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There is no clear recommendation for wound closure material in foot and ankle surgery. Thus, we hypothesized that there was no difference in clinical outcomes among 3 suture materials, namely, absorbable sutures, nonabsorbable sutures, and metallic staples. This study compared the 3 materials for wound closure in foot and ankle surgery. In this prospective randomized study, 124 patients were randomly divided into the nonabsorbable suture group, absorbable suture group, and staple group. ASEPSIS score, Hollander Wound Evaluation Scale, and numerical rating scale (regarding pain and satisfaction) were collected at first dressing changes, suture removal, and 6 weeks after surgery. Suture time and incision length were recorded. No significant differences were detected for the ASEPSIS and Hollander Wound Evaluation Scale scores. There was significantly more pain after 6 weeks in the nonabsorbable suture group. The closure time (13 s/cm) with staples was significantly lower in the nonabsorbable suture group than in the other groups. Regardless of wound closure material, male sex and obesity appeared to be associated with a higher risk for the occurrence of wound complications. The 3 suture materials showed no significant differences regarding the frequency of wound complications. Staples and absorbable sutures should therefore be considered in the repertoire of suture materials used in foot and ankle surgery. [ABSTRACT FROM AUTHOR]

• Self-reporting data assets are introduced as an implementation of FAIR data. • Requirements for SRDAs are extracted from top pharma and biotech workflows. • A fit/gap analysis for Allotrope Data Format, AnIML, JCAMP-DX, and JSON is presented. • Allotrope Data Format is found to be the best representation for SRDAs. Standardizing data is crucial for preserving and exchanging scientific information. In particular, recording the context in which data were created ensures that information remains findable, accessible, interoperable, and reusable. Here, we introduce the concept of self-reporting data assets (SRDAs), which preserve data and contextual information. SRDAs are an abstract concept, which requires a suitable data format for implementation. Four promising data formats or languages are popularly used to represent data in pharma: JCAMP-DX, JSON, AnIML, and, more recently, the Allotrope Data Format (ADF). Here, we evaluate these four options in common use cases within the pharmaceutical industry using multiple criteria. The evaluation shows that ADF is the most suitable format for the implementation of SRDAs. [ABSTRACT FROM AUTHOR]

Der Hallux rigidus ist eines der häufigsten Beschwerdebilder des Fußes. Besonders Sportler sind gefährdet, einen frühzeitigen Verschleiß im Metatarsophalangealgelenk I (MTP-I) zu entwickeln. Je nach gewählter Sportart kann es hierbei zu Einschränkungen und Folgeproblemen kommen. Dieser Artikel liefert eine Übersicht über mögliche konservative und operative Therapieoptionen insbesondere in Hinblick auf die Wiederaufnahme der sportlichen Aktivität. Unter Berücksichtigung der aktuellen Literatur sind neben Einlagenversorgung und manueller Therapie operativ besonders die Cheilektomie und MTP-I-Arthrodese zu empfehlen. Zuletzt haben Hydrogel-Implantate eine zunehmende Verbreitung erfahren. Diese können eine gute operative Alternative darstellen. Eine abschließende Bewertung diesbezüglich ist aktuell aber noch nicht möglich. Hallux rigidus is one of the most common pathologies of the foot. Athletes in particular are at risk of developing premature degeneration of the metatarsophalangeal joint I (MTPJ-I). This article provides an overview of conservative and operative therapy options. Specific focus is given to treatments that facilitate earliest possible return to sports activity. Considering the current literature, cheilectomy and MTP-I arthrodesis are recommended aside from foot orthosis and manual therapy. Besides, hydrogel implants are getting more popular and represent a promising alternative. [ABSTRACT FROM AUTHOR]

This article examines the relationship between conflict resolution styles and substance abuse among teenagers. The authors maintain teenagers who resorted to inappropriate styles of conflict resolution were more likely to exhibit other externalizing behaviors such as substance abuse, fighting, and low academic achievement.

