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The optimal extent of arthrodesis for severe and rigid progressive collapsing foot deformity is controversial. Traditionally, triple arthrodesis has been recommended; however, good results have been reported using subtalar arthrodesis only. We compared the results of triple arthrodesis and isolated subtalar repositional arthrodesis. A total of 22 symptomatic feet were evaluated retrospectively. Isolated subtalar repositional arthrodesis was performed in 13 cases (the subtalar group) and double or triple arthrodesis in 9 cases (the triple group). Various radiographic variables for assessing flatfoot and osteoarthritic changes in ankle and tarsal joints were measured and compared between the 2 groups at 3 time points: preoperatively, 3 months postoperatively, and 4 y postoperatively. Additionally, we analyzed various factors that affect postoperative valgus talar tilt in the ankle joint, which has been associated with poor prognosis. There were no differences in preoperative demographic data and the severity of the disease between the 2 groups; both groups showed improvement in radiographic parameters postoperatively compared with preoperative results. With the numbers available, no significant differences could be detected in postoperative radiographic measurements between the 2 groups. Of all the variables analyzed, postoperative hindfoot alignment angle was associated with postoperative talar tilt development. Additionally, postoperative talar tilt was observed more in triple group than in subtalar group. In conclusion, isolated subtalar repositional arthrodesis is an effective procedure to correct advanced progressive collapsing foot deformity. In addition, Chorpart joint arthrodesis with improper position can cause valgus talar tilt in the ankle joint., (Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA., Methods: Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment., Results: The mean hallux valgus angle decreased from 38.0° (range, 25°-65°) preoperatively to 3.5° (range, 0°-17°) at the final follow-up ( p < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°-22°) preoperatively to 4.3° (range, 2°-11°) at the final follow-up. ( p < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0-10) showed no significant change, decreasing from 3.83 (range, 0-6) preoperatively to 3.54 (range, 0-4) at the final follow-up ( p = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case., Conclusions: DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Objectives: Arthroscopic treatment is indicated for external snapping hip (ESH) syndrome in patients refractory to conservative treatment, but snapping does not disappear completely in some case. No previous studies have described the clinical course of ESH syndrome in patients who presented with persistent snapping after an arthroscopic procedure. We demonstrated the clinical outcomes following an incomplete arthroscopic iliotibial band (ITB) release for ESH syndrome., Methods: This retrospective observational study was performed at two teaching hospitals between October 2015 and December 2021. We reviewed the data of 33 patients (34 hips) aged ≥18 years, diagnosed with ESH syndrome, who were treated with arthroscopic ITB release. Patients who presented with persistent snapping despite sufficient arthroscopic ITB release following systematic order were defined as having an incomplete release. We collected the data for recurrent symptomatic snapping hip as the primary outcome after a minimum 2-year follow-up. The visual analogue scale (VAS) and modified Harris hip (mHHS) scores were measured as secondary outcome., Results: "Incomplete release" was identified in three of the 34 hips (8.9%). Cases of recurrent symptomatic snapping or conversion to open surgery were not observed. The symptoms of residual snapping spontaneously disappeared in all cases following routine postoperative rehabilitation within a 3-month follow-up period. The VAS (4 ± 1) and mHHS (17 ± 6) scores of all the patients improved., Conclusion: When refractory ESH syndrome is identified during arthroscopic surgery, appropriate ITB release and removal of the major lesion causing snapping are expected to lead to resolution of residual symptoms without conversion to open surgery., (© 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819-4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749-1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Diagnosis of flatfoot using a radiograph is subject to intra- and inter-observer variabilities. Here, we developed a cascade convolutional neural network (CNN)-based deep learning model (DLM) for an automated angle measurement for flatfoot diagnosis using landmark detection., Methods: We used 1200 weight-bearing lateral foot radiographs from young adult Korean males for the model development. An experienced orthopedic surgeon identified 22 radiographic landmarks and measured three angles for flatfoot diagnosis that served as the ground truth (GT). Another orthopedic surgeon (OS) and a general physician (GP) independently identified the landmarks of the test dataset and measured the angles using the same method. External validation was performed using 100 and 17 radiographs acquired from a tertiary referral center and a public database, respectively., Results: The DLM showed smaller absolute average errors from the GT for the three angle measurements for flatfoot diagnosis compared with both human observers. Under the guidance of the DLM, the average errors of observers OS and GP decreased from 2.35° ± 3.01° to 1.55° ± 2.09° and from 1.99° ± 2.76° to 1.56° ± 2.19°, respectively (both p < 0.001). The total measurement time decreased from 195 to 135 min in observer OS and from 205 to 155 min in observer GP. The absolute average errors of the DLM in the external validation sets were similar or superior to those of human observers in the original test dataset., Conclusions: Our CNN model had significantly better accuracy and reliability than human observers in diagnosing flatfoot, and notably improved the accuracy and reliability of human observers., Key Points: • Development of deep learning model (DLM) that allows automated angle measurements for landmark detection based on 1200 weight-bearing lateral radiographs for diagnosing flatfoot. • Our DLM showed smaller absolute average errors for flatfoot diagnosis compared with two human observers. • Under the guidance of the model, the average errors of two human observers decreased and total measurement time also decreased from 195 to 135 min and from 205 to 155 min., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

