Hind Foot Research Articles

The Evaluation of Muller Weiss Diseased and Normal Feet on a Three-Dimensional Foot Model

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The deformities associated with Müller Weis Disease (MWD) have not been well understood which inevitably impacts clinical and surgical decision making. Despite most previous studies characterizing MWD as a paradoxical flatfoot deformity, ie, a flat arch and a varus heel, some studies have treated MWD as a flatfoot deformity by performing a medializing calcaneus osteotomy, and others as an arthritic disorder treated with hind foot arthrodesis but without correcting the deformity. This study used an automatic 3D segmentation program to create an average 3D foot model for both normal controls and a large group of MWD feet, to demonstrate the deformity pattern, and to provide surgeons with a foundation for detailed alignment evaluation and surgical planning. Methods: Weight bearing Scans of 55 health feet without deformities, trauma and surgical histories, and 69 MWD feet were included in this study. The Bonelogic program (Disior, Paragon 28,) was used to automatically segment the bones and 3D information of each foot in the same group was pooled to create an average foot model for both the controls and the MWD feet. Videos were created using all feet in both groups to demonstrate the deformity patterns ranging from normal feet transitioning to MWD feet. Since current axial and angular metrics for alignment evaluation using traditional 2D imaging cannot be extrapolated to 3D this study was kept as a descriptive paper, and no traditional metrics were analyzed and reported. Results: Compared to the average normal foot, the MWD foot model demonstrated the following features: narrowing on the lateral pole and dorsal side of the navicular, lateral rotation and slight dorsal lifting of the talar head and medial rotation of the navicular, a varus heel with more opening in the sinus tarsi, proximal shift of the calcaneal tuberosity, a flat medial arch with subsidence at the talonavicular joint, decreased adduction of the forefoot, medial translation of the cuboid at the calcaneocuboid articulation, and a shortened 1st metatarsal. All of the above changes were consistently demonstrated in video one (a comparison between the two foot models), and video two (a comparison of the peritalar joint alignment between the two groups). Conclusion: The foot models were built up with pixels, with each pixel carrying its own 3D information in space allowing exploration of real 3D alignment evaluation tools. The MWD foot model clearly demonstrated and validated the deformity patterns originally described by Maceira, and subsequently by other authors using both radiographs and WBCT scans. This model facilitates evaluation of alignment from the hindfoot to the forefoot, as well as advanced 3D analysis to assess the morphology of the bones and joints and can be the foundation for surgical planning and predication of outcomes.

Reliability of Cone Bean Weight-Bearing Measurements of the Postoperative Outcome of Total Ankle Arthroplasties and Inter-Method Reliability with Respect to the Weight Bearing x-rays

Category: Ankle Arthritis; Ankle Introduction/Purpose: Postoperative evaluation of the total ankle arthroplasty (TAA) alignment is a fundamental step in measuring the surgical outcome. The current reference standard, weight-bearing x-ray (WBXR), is subject to technical bias. Weight-bearing cone beam computer tomography (WBCT) allows visualization of the complex three-dimensional (3D) structure of the foot under the influence of its deforming forces. A WBCT-based measurement system to assess postoperative outcomes has yet to be validated. The purpose of this study was (1) to measure the surgical outcome of TAA using semiautomatic generated models, (2) to evaluate the agreement levels between two raters, and (3) to evaluate the inter-method reliability with respect to WBXR. Methods: Fifty-five consecutive patients were retrospectively viewed. Two raters independently created a 3D model using dedicated software. Each rater measured six different measurements: α angle tibiotalar angle, hind foot angle (HFA), β angle, γ angle, and Φ angle using a semiautomatic 3D model and one measurement, the tibiatalar ratio (TTR) using WBCT on sagittal view. Measurements were repeated two months apart in the same independent fashion. Results were compared to standard weight- bearing x-rays. Consequently, interobserver, intraobserver, and intermethod agreements were calculated. Results: All seven measurements showed good to excellent interobserver and interobserver reliability. (ICC 0.85-0.95). The intermethod agreement showed good agreement for the γ angle (0.79) moderate agreement levels for the α angle, TTS angle, β angle, and TTR (ICC 0.68, 0.69, 0.70, 0.69 respectively), a poor agreement for the HFA angle (ICC 0.25), and a negative agreement for the φ angle (ICC -0.2). Conclusion: Postoperative analysis of TAA using WBCT demonstrated good to excellent interobserver and intraobserver agreement and can be reliably used. When compared to WBXR, moderate to good agreement was measured for the sagittal and coronal alignment of the components. A poor agreement was measured for the coronal alignment of the hindfoot, and a negative agreement was measured for the axial rotation angle, indicating that the intermethod comparison is unreliable.