Background The history of total ankle arthroplasty (TAA) has different evolution steps to improve the outcome. The third generation implants show an overall 8-year survival rate up to 93%. The main reported reason for early failure of TAA is aseptic loosening, cyst formation is also frequently reported. The aim of the present study is to use the finite element (FE) method to analyze the adaptive bone remodeling processes, including cyst formation after TAA. Methods Bone characteristics applied to the model corresponded to information obtained from computed tomography. Finite element models for the tibia and the talus were developed and implant components were virtually implanted. Results The calculated total bone loss is 2% in the tibia and 17% in the talus. Cysts and areas of increased bone density were detectable dependent on prosthesis design in the tibia and talus. Conclusion Our FE simulation provides a theoretical explanation for cyst formation and increasing bone density depending on implant design. However, cysts are not mono-causal, histo-chemical reactions should also be considered. Further clinical studies are necessary to evaluate the relevance of cyst formation and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. The aim of the present study was to examine the clinical outcomes after HemiCAP ® implantation for OCDs of the medial talar dome after failed previous surgery. Our retrospective study included 11 patients, who had undergone surgery from June 2009 to September 2012 for an OCD of the medial talar dome and received a HemiCAP ® on the talus after failed previous surgery for OCD. The data were acquired using patients’ medical records and standardized questionnaires, including the Foot and Ankle Outcome Score (FAOS), University of California at Los Angeles (UCLA) activity score, EQ-5D, numerical rating scale (NRS), and Short-Form 36-item Health Survey (SF-36). Using these scores, the possibility of returning to work and sports was determined. Any complications and the need for revision surgery were recorded. One patient refused to participate in the study, leaving 10 patients for evaluation. The mean age was 47.64 ± 10.97 years. The mean follow-up period was 43.5 ± 35.51 months. The FAOS and SF-36 subscale scores and the EQ-5D and UCLA activity scores did not improve significantly ( p < .05). The mean postoperative pain score on the NRS improved significantly from 6.6 ± 1.77 preoperatively to 5.1 ± 2.02 postoperatively ( p < .05). A greater body mass index led to worse postoperative outcomes with higher scores on the pain-NRS and less satisfaction ( p < .05). Ten revisions for ongoing pain were performed in 7 patients (70.0%) within a mean of 28.4 ± 13.35 months of the initial procedure, and 6 patients (60%) indicated they would undergo surgery again. The results of the present study have shown that implantation of the HemiCAP ® as a salvage procedure for OCDs of the talus is challenging and does not consistently lead to good clinical results. Also, overweight patients appear to have an increased risk of postoperative dissatisfaction and persistent ankle pain. [ABSTRACT FROM AUTHOR]

Charcot neuropathy (CN) is a severe joint disease that makes surgical planning very challenging, because it is combined with ankle instability, serious deformities, and recurrent ulceration. The aim of the present study was to examine the rate of bone fusion after external or internal fixation in patients with CN. We retrospectively examined 58 patients with CN who had undergone reconstruction of the ankle either with tibiotalocalcaneal or tibiocalcaneal arthrodesis. The mean age was 59.1 (range 26 to 81) years at surgery. Of the 58 patients, 38 were treated using intramedullary nail arthrodesis and 19 using an external fixator (1 patient received neither). At a mean follow-up period of 31.3 (range 12 to 57) months, limb salvage and bone fusion had been achieved in 94.83%. The mean time to bone fusion was 12 (range 6 to 18) months. Three patients (5.2%) required a more proximal amputation. All but these 3 patients gained independent mobilization in custom feet orthoses or off the shelf orthoses. Of the 58 patients in the present cohort, 56 (96.6%) would undergo surgery again. In conclusion, internal and external fixation both lead to promising results in the treatment of CN. Internal fixation should be preferred when no indications of ulcer or infection are present. [ABSTRACT FROM AUTHOR]

Summary Radiolucent lesions in the calcaneus and the talus occur as solitary bone cysts or as intraosseous lipoma. The intraosseous lipoma is one of the rarest tumours occurring in the skeleton. Solitary bone cysts are usually found in the metaphyseal region of long bones. They are rarely seen in nontubular bones such as the calcaneus or talus. Between 1990 and 1995 three new cases of cystic lesions in the calcaneus and two in the talus were diagnosed and surgically treated at the Orthopaedic Department, Hannover Medical School, Germany. In the following paper these five cases are reported and useful imaging techniques, such as radiographs, computed tomography, magnetic resonance imaging and radionuclide bone scans, are described in the differential diagnosis between a lipoma and a solitary bone cyst. Using these imaging techniques in most cases a diagnosis can be made with adequate certainty. Once this diagnosis is made and the patient presents pain in the region of involvement surgery should be done. In case of structural weakening of the one bone a homologous bone graft should be performed. [ABSTRACT FROM AUTHOR]