A novel design for an anodic WO3 mesosponge @ carbon has been introduced as a highly stable and long cyclic life Li-ion battery electrode. The nanocomposite was successfully synthesized via single-step electrochemical anodization and subsequent heat treatment in an acetylene and argon gas environment. Morphological and compositional characterization of the resultant materials revealed that the composite consisted of a three-dimensional interconnected network of WO3 mesosponge layers conformally coated with a 5 nm thick carbon layer and grown directly on top of tungsten metal. The results demonstrated that the carbon-coated mesosponge WO3 layers exhibit a capacity retention of 87% after completion of 100 charge/discharge cycles, which is significantly higher than the values of 25% for the crystalline (without carbon coating) or 40% for the as-prepared mesosponge WO3 layers. The improved electrochemical response was attributed to the higher stability and enhanced electrical conductivity offered by the carbon coating layer.

In this work, silicon (Si) containing carbon coated core-shell nanostructures were synthesized by electrical explosion of Si wires in ethanol solution followed by high energy mechanical milling (HEMM) process. Material characterization was carried-out using transmission electron microscopy (TEM), field-emission scanning electron microscopy (FESEM), energy dispersive X-ray spectroscopy (EDS), and X-ray diffraction (XRD) analysis. HEMM led to very fine and amorphous Si particles in the presence of carbon and inactive Silicon-Carbide (SiC) matrix. These Si based nanocomposites, obtained through electrical explosion followed by HEMM (milled sample), exhibited enhanced electrochemical performance than unmilled nanocomposites, when evaluated as anode material for lithium-ion batteries (LIBs). On completion of (the) 1st cycle, milled and unmilled sample(s) showed specific discharge capacities around 825 mAh/g and 717 mAh/g, respectively. Interestingly, the coulombic efficiencies of milled and unmilled samples were 98.5% and 97% after 60th cycle respectively. The enhanced electrochemical performance is attributed to fine and amorphous Si based nanocomposite obtained through HEMM process.

This work is a comparative study of the electrochemical performance of crystalline and amorphous anodic iron oxide nanotube layers. These nanotube layers were grown directly on top of an iron current collector with a vertical orientation via a simple one-step synthesis. The crystalline structures were obtained by heat treating the as-prepared (amorphous) iron oxide nanotube layers in ambient air environment. A detailed morphological and compositional characterization of the resultant materials was performed via transmission electron microscopy (TEM), field-emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD), and Raman spectroscopy. The XRD patterns were further analyzed using Rietveld refinements to gain in-depth information on their quantitative phase and crystal structures after heat treatment. The results demonstrated that the crystalline iron oxide nanotube layers exhibit better electrochemical properties than the amorphous iron oxide nanotube layers when evaluated in terms of the areal capacity, rate capability, and cycling performance. Such an improved electrochemical response was attributed to the morphology and three-dimensional framework of the crystalline nanotube layers offering short, multidirectional transport lengths, which favor rapid Li(+) ions diffusivity and electron transport.

Regardless of high capacity and stability during lithium extraction, LiFePO4 materials have difficulty in the applications for high electrical density because of low electrical conductivities. In order to optimize this problem, we synthesized carbon coated LiFePO4 by adding humic acid using solid state reaction method. We characterized the synthesized compounds via the crystallinity, the valence states of Fe ions, and their shapes. We found the carbon coating using X-ray photoelectron spectroscopy (XPS) and transmission electron microscope (TEM). We also found that the iron ion is substituted from 3+ to 2+ through XPS measurement. We showed that the carbon coating increased the electrochemical behavior by measuring the charge-discharge characteristics.