Can the Contralateral Ankle be used for Preoperative Planning in Total Ankle Arthroplasty in the Posttraumatic Patient? A Prospective Study

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) for posttraumatic osteoarthritis (OA) is becoming an increasingly popular treatment option. Clinical results and prosthesis longevity correlate directly with the hind foot and components' postoperative alignment. Therefore, a preoperative plan (PROP) that can accurately predict postoperative alignment of TAA could be valuable. Most PROPs use the diseased ankle as a reference despite the arthritic deformation. PROPs of the contralateral, unaffected limb have been tested in other fields, but not in TAA. In most cases of posttraumatic OA, the contralateral ankle is relatively preserved and therefore could serve as a valuable tool for preoperative planning. This prospective study aims to assess the accuracy of preoperative planning using a WBCT of the contralateral healthy ankle for TAA in the treatment of posttraumatic OA. Methods: A total of 44 patients were included. For each case, a preoperative WBCT scan of the contralateral foot was acquired. Individual PROPs consisted of virtual realignment and osteotomies prior to each surgery. After surgery, postoperative WBCT scan of the affected foot was performed. Six angles were used to assess the accuracy of the coronal and sagittal alignment of the prosthesis. Results: Forty-four ankles across 44 patients were operated on. Three angles had a statistically significant difference between the pre and postoperative measurements: (1) α angle was -3±4 degrees (p-value < 0.0001), (2) TTS 2.884±4 degrees (p-value < 0.00001), (3) TTR -7±14 mm (p-value < 0.001). Only 49% and 34% of the coronal and sagittal angles could be found within 3 degrees from the PROPs. Conclusion: In conclusion, the contralateral ankle cannot be used accurately as a preoperative planning tool for TAA. It should be used only in cases where the diseased ankle cannot be a referenced in the setting of deformation.

Predictive Model for Reintervention in Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Osteoarthritis (OA) of the tibiotalar joint is associated with a high degree of morbidity, being comparable with final stages of renal and heart failure. The incidence of OA of the tibiotalar joint is as high as 47.7 per 100,000 habitants, of whom most of them will need a surgical intervention to improve their quality of life. Up to date evidence supports the use of the total ankle arthroplasty for its management. A great effort has been made to elucidate the factors associated with failure of the total ankle prothesis, until now no attempt has been made to look for factors associated with the need of surgical reintervention, beyond revision of the prothesis. Methods: Prospective cohort study in patients with tibiotalar OA operated between 2015 and 2022, with a minimum follow-up of 12 months, excluding revision prothesis and lost to follow-up. Reintervention was considered as any complication, related to the prothesis, that needed a surgical intervention that was not planned. We performed a multivariate logistic regression model with 13 variables (diabetes, hypertension, tabaquism, age, etiology, hind foot alignment, subtalar OA, talonavicular OA, calcaneocuboid OA, pes planus, cavo varus, previous subtalar arthrodesis and surgical time). Confounding effect was assessed with the change of the odds ratio of the principal independent variable, by adding or subtracting potentially confounder variables into the model. The variables that were statistically non-significant and those variables that do not cause confusion effect, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. The Kaplan-Meier curve was used for survival analysis. Results: 105 total ankle arthoplasties were included, the statistically significant variables were: take-down etiology OR = 171.73 (CI: 6.87 - 4294.95, p < 0.01), post-traumatic etiology OR = 14.56 (CI: 1.98 - 107.04, p < 0.01) and surgical time OR = 0.96 (CI: 0.92 - 0.99, p = 0.04), while age OR = 1.02 (CI: 0.96 - 1.09, p = 0.57) and cavo varus OR = 4.75 (CI: 0.71 - 31.93, p = 0.11), wereincluded in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately (p = 0.84). The ROC curve demonstrates 89.03% discriminatory power. The survival rate at 8 years was 80.39%, median of survival rate was not determined, because longer follow-up was needed. Conclusion: The take-down and post-traumatic etiology can be considered as important risk factors for requiring a surgical reintervention. Patients with a take-down etiology that have a cavo varus deformity and higher age, have a higher risk to require a surgical reintervention. Longer surgical time can be considered as a protective factor for needing a surgical reintervention. At 8 years 20.61% of patients will need a surgical reintervention, related to their Total Ankle Arthroplasty.

