Madeleine Willegger

Plantar pressure characteristics in hallux valgus feet

Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push‐off. We assessed loading parameters in hallux valgus feet. Based on dorsal‐plantar weight bearing radiographs of 61 feet, the intermetatarsal‐, hallux valgus‐, distal metatarsal articulation‐angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r = −0.301, p < 0.023), the maximum force of the hallux (r = −0.481, p < 0.001), and contact time of the great toe (r = −0.448, p < 0.001), and positive correlations for force time integral (r = 0.348, p < 0.001), contact area (r = 0.307, p < 0.020), maximum force (r = 0.430, p < 0.001), and peak pressure (r = 0.361, p < 0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r = 0.294, p < 0.034), and a negative correlation between the contact area of the hallux (r = −0.232, p < 0.020) was shown. Depending on the severity, hallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet.

Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour

Resection of a primary sarcoma of the diaphysis of a long bone creates a large defect. The biological options for reconstruction include the use of a vascularised and non-vascularised fibular autograft. The purpose of the present study was to compare these methods of reconstruction. Between 1985 and 2007, 53 patients (26 male and 27 female) underwent biological reconstruction of a diaphyseal defect after resection of a primary sarcoma. Their mean age was 20.7 years (3.6 to 62.4). Of these, 26 (49 %) had a vascularised and 27 (51 %) a non-vascularised fibular autograft. Either method could have been used for any patient in the study. The mean follow-up was 52 months (12 to 259). Oncological, surgical and functional outcome were evaluated. Kaplan-Meier analysis was performed for graft survival with major complication as the end point. At final follow-up, eight patients had died of disease. Primary union was achieved in 40 patients (75%); 22 (42%) with a vascularised fibular autograft and 18 (34%) a non-vascularised (p = 0.167). A total of 32 patients (60%) required revision surgery. Kaplan-Meier analysis revealed a mean survival without complication of 36 months (0.06 to 107.3, sd 9) for the vascularised group and 88 months (0.33 to 163.9, sd 16) for the non-vascularised group (p = 0.035). Both groups seem to be reliable biological methods of reconstructing a diaphyseal bone defect. Vascularised autografts require more revisions mainly due to problems with wound healing in distal sites of tumour, such as the foot.

Elevated serum creatinine and low albumin are associated with poor outcomes in patients with liposarcoma.

Low serum albumin levels and impaired kidney function have been associated with decreased survival in patients with a variety of cancer types. In a retrospective cohort study, we analyzed 84 patients with liposarcoma treated at from May 1994 to October 2011. Uni‐ and multivariable Cox proportional hazard models and competing risk analyses were performed to evaluate the association between putative biomarkers with disease‐specific and overall survival. The median age of the study population was 51.7 (range 19.6–83.8) years. In multivariable analysis adjusted for AJCC tumor stage, serum creatinine was highly associated with disease‐specific survival (Subdistribution Hazard ratio (SHR) per 1 mg/dl increase = 2.94; 95%CI 1.39–6.23; p = 0.005). High albumin was associated with improved overall and disease‐specific survival (Hazard Ratio (HR) per 10 units increase = 0.50; 95%CI 0.26–0.95; p = 0.033 and SHR = 0.64; 95%CI 0.42–1.00; p = 0.049). The serum albumin‐creatinine‐ratio emerged to be associated with both overall and disease‐specific survival after adjusting for AJCC tumor stage (HR = 0.95; 95%CI 0.92–0.99; p = 0.011 and SHR = 0.96; 95%CI 0.93–0.99; p = 0.08). Our study provides evidence for a tumor‐stage‐independent association between higher creatinine and lower albumin with worse disease‐specific survival. Low albumin and a high albumin‐creatinine‐ratio independently predict poor overall survival. Our work identified novel prognostic biomarkers for prognosis of patients with liposarcoma.

Reliability of the Radiographic Sagittal and Frontal Tibiotalar Alignment after Ankle Arthrodesis.

