hindfoot arthrodesis and transtibial amputation. More prospective studies with consistent reporting of outcomes, complications, and revision rates with long-term follow-up are needed. [ABSTRACT FROM AUTHOR]

Since the inception of the first surgical training system by Sir William Stewart Halsted, resident surgical skill development has been promulgated in teaching hospitals. Currently, the Council on Podiatric Medical Education does not mandate the availability of a cadaver lab as a residency curriculum requirement. The purpose of the present study is to assess the structure of the cadaver lab and availability in the current podiatric surgical training programs. A survey was sent electronically to 229 American Association of Colleges of Podiatric Medicine – approved residency programs, excluding OhioHealth, across all residency programs. A total of 173 (6.9%) residents from 74 (32.3%) residency programs completed the survey. This survey analyzed the characteristics and perception of the current state of cadaver lab in podiatric residency. The most reported type of cadaver labs available were medical company sponsored and hospital sponsored. Other hands-on training, including inanimate simulators (n = 24) and animal models (n = 5), was also reported. Overall, 87.9% of the surveyed residents found that cadaver lab is either extremely beneficial (57.8%) or somewhat beneficial (30.1%). The most important factors perceived in a successful cadaver lab were faculty instruction (n = 78), accessibility of lab (n = 46), and availability of instrumentation/hardware (n = 26). This qualitative survey is the first study to address the uniformity, perception, and potential value of the cadaver lab in a podiatric surgical residency. [ABSTRACT FROM AUTHOR]

Naviculocuneiform (NC) joint arthrodesis is an effective procedure to treat pain and provide stability to the medial column. Various forms of fixation have been described for NC arthrodesis. Despite this, the available literature is scant and questions remain regarding nonunion rate and contributory factors. A systematic review of the literature was undertaken to determine the rate of nonunion for NC joint arthrodesis. Seven studies involving 139 NC joint arthrodeses met inclusion criteria. The nonunion rate was 6.5% at a weighted mean follow-up of 73.2 months. There is insufficient evidence to provide a practice guideline based on the current literature. Adequately powered prospective clinical trials comparing well-matched patient groups with long-term follow-up are required to limit systematic error and enhance external validity. Specific outcomes measures should include union, functional assessment, complications, and cost-benefit analysis. [ABSTRACT FROM AUTHOR]

Hallux interphalangeal joint arthrodesis is an effective procedure to treat pain and provide stability and is often performed for intrinsic pain to the hallux interphalangeal joint. Additionally, this procedure is typically used in concert with the Jones tenosuspension. Although this as an accepted technique, the available data are scant, and questions remain regarding nonunion rates and contributory factors to poor healing. A systematic review of the reported data were undertaken to determine the rate of nonunion for hallux interphalangeal joint arthrodesis. Seven studies involving 313 hallux interphalangeal joint arthrodeses met the inclusion criteria. The nonunion rate was 28.3% at a weighted mean follow-up period of 8.4 months. The overall complication rate was 33.0%. Considering the increased rate of complications and nonunion rate for this commonly used procedure, additional prospective comparative analyses are needed regarding this topic to identify important patient demographic data and determine superior fixation constructs. [ABSTRACT FROM AUTHOR]

Abstract: Restoration of dysregulated bone homeostasis is a therapeutic goal in many diseases including osteoporosis, rheumatoid arthritis and metastatic cancer. The molecular pathways regulating bone remodeling are major therapeutic targets, and studies continue to reveal endogenous factors that may be pathologically up- or down-regulated and lead to an uncoupling of bone formation and resorption. The purpose of this commentary is to highlight new mechanisms of bone homeostatic regulation mediated through the induction of endogenous interferon-β (IFN-β). The receptor activator of nuclear factor-κB (RANK) ligand (RANKL) is an important factor in the bone resorption cascade, and the RANK–RANKL interaction has been shown to induce IFN-β and osteoclastogenesis via induction of the c-fos gene. Subsequent binding of IFN-β to its biological receptor initiates a signal transduction cascade through the classic JAK/STAT pathway, causing an inhibition of c-fos protein production and osteoclast proliferation and differentiation (negative feedback). Another mechanism pertinent to the anti-resorptive effect of IFN-β is the induction of nitric oxide which has been shown to inhibit osteoclast formation. The role of IFN-β in bone metabolism could warrant its systematic evaluation as a potential adjunct to therapeutic regimens of osteolytic diseases. Here we also provide discussion of the potential challenges to optimizing IFN-β pharmacotherapy for such purposes. [Copyright &y& Elsevier]

Objectives: To compare the ultrasound bladder volume accuracy and level of agreement between two portable bladder scanners (Bladderscan and Bardscan) and a three-dimensional ultrasound (3D-US) system. Methods: A total of 50 healthy volunteers were scanned using the Bladderscan BVI 3000, Bardscan, and 3D-US system (HDI 4000), in random sequence. The BVI3000 is a dedicated bladder volume calculator, and the Bardscan combines real-time ultrasonography with bladder volume calculation. The ultrasound bladder volumes were compared with the voided volume measurements. The volunteers underwent repeat scanning after voiding, and those with a measurable residual volume were excluded from the final analysis. Results: A residual volume was detected in 16 subjects (32%). In the remaining 34 subjects, the mean voided volume +/- standard deviation was 252.9 +/- 167.4 mL (range 33 to 709). A significant correlation (P <0.001) was found between the voided and ultrasound volumes with all three methods (Bardscan, r = 0.97; Bladderscan, r = 0.98; and 3D-US system, r = 0.99). No significant differences were found between the voided volumes and the Bladderscan or 3D-US volumes; however, the Bardscan significantly underestimated the voided volume by a mean of 21.4 mL (t = 2.84, P = 0.0076). The Bland-Altman 95% limit of agreement between the voided and calculated volumes was -64.5 to 107.2 mL, -73.7 to 88.4 mL, and -28.9 to 40.0 mL for the Bardscan, Bladderscan, and 3D-US systems, respectively. Conclusions: The results of our study have shown that although the Bardscan has the advantages of real-time scanning with portability and instantaneous volume calculation, it is not as accurate as the Bladderscan. The accuracy and level of clinical agreement was greatest when using the 3D-US system to calculate the bladder volume. [ABSTRACT FROM AUTHOR]