Use of Anatomical Landmarks in Ankle Arthroscopy to Determine Accuracy of Syndesmotic Reduction: A Cadaveric Study

2019 ◽  
Vol 13 (3) ◽  
pp. 219-227 ◽  
Author(s):  
Spenser J. Cassinelli ◽  
Thomas G. Harris ◽  
Eric Giza ◽  
Christopher Kreulen ◽  
Lauren M. Matheny ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Ankle Arthroscopy ◽  
Matched Pair ◽  
P Value ◽  
Anatomical Landmarks ◽  
Foot And Ankle ◽  
Tibiofibular Ligament ◽  
Diagnostic Arthroscopy ◽  
Anterior Inferior Tibiofibular Ligament

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

scholarly journals Portable Dynamic Ultrasonography Versus Fluoroscopy for the Evaluation of Syndesmotic Instability: A Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Noortje Hagemeijer ◽  
Bart Lubberts ◽  
Jirawat Saengsin ◽  
Rohan Bhimani ◽  
Go Sato ◽  
...  
Keyword(s):  
External Rotation ◽  
Intraclass Correlation ◽  
Diagnostic Technique ◽  
P Value ◽  
Proximal Tibiofibular Joint ◽  
Diagnostic Modality ◽  
Interosseous Ligament ◽  
Cadaveric Specimen ◽  
Tibiofibular Ligament ◽  
The Us

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The purpose of this study was to determine the association between tibiofibular clear space (TFCS) values measured with 1) a portable ultrasound (US) device and 2) fluoroscopy during applied external roation stress for the evaluation of syndesmotic instability. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. Portable US device (Butterfly iQ, Butterfly Network Inc) images and fluoroscopic images taken by a mini C-arm were used to evaluate the ankle syndesmosis in the intact stage, and after sequentially sectioning of the anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL) at 7.5Nm torque. A Pearson’s correlation was performed to investigate the correlation between the TFCS among the two modalities. A paired t-test was used to compare TFCS values measured with US or fluoroscopy. Three cadavers were measured by two independent observers to assess reliability of the measurements for each diagnostic modality and analyzed using intraclass correlation coefficients (ICC). P-values of < 0.05 were considered significant. Results: The mean TFCS (+- SD mm) values measured with the US and fluoroscopy are presented in Table 1. TFCS values obtained with the US and fluoroscopy correlated (rho 0.60). Between the imaging modalities similar TFCS values were found in the intact state (difference 0.81+-1.0, p-value 0.061). Compared with fluoroscopy, the TFCS values measured using US increased significantly after sequential transection of the AITFL (0.039), IOL (p=0.004) and PITFL (p<0.001). The ICC for measuring the TFCS with US was 0.86 and 0.84 with fluoroscopy indicating excellent agreement. Conclusion: During application of an external rotation force to the ankle, US and fluoroscopic TFCS measurements among different stages of syndesmotic ligamentous injury correlate. However, compared with fluoroscopy, a portable US ultrasound device seems to be a more sensitive diagnostic technique to evaluate subtle syndesmotic instability. [Table: see text]

scholarly journals Automatic 3D dense phenotyping provides reliable and accurate shape quantification of the human mandible

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pieter-Jan Verhelst ◽  
H. Matthews ◽  
L. Verstraete ◽  
F. Van der Cruyssen ◽  
D. Mulier ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Intraclass Correlation ◽  
Three Dimensional ◽  
Correlation Coefficients ◽  
Surface Registration ◽  
Anatomical Landmarks ◽  
Centroid Size ◽  
Intraclass Correlation Coefficients ◽  
Total Variability ◽  
Automatic Phenotyping

AbstractAutomatic craniomaxillofacial (CMF) three dimensional (3D) dense phenotyping promises quantification of the complete CMF shape compared to the limiting use of sparse landmarks in classical phenotyping. This study assesses the accuracy and reliability of this new approach on the human mandible. Classic and automatic phenotyping techniques were applied on 30 unaltered and 20 operated human mandibles. Seven observers indicated 26 anatomical landmarks on each mandible three times. All mandibles were subjected to three rounds of automatic phenotyping using Meshmonk. The toolbox performed non-rigid surface registration of a template mandibular mesh consisting of 17,415 quasi landmarks on each target mandible and the quasi landmarks corresponding to the 26 anatomical locations of interest were identified. Repeated-measures reliability was assessed using root mean square (RMS) distances of repeated landmark indications to their centroid. Automatic phenotyping showed very low RMS distances confirming excellent repeated-measures reliability. The average Euclidean distance between manual and corresponding automatic landmarks was 1.40 mm for the unaltered and 1.76 mm for the operated sample. Centroid sizes from the automatic and manual shape configurations were highly similar with intraclass correlation coefficients (ICC) of > 0.99. Reproducibility coefficients for centroid size were < 2 mm, accounting for < 1% of the total variability of the centroid size of the mandibles in this sample. ICC’s for the multivariate set of 325 interlandmark distances were all > 0.90 indicating again high similarity between shapes quantified by classic or automatic phenotyping. Combined, these findings established high accuracy and repeated-measures reliability of the automatic approach. 3D dense CMF phenotyping of the human mandible using the Meshmonk toolbox introduces a novel improvement in quantifying CMF shape.