MORPHOLOGICAL INDICATORS OF THE NARROW-CRUSTED VOLE OF THE ANTHROPOGENIC TERRITORY OF NORTH-EASTERN KAZAKHSTAN

This study delves into the intricate relationships between ecological factors, adaptation, and the effects of anthropogenic activities on small mammals in the Northeastern region of Kazakhstan. External traits, including body mass, length, tail length, ear height, and hind foot length, provide valuable insights into adaptive adjustments in response to various climatic and ecological conditions. Industrial areas reveal a reduction in average body mass, attributed to patchy vegetation and proximity to factories and roads. Size variations are closely tied to food availability, with a reduction in body size and growth rates observed in technogenic zones. Tail sizes differ by age and sex, while foot sizes tend to even out as animals mature. Notably, anthropogenic pollution has minimal impact on ear length. The heart index reflects an individual’s mobility and thermoregulation, while the liver index is influenced by food availability and energy resources. Notably, the analysis extends beyond average differences, considering the range of variability to identify increased diversity, even in ecologically challenging areas. Small mammals exhibit a high metabolic rate and limited physiological stress adaptability, yet the population demonstrates remarkable adaptation. Enlarged heart indices suggest increased locomotor activity associated with overcoming anthropogenic barriers, such as railways and highways. In addition to heart indices, liver mass calculations reflect the accumulation of energy reserves and materials for growth. The study highlights that the liver mass index of field mice in industrial zones exceeds that of the control group, indicating the impact of anthropogenic activities on these organisms. This research provides valuable insights into the intricate relationships between ecological factors, adaptation, and human influence on small mammal populations in the Northeastern region of Kazakhstan. Keywords: small mammals, narrow-crusted vole, morphophysiological indicators method, exterior signs, interior signs.

Effect of different suspension moxibustion methods on syndrome characteristics of rats with rheumatoid arthritis of heat bi syndrome based on "moxibustion can be used for heat syndrome"

To observe the effects of different suspension moxibustion methods on the syndrome characteristics and inflammatory factors of rats with rheumatoid arthritis (RA) of heat bi syndrome and to prove the concept of "moxibustion can be used for heat syndrome". Among seventy Wistar rats, 12 rats were randomly selected as a normal group, and the remaining rats were induced by collagen combined with wind, dampness, and heat environmental stimulation to establish the RA model of heat bi syndrome. Forty-eight rats with successful model establishment were further randomly divided into a model group and three moxibustion groups (mild moxibustion group, rotating moxibustion group and sparrow-pecking moxibustion group), with 12 rats in each group. The acupoints "Quchi" (LI 11), "Dazhui" (GV 14) and ashi point were used in all moxibustion groups, with mild moxibustion, rotating moxibustion, and sparrow-pecking moxibustion intervention given respectively, each acupoint was treated with moxibustion for 10 min a day, and 6 days were considered one course of treatment, with a total of three courses. After the intervention, the arthritis index (AI), the Evans blue (EB) extravasated volume in the soft tissue of the right hind paw, and the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-10 in the serum were measured by ELISA in each group. The volume of the bilateral hind paw was measured; the infrared thermal imaging was collected to analyze the temperature of the plantar area of the bilateral foot pads, and the reaction time of plantar heat pain was calculated before and after modeling, as well as after the 1st, 2nd and 3rd courses of interrention. The ankle dorsiflexion angle of the right hind foot was also measured before and after modeling, as well as after the intervention. After modeling, compared with the normal group, the rats in the model group had more high-temperature areas in the bilateral hind limbs, abnormal AI score, abnormal bilateral hind paw volume, abnormal temperature of the plantar area of the bilateral foot pads, abnormal foot pain response time, abnormal right hind ankle dorsiflexion angle, abnormal right hind paw soft tissue EB extravasation, and abnormal serum TNF-α and IL-10 levels (P<0.01, P<0.05). After the intervention, compared with the model group, the rats in each moxibustion group had decreased or disappeared high-temperature areas in the bilateral hind limbs, EB extravasated volume in the soft tissue of the right hind paw was reduced (P<0.05), and the right ankle dorsiflexion angle was increased (P<0.05), serum level of TNF-α was reduced, and level of IL-10 increased (P<0.05); the AI scores in the mild moxibustion group and the sparrow-pecking moxibustion group was decreased (P<0.01, P<0.05). After the 1st, 2nd and 3rd courses of intervention, compared with the model group, the bilateral hind paw volume of rats in each moxibustion group was decreased (P<0.05, P<0.01), and plantar heat pain reaction time was increased (P<0.05). After the 2nd course and the 3rd course of intervention, the temperature of the right hind paw pad area was decreased in each moribustion group (P<0.05); after the 3rd courses of intervention, the temperature of the left hind paw pad area was decreased in the mild moxibustion group (P<0.05). Suspension moxibustion could adjust the serum levels of TNF-α and IL-10 to improve the syndrome characteristics of RA rats of heat bi syndrome, such as joint redness, swelling, heat, pain and activity restriction. The effect of mild moxibustion is the most prominent. The findings could provide scientific basis for "moxibustion can be used for heat syndrome".

