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Category: Arthroscopy; Ankle Introduction/Purpose: Although patients treated with open reduction internal fixation of ankle fractures generally recover well with low pain and high function, not all patients who are treated with anatomic open reduction and fixation have excellent results. Several reports describe improved outcomes of arthroscopic assisted treatment compared with open reduction and internal fixation alone.This study aims to report the intraarticular findings and treatment of patients who underwent open reduction internal fixation with arthroscopic assistance from three different centers affiliated with MASTAF, the Multicenter Arthroscopic Study of the Ankle and Foot, and assess the relative rates of pathology by Danis-Weber classification. Methods: Utilizing data from three IRB-approved centers, we investigated the association between intra-articular pathology and patient outcomes in arthroscopically treated ankle fractures. Primary outcome data included patient-reported FAAM scores (ADL, Sports) and VAS pain levels assessed at 1, 2, and 5 years post-op. The three centers involved in the study collected fracture data on 144 patients. All ankle fractures treated by these centers during the time period were treated arthroscopically. We present intra-articular findings for 131 patients, excluding 13 who either sustained work-related injuries or have ongoing litigation. While pre-op X-rays were standard, advanced imaging was employed as deemed necessary. 86 patients whose fractures included a distal fibula component were classified according to the Danis Weber classification system, and pathologies were analyzed with respect to the Weber classification. Follow up data is presented for 45 patients with complete follow up data. All surgeries were performed by fellowship-trained foot and ankle surgeons. Results: Intra-articular pathology was documented in 90.08% of patients, with synovitis (43.51%), deltoid injury (33.59%), and syndesmotic injuries (34.35%) most commonly observed. Osteochondral defects (25.95%), soft tissue impingement (25.95%), and loose bodies (25.19%) were also observed in a significant number of cases. Weber C fractures (n=29) showed significantly higher rates of osteochondral defects (41.38% vs 29.63%) and loose bodies (31.03% vs 16.67%) compared to Weber B fractures (n=54). Weber B fractures had a higher incidence of observed deltoid injury than Weber C fractures (40.74% vs 34.48%) At follow-up, patients reported low pain levels (average VAS: 1.711), great FAAM ADL scores (mean: 87.02) and good FAAM Sports scores (mean: 62.09). Conclusion: While the prevalence of osteochondral defects in ankle fractures has previously been cited as a reason for arthroscopic intervention, our study highlights the substantial prevalence of other pathologies such as loose bodies (33%), synovitis (43.51%), and soft tissue impingement (25.95%). We also identified higher rates of deltoid injury than existing literature (33.59% vs 20%), with the difference being most prominent for Weber B fractures. This, coupled with our positive patient outcomes, suggests that arthroscopy allows for improved detection of intra-articular pathologies during treatment and may aid in the detection of deltoid injuries compared to historical reports. [ABSTRACT FROM AUTHOR]