scholarly journals 600 The Use of a Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Technique in Foot and Ankle Procedures - A Randomised Control Trial

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T M Borg ◽  
M Tahir ◽  
N Heidari
Keyword(s):  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Randomised Control Trial ◽  
P Value ◽  
Foot And Ankle ◽  
Post Procedure ◽  
Trimalleolar Fractures ◽  
Post Operative Pain ◽  
Wide Awake ◽  
No Tourniquet

Abstract Introduction Wide awake local anaesthesia no tourniquet (WALANT) is a widely used technique in upper limb procedures that has gained increasing popularity during the coronavirus pandemic. The benefit of WALANT for foot and ankle surgeries is less clear, especially in patients with multiple comorbities. The primary aim of this study was to compare post-operative pain levels in patients undergoing ankle fracture fixation. Secondary objectives included comparison of intra-operative patient experiences, clinical outcomes, and patient satisfaction 1-year post-procedure. Method 129 patients presenting with ankle fractures were enrolled in a multicenter randomised control trial from February 2016 to January 2020. Patients with medial malleolar, lateral malleolar, bimalleolar or trimalleolar fractures received either WALANT (62 patients) or spinal anaesthesia (67 patients). A 5ml solution of 0.9% saline and 2% lidocaine with 1: 100,000 adrenaline was used for WALANT. Results Compared to patients who received spinal anaesthesia, those in the WALANT group experienced less post-operative discomfort and were more satisfied 1-year post-procedure (p-value = 0.003). Surgical outcomes were similar for both groups. Cost analysis revealed that WALANT is significantly more economical. Conclusions WALANT is an effective and safe anaesthetic for foot and ankle procedures. Without use of a tourniquet, it reduces post-operative pain and so, eases patient recovery.

scholarly journals Arthroscopic Posterior Ankle Ligament Anatomy

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110006
Author(s):  
Richard D. Ferkel ◽  
Cory Kwong ◽  
Randall Farac ◽  
Mark Pinto ◽  
Nader Fahimi ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Case Series ◽  
Ankle Arthroscopy ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Tibiofibular Ligament ◽  
Ankle Ligament

Background: The purpose of this article is to document the normal arthroscopic appearance of the posterior ankle capsular and ligamentous structures, and variations in their anatomical relationships. Methods: 102 ankle arthroscopy videotapes were evaluated retrospectively for the configuration of the posterior capsuloligamentous structures. Based on these observations, the variations in the appearance and position of the posterior tibiofibular ligament (PTFL) and transverse (tibiofibular) ligament (TTFL) were documented. In addition, differences in the appearance of the flexor hallucis longus (FHL) were also noted. Results: All patients had evidence of both a PTFL and TTFL, which formed a labrum or meniscus-like addition to the posterior distal tibia. No patients demonstrated disruption of the PTFL; 3 had tears of the TTFL. We noted 4 distinct patterns of the PTFL and the TTFL. Thirty-four patients (33%) had a gap of ≥2 mm between the 2 ligamentous structures. Thirty-three (32.4%) had a gap <2 mm between the PTFL and TTFL. Twenty-six (25.5%) had a confluence of the 2 ligaments without a gap. Nine (9%) demonstrated a sizable gap between the 2 ligaments, and the TTFL appeared as a “cord-like” structure. Conclusion: To our knowledge, this is the first article to describe the variations in the arthroscopic normal posterior capsuloligamentous structures and FHL of the ankle. Level of Evidence: Level IV, case series.

scholarly journals Evaluation of laparoscopic vs robotic partial nephrectomy using the margin, ischemia and complications score system: a retrospective single center analysis