Characterizing Foot and Leg Scores for Montana's Registered Angus Cattle.

The objective of this study was to characterize foot angle and claw set scores of Montana's (USA) registered Angus cattle using a total of 4723 cattle scored: 1475 yearling bulls, 992 yearling heifers, 1044 2- and 3-year-old cows, and 1212 cows ≥ 4 years old. Yearling bulls had a 0.12 and 0.20 greater mean foot angle and claw set score, respectively, compared to yearling heifers (p < 0.01). Foot angle and claw set scores increased (p < 0.01) with advancing cow age. The combined worst foot changed quadratically with age (p < 0.01) with the majority of problem feet in cows aged 2 to 3 years and older being hind feet issues. The proportion of foot angle and claw set scores not equal to 5 increased quadratically with age (p < 0.01), with heifers having the lowest proportion of scores not equal to 5 (15.8 and 31.7%, respectively) compared to cows aged 4 years and older. Sire lines had an effect on progeny claw set (p < 0.05) and foot angle scores (p < 0.05), as well as variation of progeny foot scores. These data could potentially be used to refine expected progeny difference models.

Traumatic partial hindfoot amputation with injury to the posterior tibial artery

Introduction Talus and calcaneus fractures account for about 2 % of skeletal injury and 70 % of the foot fractures. Open fractures of the hindfoot are diagnosed in 30 %. More than half of the injuries are graded as type III according to classification of R.B. Gustilo, J.T. Anderson (1976). Injury to the posterior tibial artery is observed in 6.4 % of patients. Amputations resulting from an osseous-vascular injury and gangrene and crushed soft tissues are observed in 3-60 %.The objective was to demonstrate a rare clinical case of traumatic partial hindfoot amputation on the right side associated with open calcaneus and talus fracture and injury to the posterior tibial artery and resulted in a good outcome.Material and methods A clinical case of a 36-year-old patient who suffered a traumatic partial hindfoot amputation and injury to the posterior tibial artery.Results Restoration of the anatomy and the function of the right foot was achieved in the patient.Discussion There are no clinical guidelines and a unified classification for bone and vascular injuries and no universal method for the treatment of a combined injury including an open fracture of bones and injury to blood vessels. The choice of treatment modality, diagnosis of osteovascular injuries are produced on an individual basis depending on the external and internal factors affecting the injuries. An angiotraumatological approach used to treat the patient with the hind foot injury on the right included early primary surgical treatment of the osteovascular injury, accurate reduction and stable fixation using a sparing technique for the calcaneus, repair of the posterior tibial artery, complex drug therapy to improve blood rheology, reduce coagulability, address tissue ischemia and provide adequate regional anesthesia.Conclusion The combination of factors and use of an angiotraumatological approach employing organ sparing strategy and a multidisciplinary team of orthopaedic and trauma surgeons, angiosurgeons, anesthesiologists-resuscitators facilitated foot salvage, improved function and supportability.