Purpose: Two different operative techniques for stabilizing the patella against lateral displacement movement were investigated. Type of Study: In vitro experimental study. Methods: Five human cadaver knee specimens with a normal Q-angle were mounted in a kinematic knee simulator and investigated under simulated isokinetic extension motions. Patellar movement was measured while a 100-N laterally directed subluxation load was applied to the patella. Ligament loading of the medial patellofemoral ligament was measured using a strain gage based buckle transducer inserted in the fibers of the ligament. The knee was evaluated in an intact physiologic state, as well as after medial transfer of the tibial tuberosity, and after the medial patellofemoral ligament was transected and reconstructed using a hamstring autograft. Results: A significant reduction in lateral displacement and ligament load was observed with the use of the hamstring autograft reconstruction compared with the medial transfer of the tibial tuberosity. Conclusions: Medial transfer of the tibial tuberosity showed no significant relief of ligament loading and stabilizing effect on patellar movement, whereas reconstruction of the medial patellofemoral ligament showed a significant stabilizing effect on patellar movement. Clinical Relevance: In cadaver specimens, we evaluated the effect of tibial tubercle transfer and the patellofemoral ligament and found that reconstruction of the patellofemoral ligament alone was sufficient to restore stability in a cadaveric model. Additionally, we found that the flexion angle had little effect on the loading of the medial patellofemoral ligament autograft, which would support early mobilization of patients after surgery. We found that the graft was not unduly loaded. [Copyright &y& Elsevier]

Objective. The purpose of this in vitro study was to investigate the amount of quadriceps force required to extend the knee during an isokinetic extension cycle before and after total knee arthroplasty.Design. The magnitude of the extension torque used in simulating a constant moment extension exercise was derived from tests made using a dynamometer on patients who had received a total knee arthroplasty. Quadriceps force needed to extend the knee was measured.Methods. Human knee specimens (n=8, mean age=65 SD 7 years, all male) were tested in a kinematic knee simulating machine untreated and after implantation of two different knee prosthesis. During simulation, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm about the knee.Results. The quadriceps forces needed to extend the knee during the physiologic simulation reached levels as high as 1238.9 N (SD 46.6). After implantation the Interax®-prosthesis, quadriceps force increased up to 13.9% (P=0.003), in conjunction with resurfacing of the patella 11.9% (P=0.01). With the LCS®-prosthesis implanted, quadriceps force showed a somewhat smaller increase of up to 6.6% (P=0.007).Relevance The following study helps to clarify postoperative problems related to the extensor mechanisms of the knee after implantation of total knee arthroplasty. [Copyright &y& Elsevier]

Background: There have been no biomechanical evaluations of naviculocuneiform (NC) joint fixation. This study compared biomechanically 3 different fixation constructs for NC-1-3 joint fixation.Methods: The present study compared the three fixation constructs lag screw with locking plate for each NC joint, two crossed lag screws for each NC joint and a separate lag screw for each NC joint with bridging locking plates. NC-1-3 fixation was performed stepwise, and rotation of each joint was evaluated after the application of each lag screw or locking plate and their removal.Results: All examined fixation techniques led to a significant reduced rotation of the NC joints. For NC-1 rotation decreased from 2.8° (Range 1.2-6.6°) to 0.6° (0.2-3.0°) for lag screw and locking plate (p = 0.002) and from 5.0° (1.7-9.8°) to 1.0° (0.1-3.6°) for crossed lag screws (p = 0.002). For NC-2, locking plate constructs were better with 0.2° (0.1-0.5°) compared to crossed lag screw osteosynthesis with 0.9° (0.2-1.6°) (p = 0.011).Conclusion: Each evaluated fixation technique led to a reduced NC joint rotation. The fixation of any NC joint had no relevant effect on the adjacent NC joints. The results might support surgeons treating NC joint disorders. [ABSTRACT FROM AUTHOR]