2015 ◽  
Vol 87 (1) ◽  
pp. 49 ◽  
Author(s):  
Stefano Ricciardulli ◽  
Qiang Ding ◽  
Xu Zhang ◽  
Hongzhao Li ◽  
Yuzhe Tang ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Risk Groups ◽  
Matched Pair ◽  
P Value ◽  
Robotic Partial Nephrectomy ◽  
Score System ◽  
Operative Outcomes ◽  
System A ◽  
Binary Regression Analysis ◽  
The Relationship

Objective: To evaluate differences between Laparoscopic Partial Nephrectomy (LPN) and Robot-Assisted Partial Nephrectomy (RAPN) using the Margin, Ischemia and Complications (MIC) score system and to evaluate factors related with MIC success. Materials and Methods: Single centre retrospective study on 258 LPN and 58 RAPN performed between January 2012 and January 2014. Success was defined when surgical margins was negative, Warm Ischemia Time (WIT) was ≤ 20 minutes and no major complications occurred. Mann-Whitney-U and Pearson χ2 correlation were used to compare LPN and RAPN. A matched pair comparison was also performed. Spearman correlation (Rho) was used to evaluate the relationship between clinical, intra and post-operative and pathological patients characteristics with MIC score. A binary regression analysis was also performed to evaluate independent factors associated with MIC success. Results: The MIC rate in LPN and RAPN was 55% and 65.5% respectively. No differences in clinical, intra and post-operative outcomes between groups were found. Clinical tumor size (p-value: &lt; 0.001; OR: 0.829; 95% CI: 0.697-0.987), PADUA score (p-value: &lt; 0.001; OR: 0.843; 95% CI: 0.740-0.960), PADUA risk groups (intermediate; p-value: &lt; 0.001; OR: 0.416; 95% CI: 0.238- 0.792; high: p-value: &lt; 0.001; OR: 0.356; 95% CI: 0.199- 0.636), WIT (p-value: &lt; 0.001; OR: 0.598; 95% CI: 0.530- 0.675) were independently associated with MIC. eGFR (&lt; 60 vs ≥ 60 ml/min per 1.73 m2: p-value: &lt; 0.001; OR: 3.356; 95% CI: 1.701-6.621) and Fuhrman nuclear grade (p-value: 0.014; OR: 1.798; 95% CI:1.129-2.865) were also independently associated with MIC. Conclusions: MIC score system is a simple and useful tool to report and to compare different surgical approach.

scholarly journals Do the Readings of Digital and Aneroid Sphygmomanometer Concur? A Clinic-Based Study in an Urban Area of South Kolkata

2021 ◽  
Author(s):  
Aparajita Dasgupta ◽  
Foulisa Pyrbot ◽  
Bobby Paul ◽  
Soumit Roy ◽  
Pritam Ghosh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Intraclass Correlation ◽  
Research Work ◽  
P Value ◽  
Altman Plot ◽  
Cohen’S Kappa ◽  
Predictive Values ◽  
Bland Altman Plot ◽  
Cohen's Kappa

Introduction: Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. Thus, regular and accurate measurement of Blood Pressure (BP) is essential for its early diagnosis and follow-up. There is a surge in popularity of digital sphygmomanometer due to its convenience of use and functionality. In contrast, the traditional universally accepted sphygmomanometer is aneroid type, hence there arise a need for comparison of digital and universally accepted Aneroid Sphygmomanometer in terms of agreement and correlation. Aim: To evaluate the agreement and correlation between blood pressure measurement by digital and aneroid sphygmomanometer. Materials and Methods: The clinic based cross-sectional study was conducted in the Out Patient Department (OPD) of Urban Heath Centre, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India. Adults visiting the OPD on two chosen days of the week, between June 2019 to July 2019 were selected using systematic random sampling. A total of 400 participants were included. Agreement and correlation between BP measurements by digital and aneroid sphygmomanometer was analysed by Cohen’s Kappa, Bland Altman Plot along with sensitivity, specificity and predictive values using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 16.0. the p-value <0.05 was considered significant for the statistical test in the analysis. Results: Cohen’s Kappa value (0.59) revealed these two tools had moderate agreement in diagnosing hypertension. Sensitivity and specificity of digital sphygmomanometer taking aneroid sphygmomanometer as gold standard is 86% and 83.1% respectively. The BP readings of these two-tools showed moderate correlation as Intraclass Correlation Coefficient (ICC) for Systolic BP (SBP) and Diastolic BP (DBP) were 0.804 and 0.624, respectively. Bland Altman plot showed gross disagreement of SBP findings and disagreement between DBP findings was also noted. Conclusion: Digital device was found to be less accurate in detecting hypertension. Therefore, more similar research work is solicited to verify the accuracy of the very easy to use, the Digital BP monitor.