107 OPEN to Change: Can District General Hospitals Deal with Open Fractures Too?

Abstract Introduction Fractures compromising soft tissues puts patients at risk of significant morbidity, therefore require timely multidisciplinary management. The British Orthopaedic Association Standard for Trauma (BOAST) Guidelines, updated December 2017, state “Patients with open fractures of long bones, hind foot or midfoot should be taken directly or transferred to a specialist centre that can provide Orthoplastic care.” Northern Ireland’s population is estimated at 1.8 million, within this there are between 370 and 500 cases of major trauma each year. Method This review looks at patients presenting to Craigavon Area Hospital in Northern Ireland, between October 2021 to October 2022, with open fractures. Results Over the study period, 41 Open fractures presented, 12 meeting criteria for transfer to a major trauma centre with orthopastic’s present as per BOAST Guidelines point 1. However, 11 patients were managed in Craigavon Area Hospital and 1 patient required transfer to a site with plastics available. Conclusions Can we learn from this same subgroup of patients? There is an ever-growing demand to major trauma centres in Northern Ireland some of the burden on which can be dealt with by DGH’s. This data should help contribute to any future updates of BOAST’s guidelines.

Investigating the effect of prophylactic claw trimming on the interval between calving and first observed elevated locomotion score in pasture-based dairy cows

ABSTRACT Aims To evaluate, in a pasture-based dairy herd, the response to a three-time point hoof trimming regime on lameness incidence and time from calving to observation of an elevated locomotion score (LS). Methods This study was conducted on a 940-cow spring-calving herd in New Zealand’s North Island between May 2018 and May 2019. Cows (n = 250) were randomly allocated to the hoof trimming group, with the remainder assigned to the non-trim cohort. One trained professional hoof trimmer used the five-step Dutch method to trim the hind feet of the trimming group. Throughout the subsequent production season, the whole herd was locomotion-scored fortnightly using the 4-point (0–3) Dairy NZ lameness score. Kaplan–Meier survival curves were used to assess the univariable effect of trimming on the interval between calving and first LS of ≥ 2 and first LS ≥ 1. A multivariable Cox proportional hazards regression was used to further evaluate the effect of trimming on time to elevated LS. Results Mean lameness (LS ≥ 2) prevalence was 2.6%, with 30% of cows having ≥ 4 observations during the study period when at least one LS was ≥ 2. For LS ≥ 1, mean prevalence was 40%, with 98.6% of cows having ≥ 4 observations during the study period when at least one LS was ≥ 1 during lactation. Hoof trimming had no apparent effect on the incidence of clinical lameness (LS ≥ 2) (trimmed vs. non-trimmed: 33.2% vs. 28.8%, respectively), but for LS ≥ 1, there was a small decrease in the incidence of LS ≥ 1 (trimmed vs. non-trimmed: 96.9% vs. 99.3%, respectively). The hazard of a cow having a first observed LS ≥ 2 in the control group was 0.87 (95% CI = 0.66–1.14) times that of the trimmed group; however, the hazard of a cow having a first LS ≥ 1 was 1.60 (95% CI = 1.37–1.88) times higher in the control than in the trimmed group. Conclusion and clinical relevance On this farm, prophylactic hoof trimming had no clinically relevant impact on the incidence of clinical lameness and was not associated with clinically beneficial reductions in time to first observed LS ≥ 2. This may be because claw horn imbalance was not pronounced on this farm, with 53% of cows needing no trim on either hind limb on the first trimming occasion. Further research on the response to prophylactic trimming in pasture-based dairy cattle is required.

Using 3D printing-assisted shaping titanium cages and Masquelet techniques to reconstruct calcaneal osteomyelitis complicated by extensive soft tissue and uncontrolled defects

ObjectiveTo investigate the clinical efficacy of three-dimensional (3D) printing-assisted shaping titanium cage combined with Masquelet technology in the treatment of calcaneal infectious defects. MethodsA retrospective analysis was performed of the data from nine patients with chronic calcaneal infection defects treated with distal gastronal flap coverage and one patient with free anterolateral thigh flap coverage, also using a 3D printing-assisted shaping titanium cage combined with both mask technology and rib autografting from January 2017 to January 2019. There were seven males and three females, with a mean age of 37 years (range, 17–52 years). The injury mechanism of the 10 patients included four motor vehicle incidents, four high fall injuries, and two rolling compactions. All patients were treated by two⁃stage procedures. The first stage included debridement, polymethyl methacrylate (PMMA) filling, and regional flap coverage. The soft tissue defect of the 10 cases included 80 cm2 in four cases and 56 cm2, 40 cm2, and 15 cm2 in each of two cases. The bone defect was 24 cm3 and 18 cm3 in each of four cases and 3 cm3 in two cases. The second stage was the mask technology of 3D printing-assisted shaping titanium cage combined with rib autografting. Time of bone union, calcaneus morphology, implant position, and the Maryland and AOFAS hind foot scores were recorded to evaluate the clinical outcome. ResultsAll 10 patients were followed up for a mean of 18.5 months (range, 12–30 months). Infection occurred in two patients 2 months after the first stage operation and were successfully treated by debridement and PMMA replacement. The incision of the other eight cases all healed successfully. Cultures from the 10 cases included five cases of methicillin-resistant Staphylococcus aureus, three cases of S. aureus, and one case each of Escherichia coli and Pseudomonas aeruginosa. All 10 patients exhibited calcaneus bone union after the second stage operation. The mean time for bone union was 4.32 (range, 3–8) months. Bone trabeculae were observed in a CT scan 13 (range, 10–22) months post-operation. The mean Maryland score at 12 months post-operation was 92 (range, 86–98) and the mean AOFAS ankle hind foot score was 89.8 (range, 83–100). ConclusionThree-dimensional printing-assisted shaping titanium cages and Masquelet technology may be effective methods for the treatment of infectious calcaneal defects.