Background: Although the outcomes of total ankle arthroplasty (TAA) have improved, unsolved problems such as stress shielding remain. Although dual energy X-ray absorptiometry (DEXA) is the "gold standard" for evaluation of these issues, it is rarely used in patients after TAA. This study aimed to establish a scan technique and to assess the mechanical changes in bone density caused by bone stock preparation.Methods: Eight fresh-frozen cadaver legs were investigated by DEXA before TAA, with implant in situ, and after implant removal. Scan surface, bone mineral content, and bone mineral density were analysed to assess mechanical bone mass changes.Results: We examined data for density changes by bone compression after TAA, and found "good" results for internal reliability but only "acceptable" results for external reliability.Conclusions: The results were reliable and reproducible. Using the present data, mechanical and biological processes can be considered together to understand the postoperative phases of bone remodelling after TAA. [ABSTRACT FROM AUTHOR]

Background Hallux valgus is a common diagnosis in orthopedics. Only a few studies have analyzed the effects of conservative therapy. Therefore, the current study analyzed the effect of a dynamic hallux valgus splint. Methods Seventy patients were included in this prospective randomized trial. Patients with a hallux valgus were treated using a dynamic splint or underwent no treatment. Clinical and radiological parameters were evaluated. Results We found no significant changes in hallux valgus angle, intermetatarsal I-II angle, AOFAS score, FAOS or SF-36 score between the groups. However, a significant between-group difference was found for pain during walking and running and in the FAOS subscale for pain and pain at rest at follow-up. Conclusions Wearing a dynamic hallux valgus splint does provide some pain relief in patients with a symptomatic hallux valgus, but showed no effect on hallux valgus position. Level of evidence: 1. [ABSTRACT FROM AUTHOR]

Background: Thorough understanding of the morphometry of the ankle joint is crucial to optimize conservative and operative therapy of ankle joint disorders. Despite recent improvements, basic anatomic and biomechanical correlations of the ankle joint including the orientation of the ankle joint axis and joint morphology as its key biomechanical features are not sufficiently recorded to date. The aim of this study was the evaluation of the ankle morphometry to gain information about the ankle joint axis.Material and Methods: In this study 98 high-resolution CT-scans of complete Caucasian cadaver legs were analysed. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar articular areas. Additionally, the radii of the articular areas, the medial distal tibial angle and the height of the talar dome were determined.Results: The radius of the central trochlea tali was 44.6±4.1mm (mean±SD). The central trochlea tali arc length was 40.8±3.0mm and its width was 27.4±2.5mm. Additionally we determined 47.0±4.4mm for the tibial sagittal radius, 27.6±3.0mm for the tibial arc length and 27.4±2.5mm for the central tibial width.Conclusion: The present study describes the three-dimensional morphometry of Caucasian ankle joints in detail. This dimensional analysis of the ankle joint will inform the development and placements of implants and prostheses. [ABSTRACT FROM AUTHOR]

Background: Despite intensive research there is no consensus about the talocrural joint axis. The aim of the present study is a new method to determinate the geometric rotational axis of the talocrural joint.Methods: We analyzed 98 CT-scans of full cadaver Caucasian legs. We generated three-dimensional reconstruction models of the talus. A best fitting cone was orientated to the talar articular surface. The geometric rotational axis was defined to be the axis of this cone.Results: The geometric rotational axis of the talocrural joint is orientated from lateral-distal to medial-proximal (85.6°±10 compared to anatomical tibial axis in torsional plane), from posterior-distal to anterior-proximal (81.43°±44.35 compared to anatomical tibial axis in sagittal plane) and from posterior-medial to anterior-lateral (169.2°±5.91 compared to intermalleolar axis in axial plane).Conclusions: The consideration of our results might be helpful for better understanding of ankle biomechanics. [ABSTRACT FROM AUTHOR]

Abstract: Background: The post/cam mechanism of posterior cruciate substituting total knee arthroplasty, which is intended to achieve maximum range of flexion, offers the risk of failure due to mechanical overload. The purpose of this in vitro study was to investigate load and contact pressure on the inlay post of posterior substituting knee prosthesis with different designs. Methods: Isokinetic extension/flexion motions of seven fresh frozen left knee specimens were simulated dynamically in a specially designed knee simulator with an extension moment of 31Nm. After implantation of the knee prosthesis system, which provides a fixed and a rotating posterior cruciate substituting inlay, a pressure sensitive film was fixed on the inlay post surface to measure maximum load and contact pressure. Findings: Both types of inlays showed nearly the same contact load of up to 480N on the posterior surface of the inlay post at 120° knee flexion. Contact pressure was measured to be up to 19.7MPa at 120° flexion on the posterior surface of the post of the fixed inlay, whereas contact pressure was measured to be significantly lower (6.8MPa, p =0.04) on the inlay post of the rotating inlay. Interpretation: The modification of a rotating posterior cruciate substituting inlay could not decrease the horizontal load, but offers the possibility to decrease contact pressure on the inlay post to avoid mechanical overload of the polyethylene inlay. [Copyright &y& Elsevier]