scholarly journals Functional assessment of foot and ankle tendinopathies treated with tendoscopy

2021 ◽  
Vol 15 (2) ◽  
pp. 128-132
Author(s):  
Rodrigo Guimarães Huyer ◽  
Mário Sérgio Paulillo Cillo ◽  
Carlos Daniel Cândido Castro Filho ◽  
Hallan Douglas Bertelli ◽  
Renato Morelli Berg
Keyword(s):  
Functional Assessment ◽  
Descriptive Analysis ◽  
Case Series ◽  
P Value ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Treatment Results ◽  
Duration Of Treatment ◽  
Aofas Score ◽  
Level Of Evidence

Objective: To assess postoperative clinical functional outcomes, based on the American Orthopaedic Foot & Ankle Society (AOFAS) score, of tendoscopies performed in the treatment of foot and ankle pathologies. Methods: Our comparative assessment used AOFAS scores obtained preoperatively and at early and late postoperative stages - 1 month and 6 to 12 months after surgery - of 14 patients with foot and ankle tendinopathies. These included peroneal tendon dislocation, peroneal tendonitis, and tearing of the peroneus longus or brevis, all treated with tendoscopy for peroneal reconstruction and tenorrhaphy. The AOFAS score was obtained by functional assessment during outpatient physical examination. We presented a descriptive analysis of cases, comparing scores over time through the Friedman test followed by Dunn’s test. The relationship between score variations and sex was assessed using the Mann-Whitney test; their comparison with age used Spearman’s linear correlation coefficient. Significance levels were 5%.Results: The AOFAS score showed important improvements such as preoperative scores of 56 and 67 followed by postoperative scores of 100 both in the early and late stages, supporting the efficacy and persistence of this treatment strategy. The p-value obtained after statistical analysis was <0.0001. Conclusion: We concluded that the treatment of foot and ankle comorbidities with tendoscopy, in addition to being less invasive, shows consistency and efficacy as demonstrated by the AOFAS score and functional assessment via postoperative physical examinations. AOFAS scores were increased and maintained at high levels in the postoperative period, demonstrating the efficacy of this procedure and the duration of treatment results. Level of Evidence IV; Case Series; Therapeutic Studies - Investigation of Treatment Results.

scholarly journals PENGARUH METODE PROBLEM BASED LEARNING TERHADAP MOTIVASI, KESIAPAN DAN HASIL BELAJAR

2018 ◽  
Vol 19 (1) ◽  
pp. 12-20
Author(s):  
Dina Martha Fitri ◽  
Srihartati P Pandi
Keyword(s):  
Learning Outcomes ◽  
Total Population ◽  
Problem Based Learning ◽  
Sampling Technique ◽  
Matched Pair ◽  
P Value ◽  
Probability Sampling ◽  
Dependent Variables ◽  
Quasi Experimental ◽  
Teaching Learning

The purpose of this research is to investigate the effect of problem based learning (PBL) method on motivation readiness and learning outcomes.The research employs quasi experimental design “On Group Pretest-Postest Design”. The total population is 70 students, and the samples selected is18 respondent. The sampling technique employed is non probability sampling. The results of analysis using Wilxocon Matched Pair indicates that there is significant influence of  PBL on the dependent variables, with the p-value for learning motivation, p = 0,000, study readiness, p = 0,001 and learning outcomes p = 0,001. The findings confirm that problem based learning (PBL) method has significant effects on motivation study, readiness and learning outcomes, which implies that this methods can be employed for effective teaching learning.   Penelitian ini bertujuan untuk menjelaskan pengaruh metode Problem Based Learning (PBL) terhadap motivasi, kesiapan dan hasil belajar. Jenis penelitian yang digunakan adalah quasi eksperimen (quasi eksperimental design) dengan rancangan “One Group Pretest-Posttes Design”. Jumlah populasi 70 mahasiswa dan sampel yang diambil sebanyak 18 responden. Teknik pengambilan sample dengan Non probability Sampling jenis purposive sampling. Hasil pengolahan data uji Wilcoxon Matched Pair menyatakan bahwa terdapat pengaruh dengan nilai p-value dari masing-masing variabel yaitu motivasi belajar p =0,000, kesiapan belajar p = 0,001 dan hasil belajar p = 0,001. Dari hasil penelitian ini dapat disimpulkan bahwaterdapat pengaruh signifikan penggunaan metode problem based learning (PBL) terhadap motivasi, kesiapan dan hasil. Dengan demikian metode problem based learning ini dapat menjadi bahan pertimbangan dalam upaya menghasilkan pembelajaran yang efektif.

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