Background: Real-time monitoring of tree growth can provide novel information about trees in urban/suburban areas and the myriad ecosystem services they provide. By monitoring irrigated specimen trees, we tested the hypothesis that in trees with sufficient water, growth is governed by environmental factors regulating energy gain rather than by factors related to water use. Methods: Internet-enabled, high-resolution dendrometers were installed on 3 trees in Southampton, NY, USA. The instruments, along with a weather station, streamed data to a project web page that was updated once an hour. Growing periods were determined using a Hidden Markov Model based on a zero-growth model. Linear models and conditional inference trees correlated environmental variables to growth magnitude and rate of growth. Results: Growth was governed by the interacting environmental variables of air temperature, soil moisture, and vapor pressure deficit (VPD), and took place primarily at night. Radial growth of spruce began April 14 after the accumulation of 69.7 °C growing degree days and ended September 7. Cedar growth began later (April 26) after the accumulation of 160.6 °C and ended later (November 3). During the observation period, these 3 modest suburban trees sequestered 115.1 kg of CO2. Conclusions: Though irrigated, residential tree growth in our experiment was affected by environmental factors relating to both water use and energy gain through photosynthesis. Linking tree growth to fluctuations in environmental conditions facilitates the development of a predictive understanding useful for ecosystem management and growth forecasting across future altering climates. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to determine the accuracy of ankle arthroscopy as a means for diagnosing syndesmotic reduction or malreduction and to determine anatomical landmarks for diagnosis. Methods. Six matched-pair cadavers (n = 12) with through-knee amputations were studied. Component parts of the syndesmosis and distal 10 cm of the interosseous membrane (IOM) were sectioned in each. The 12 specimens were divided into 2 groups: 6 specimens in the in-situ group fixed with suture button technique and 6 specimens in the malreduced group rigidly held with a 3.5-mm screw. Specimens were randomized to undergo diagnostic arthroscopy by 3 fellowship-trained foot and ankle orthopaedic surgeons in a blinded fashion. Surgeons were asked to determine if the syndesmosis was reduced or malreduced and provide arthroscopic measurements of their findings. Results. Of 36 arthroscopic evaluations, 34 (94%) were correctly diagnosed. Arthroscopic measurement of 3.5 mm diastasis or greater at the anterior aspect of the distal tibiofibular syndesmosis correlated with a posteriorly malreduced fibula. Arthroscopic evaluation of the Anterior inferior tibiofibular ligament (AITFL), IOM, Posterior inferior tibiofibular ligament (PITFL), lateral fibular gutter, and the tibia/fibula relationship were found to be reliable landmarks in determining syndesmotic reduction. An intraclass correlation coefficient (ICC) for interrater reliability of 1.00 was determined for each of these landmarks between 2 surgeons (P < .001). The ICCs between 2 surgeons' measurements and the computed tomography measurements were found to be 0.896 (P value < .001). Conclusions. Ankle arthroscopy is a reliable method to assess syndesmotic relationship when reduced in situ or posteriorly malreduced 10 mm. Levels of Evidence: Level V: Cadaveric. [ABSTRACT FROM AUTHOR]

Private timber sale transactions are vital to the forest products industry in the US South. Consulting foresters often assist private landowners in administering timber sales, and their decisions and practices have a major impact on landowner compensation, satisfaction, and market efficiency. This study used a mixed-mode survey of consulting foresters in 11 southern states to examine contract terms, timber sale practices, and market conditions on private sales. Responses were received from 430 consultants, resulting in a 37 percent response rate. Final harvests are primarily offered to bidders, whereas thinnings are more likely to have timber prices negotiated. Pay-as-cut payment terms are typical for thinnings, but less common in the Mountains where lump sum is relatively more common. Well under 50 percent of firms from the Coastal Plain and Piedmont conduct presale inventories on thinnings, whereas nearly two-thirds of firms in the Mountains use inventories on these types of harvests. Fewer than 25 percent of responding foresters suggested that restrictive quotas reduced landowner revenue on pay-as-cut timber sales. Consulting firms reporting that sawtimber quotas were never a problem in their area reported at least two more sawtimber outlets than those concerned about restrictive mill quotas. [ABSTRACT FROM AUTHOR]

Common surgical treatment of first tarsal-metatarsal arthritis is by first metatarsocuneiform joint arthrodesis. While crossed-screw and locking plate fixation are the most widely used methods, a novel construct was designed to alleviate soft tissue irritation while still providing stable fixation. Using anatomic first metatarsal and medial cuneiform composites, we compared 3 arthrodesis implants (crossed-screw, dorsal locking plate, and IO Fix) under 2 cyclic bending loading scenarios (cantilever and 4-point bending). Additionally, the optimal orientation (plantar-dorsal or dorsal-plantar) of the IO Fix construct was determined. Failure load, diastasis, joint space angle, and axial and angular stiffness were determined. Both crossed-screw fixation and the IO Fix constructs experienced significantly higher failure loads than the dorsal locking plate during both loading scenarios. Additionally, they had lower plantar diastasis and joint space angle at failure than the plate. Moreover, the plantar-dorsal IO Fix construct was significantly stiffer than the crossed-screw during cantilever bending. Finally, the plantar-dorsal orientation of the IO Fix device had higher failure load and lower diastasis and angle at failure than in the dorsal-plantar orientation. The results suggest that the IO Fix system can reduce motion at the interfragmentary site and ensure compression for healing comparable to that of the crossed-screw fixation.Levels Of Evidence: Level V: Bench testing. [ABSTRACT FROM AUTHOR]