Abstract: Background: Surgical reconstruction of the medial patellofemoral ligament used to stabilize the patella against lateral dislocation may concomitantly produce alteration of the patellofemoral contact pressure distribution. Two different tendon transfer techniques of reconstructing the medial patellofemoral ligament, one dynamic and one static, as well as a proximal soft tissue realignment of the patella were investigated. Methods: Eight human knee specimens were mounted in a kinematic knee simulator and isokinetic extension motion was simulated. Patellofemoral pressure was measured using a pressure sensitive film while a 100N laterally directed dislocation load was applied to the patella. The specimens were evaluated in a physiologic state, as well as after dynamic reconstruction of the medial patellofemoral ligament using a distal transfer of the semitendinosus tendon, following static reconstruction using a semitendinosus autograft, and following proximal soft tissue realignment of the patella. Findings: Following both reconstruction techniques of the medial patellofemoral ligament patellofemoral contact pressure was not significantly (P =0.49) altered. In contrast, after proximal realignment a trend (P =0.07) towards higher contact pressure near knee extension was observed. In the absence of a lateral dislocation load dynamic and static reconstruction resulted in a medialization (P =0.04) of the center of pressure, whereas under the application of a 100N dislocation load the center of pressure showed no significant alteration. Following proximal realignment the center of pressure was significantly medialized without (P <0.01) and with a dislocation load (P =0.01) throughout the entire range of knee motion. Interpretation: Static and dynamic ligament reconstruction of the medial patellofemoral ligament did not alter patellofemoral pressure. Proximal realignment, on the other hand, resulted in a constant medialization of the patellofemoral pressure. The data suggest that the reconstruction techniques would be associated with a low risk of causing premature cartilage degeneration due to excessive patellofemoral contact pressure, whereas proximal realignment could cause medial overload of the patellofemoral joint. [Copyright &y& Elsevier]

Abstract: Background: To prevent excessive tension on the posterior cruciate ligament, some knee prosthesis-systems offer the option of creating a posterior tibiofemoral slope of the tibial component. The objective of this study was to investigate the effect of the amount of tibiofemoral slope on the posterior cruciate ligament load and tibiofemoral contact stress after total knee arthroplasty under isokinetic in vitro conditions. Methods: Twelve fresh frozen knee specimens were tested in a knee simulator. After implantation of the Interax I.S.A.® knee prosthesis-system with a mobile bearing inlay, a bow shaped load transducer was fixed in the medial fibres of the posterior cruciate ligament. A pressure sensitive film was fixed on the femoral inlay surface. The test cycle simulated an isokinetic extension cycle from 120° of flexion to full extension. First, posterior cruciate ligament load and tibiofemoral peak contact stress were measured with the tibial component implanted with a neutral tibial slope and then with 10° posterior slope. Findings: After implantation of the tibial component without tibial slope, posterior cruciate ligament load reached a maximum load of 29.5N (SD 17.1N) at 97.8° knee flexion. Tibiofemoral contact stress on the medial compartment reached a maximum of 11.9MPa (SD 2.4MPa) on the medial compartment and 15.0MPa (SD 6.1MPa) on the lateral compartment. With a tibial slope of 10°, posterior cruciate ligament load reached a maximum of 14.5N (SD 4.9N, P =0.04) at 100.5° knee flexion and tibiofemoral stress increased to a maximum of 13.3MPa (SD 4.7MPa, P =0.38) medial and 17.4MPa (SD 8.2MPa, P =0.22) lateral in knee extension. Interpretation: Maximum posterior cruciate ligament load was observed at high knee flexion angles, decreasing to full extension. The implantation of the tibial base plate with 10° dorsal slope reduced posterior cruciate ligament load significantly in knee flexion above 50° and slightly increased tibiofemoral contact stress in knee extension. Therefore a posterior tibial slope prevents an excessive load on the posterior cruciate ligament while having little effect on tibiofemoral stress at high knee flexion angles. [Copyright &y& Elsevier]