Ultrasound-guided versus blind intraarticular injection of the foot of Egyptian buffaloes (Bubalus bubalis): A pilot study

This study was designed to compare the effectiveness of US-guided and blind IA injection techniques of buffaloes foot. Twenty adult buffalo cadaveric hind feet were randomly assigned to blind (n=10) and US-guided (n=10) injections of the fetlock, pastern, and coffin joints. Methylene blue (1%) and Iopamidol® 300 (5 ml) were used as indicative markers for IA injection. The same injection strategy was also used in vivo on 10 live sound buffaloes. The injection criteria were comparatively evaluated between the two injection techniques. The US-guided injection technique showed a significant increase in the injection parameters of the fetlock, pastern, and coffin joints in the foot of buffaloes compared with the blind technique. However, the difficulties of the injection and several trials weresignificantly higher in the blind IA injection than in the US-guided injection. The performance time was significantly shorter with the US-guided injection as compared to blind IA injection. Compared to the blind approach, US-guided injection had the highest specificity for intra-articular injection procedures at 86.66%. In conclusion, US-guided IA injection of buffaloes feet showed promising results in enhancing the quality of diagnostic and therapeutic IA injections compared to blind injections.

Ultrasound-guided versus blind intraarticular injection of the foot of Egyptian buffaloes (Bubalus bubalis): A pilot study

This study was designed to compare the effectiveness of US-guided and blind IA injection techniques of buffaloes foot. Twenty adult buffalo cadaveric hind feet were randomly assigned to blind (n=10) and US-guided (n=10) injections of the fetlock, pastern, and coffin joints. Methylene blue (1%) and Iopamidol® 300 (5 ml) were used as indicative markers for IA injection. The same injection strategy was also used in vivo on 10 live sound buffaloes. The injection criteria were comparatively evaluated between the two injection techniques. The US-guided injection technique showed a significant increase in the injection parameters of the fetlock, pastern, and coffin joints in the foot of buffaloes compared with the blind technique. However, the difficulties of the injection and several trials weresignificantly higher in the blind IA injection than in the US-guided injection. The performance time was significantly shorter with the US-guided injection as compared to blind IA injection. Compared to the blind approach, US-guided injection had the highest specificity for intra-articular injection procedures at 86.66%. In conclusion, US-guided IA injection of buffaloes feet showed promising results in enhancing the quality of diagnostic and therapeutic IA injections compared to blind injections.

Outcomes in Ankle Replacement Study (OARS).

The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures. Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics. Data from 238 patients were analyzed. There were significant improvements in MOXFQ and EQ-5D-5L among people who underwent TAA at six- and 12-month assessments compared with preoperative scores (p < 0.001). Most improvement occurred between preoperative and six months, with little further improvement at 12 months. A greater improvement in MOXFQ outcome postoperatively was associated with older age and more advanced radiological signs of ankle osteoarthritis at baseline. TAA significantly benefits patients with end-stage ankle disease. The lack of substantial further overall change between six and 12 months suggests that capturing PROMs at six months is sufficient to assess the success of the procedure. Older patients and those with advanced radiological disease had the greater gains. These outcome predictors can be used to counsel younger patients and those with earlier ankle disease on the expectations of TAA.

Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients.

Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

Integrative systematics and evolutionary history of Berylmys bowersi (Mammalia, Rodentia, Muridae).

The Bower's Berylmys (Berylmys bowersi) is one of the largest rodent species with a wide distribution range in southern China and the Indochinese Peninsula. The taxonomy and evolutionary history of the B. bowersi is still controversial and confusing. In this study, we used two mitochondrial (Cyt b and COI) and three nuclear (GHR, IRBP, and RAG1) genes to estimate the phylogeny, divergence times, and biogeographic history of B. bowersi. We also explored morphological variations among the specimens collected across China. Our phylogenetic analyses indicated that the traditional B. bowersi contains at least two species: B. bowersi and B. latouchei. Berylmys latouchei was considered a junior synonym of B. bowersi distributed in eastern China, which is confirmed to be distinguishable at specific level because of its larger size, relatively larger and whiter hind feet, and several cranial traits. The estimated split of B. bowersi and B. latouchei was at the early Pleistocene (ca. 2.00 Mya), which might be the outcome of the combined effects of climate change in the early Pleistocene and isolation by the Minjiang River. Our results highlight the Wuyi Mountains in northern Fujian, China, as a glacial refugia during the Pleistocene and call for more intensive surveys and systematic revisions of small mammals in eastern China.

Coalition excision and corrective osteotomies versus coalition excision and arthroereisis in management of pes planovalgus with talo-calcaneal coalition in adolescents: A randomized controlled trial

BackgroundTalocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, foot and ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including coalition excision only or coalition excision with hind foot arthrodesis or corrective osteotomies. However, the effect of arthroereisis after coalition excision is still questionable. Patients and methodsThirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition, who presented to our institution between September 2018 and April 2020, were prospectively analyzed. Randomization was performed by random allocation using a computer-based system into two groups: group A for coalition excision and arthroereisis, group B for coalition excision and osteotomies. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for the Social Sciences software. ResultsThirty feet in 28 patients were included in the final analysis (15 feet in each group). One patient in each group had bilateral affection. The mean age was 14.5 years, and the mean follow-up duration was 24 months. At final follow-up, the mean AOFAS was 78.8 ± 4.04 in group A and 76.73 ± 4.66 in group B, while the FAAM scores were 80 ± 5 and 79 ± 3 in groups A and B, respectively. The complication rate was higher in group A, however with no statistical significance. ConclusionThe combination of talocalcaneal coalition resection with either corrective osteotomies or arthroereisis had a significant improvement of functional and radiological outcomes in the management of rigid pes planovalgus.

Effect of acupuncture at "Houxi" (SI3) and"Huantiao" (GB30) on high mobility group box 1 protein in spinal nerve trunk of rats with lumbar disc herniation

To observe the effect of acupuncture at "Houxi"(SI3) and "Huantiao"(GB30) on high mobility group box 1(HMGB1) protein and mRNA in spinal nerve trunk(SNT) of rats with lumbar disc herniation(LDH), so as to explore the mechanisms of acupuncture at this paired points on the treatment for LDH. SD rats were randomly divided into sham operation, model, conventional acupuncture(CA) and paired points(PP) groups (with 8 rats in each group). The LDH model was established by injection of autologous suspension made from rats' own nucleus pulsus into the epidural space. Rats in the CA group received acupuncture treatment at bilateral "Weizhong"(BL40), "Dachangshu"(BL25) and "Shenshu"(BL23), while rats in the PP group received acupuncture at bilateral SI3 and GB30, 30 min each time, once daily for 14 consecutive days. The thermal pain threshold of bilateral hind feet of rats was detected by thermal pain stimulator. The contents of serum IL-1β, IL-6 and IL-8 of rats were detected by ELISA. Western blot and immunofluorescence were used to detect the expression of HMGB1 protein in the lumbar(L)5 SNT of rats. The relative expression of HMGB1 mRNA in L5 SNT was determined by qPCR. HE staining was used to observe the morphological changes of L5 SNT. Compared with the sham operation group, the thermal pain threshold of bilateral hind feet in the model group was decreased (P<0.05); compared with the model group, the thermal pain threshold of bilateral hind feet in the CA group and the PP group were increased (P<0.05). The expressions of HMGB1 protein and mRNA in L5 SNT, and the contents of serum IL-1β, IL-6 and IL-8 of rats in the model group were significantly increased(P<0.000 1, P<0.001) in contrast to the sham operation group. The expressions of HMGB1 protein and mRNA in L5 SNT, and the levels of serum IL-1β, IL-6 and IL-8 were significantly decreased (P<0.01, P<0.000 1, P<0.001, P<0.05) in the CA and PP group, in comparison with those of the model group. Compared with the CA group, the above indexes of rats in the PP group recovered more significantly (P<0.05,P<0.001, P<0.01,P<0.000 1). The histomorphological results showed scattered and various-sized nerve fibers, vacuolation, a large number of disintegrating myelin sheath and lysed Schwann cells in the model group. Myelin sheaths regeneration, regularly-arranged nerve fibers were seen in the CA group and the PP group, with more obvious histopathological recovery observed in the PP group than the CA group. Acupuncture intervention inhibites the expressions of HMGB1 protein and mRNA in rats with LDH, and further reduces the production of IL-1β, IL-6 and IL-8, which is beneficial to inflammatory response inhibition and pain alleviation. The therapeutic effect of the PP group is more obvious than that of the CA group.

Persistence of orthopaedic hoof blocks for the treatment of lame cattle kept permanently at pasture

ABSTRACT Aims To compare the retention by New Zealand dairy cows kept at pasture in a lame cow group, of three hoof block products commonly used in the remediation of lameness. Methods Sixty-seven farmer-presented Friesian and Friesian x Jersey dairy cows from a single herd in the Manawatū region (New Zealand) suffering from unilateral hind limb lameness attributable to a claw horn lesion (CHL) were randomly allocated to one of three treatments: foam block (FB), plastic shoe (PS) and a standard wooden block (WB). Blocks were applied to the contralateral healthy claw and checked daily by the farm staff (present/not present) and date of loss was recorded. Blocks were reassessed on Day 14 and Day 28 and then removed unless further elevation was indicated. Daily walking distances were calculated using a farm map and measurement software. Statistical analyses included a linear marginal model for distance walked until block loss and a Cox regression model for the relative hazard of a block being lost. Results Random allocation meant that differences between products in proportion used on left or right hind foot or lateral or medial claw were small. Mean distance walked/cow/day on farm tracks whilst the block was present was 0.32 (min 0.12, max 0.45) km/day; no biologically important difference between products in the mean distance walked was identified. Compared to PS, cows in the WB group were five times more likely to lose the block (HR = 4.8 (95% CI = 1.8–12.4)), while cows in the FB group were 9.5 times more likely to lose the block (HR = 9.5 (95% CI = 3.6–24.4)). Conclusions In this study, PS were retained for much longer than either FB or WB. As cows were managed in a lame cow group for the study duration, walking distances were low and did not impact on the risk of block loss. More data are needed to define ideal block retention time. Clinical relevance In cows with CHL the choice of block could be based on the type of lesion present and the expected re-epithelisation times.

Эндопротезирование при лечении пациентов с аваскулярным остеонекрозом таранной кости: обзор литературы

Introduction The paper discusses the main issues of treating patients with avascular osteonecrosis of the talus. The importance of the problem of treating patients with avascular osteonecrosis of the talus is explained by its high incidence, the difficulty of diagnosis in the early stages of the disease and poor treatment results with the use of traditional methods. Рurpose Based on the analysis of foreign and domestic literature, to determine the current state of the problem of surgical treatment of avascular osteonecrosis of the talus and to identify the range of possible surgical interventions in patients with the pathology under the study, to analyze in historical retrospect the arthroplasty of the talus bone due to its total involvement in the pathological process. Materials and methods The review analyzes the literature on this topic, in which 79 foreign studies, published in the period from 1911 to 2021, were selected along with 9 domestic publications for the period from 2011 to 2021. PubMed, MedLine and eLibrary Internet resources were used to search for publications. Results Based on the literature data, the issues of the history, etiology, pathogenesis, systematization and diagnosis of this disease are highlighted. The existing methods of treatment have been analyzed along with their advantages and shortcomings. Conclusion The analysis of current professional literature has demonstrated the preference of the method of talus bone arthroplasty in its total avascular osteonecrosis, in comparison with arthrodesis of the joints of the hind foot of various extent. Nowadays, the technology of arthroplasty of the talus bone is scientifically sound, biomechanically confirmed and effective for the treatment of patients with avascular osteonecrosis of the talus bone and its consequences, while the demand for this technology has been growing all over the world. There is a constant improvement of tools, technologies, methods and materials.