Background Accurate measurement of the tibiotalar alignment is important in radiographic outcome assessment of ankle arthrodesis (AA). In studies, various radiological methods have been used to measure the tibiotalar alignment leading to facultative misinterpretation of results. However, to our knowledge, no previous study has investigated the reliability of tibiotalar alignment measurement in AA. We aimed to investigate the reliability of four different methods of measurement of the frontal and sagittal tibiotalar alignment after AA, and to further clarify the most reliable method for determining the longitudinal axis of the tibia. Methods Thirty-eight weight bearing anterior to posterior and lateral ankle radiographs of thirty-seven patients who had undergone AA with a two screw fixation technique were selected. Three observers measured the frontal tibiotalar angle (FTTA) and the sagittal tibiotalar angle (STTA) using four different methods. The methods differed by the definition of the longitudinal tibial axis. Method A was defined by a line drawn along the lateral tibial border in anterior to posterior radiographs and along the posterior tibial border in lateral radiographs. Method B was defined by a line connecting two points in the middle of the proximal and the distal tibial shaft. Method C was drawn „freestyle”along the longitudinal axis of the tibia, and method D was defined by a line connecting the center of the tibial articular surface and a point in the middle of the proximal tibial shaft. Intra- and interobserver correlation coefficients (ICC) and repeated measurement ANOVA were calculated to assess measurement reliability and accuracy. Results All four methods showed excellent inter- and intraobserver reliability for the FTTA and the STTA. When the longitudinal tibial axis is defined by connecting two points in the middle of the proximal and the distal tibial shaft, the highest interobserver reliability for the FTTA (ICC: 0.980; CI 95%: 0.966–0.989) and for the STTA (ICC: 0.997; CI 95%: 0.996–0.999) is provided. Intergroup analysis for FTTA measurements revealed a statistically significant difference between the method in which the lateral border of the tibia was used to determine the longitudinal axis of the tibia, and the other methods in which the longitudinal axis was defined by bisecting the tibia. Conclusions When the longitudinal axis of the tibia is defined by connecting two points in the middle of the proximal and the distal tibial shaft for measuring the FTTA and STTA, the most favorable interobserver reliability is provided. Therefore, this method can be recommended for evaluating the frontal and the sagittal alignment on anterior to posterior and lateral radiographs after ankle arthrodesis.

Achskorrektur am wachsenden Skelett – therapeutisches Vorgehen

ru nt er ge la de n vo n: C or ne ll. U rh eb er re ch tli ch g es ch üt zt . ABKÜRZUNGEN BLD Beinlängendifferenz CORA Center of Rotation of Angulation CWOT Closing-Wedge-Osteotomie ED Epiphysiodese HED Hemiepiphysiodese K-Draht Kirschner-Draht MAD Mechanical Axis Deviation (Abweichung der mechanischen Achse) mLDFA mechanischer lateraler distaler Femurwinkel mMPTA mechanischer medialer proximaler Tibiawinkel OS Osteosynthese OT Osteotomie OWOT Opening-Wedge-Osteotomie PETS Percutaneous Epiphysiodesis using transphyseal Screws

Achsdeformitäten am wachsenden Skelett – diagnostisches Vorgehen

ABKÜRZUNGEN AMA anatomisch-mechanischer Winkel BLD Beinlängendifferenz CCD-Winkel Centrum-Collum-Diaphysen-Winkel CORA Center of Rotation of Angulation CPT kongenitale Pseudarthrose der Tibia DMA distale mechanische Achse HKA Hip-Knee Angle JLCA Joint Line Convergence Angle LDFA lateraler distaler Femurwinkel LDTA lateraler distaler Tibiawinkel MAD Mechanical Axis Deviation (Abweichung der mechanischen Achse) MAT Malalignment-Test mLDFA mechanischer lateraler distaler Femurwinkel MPTA medialer proximaler Tibiawinkel NSA Neck Shaft Angle PMA proximale mechanische Achse XLH X-linked hypophosphatemic rickets

Serum creatinine and albumin predict sarcoma‐specific survival in patients with myofibroblastic and fibroblastic sarcomas

Recent evidence suggests that common prognostic factors predicting disease progression and survival in soft tissue sarcomas (STS) are not applicable to all STS entities, indicating the need for histotype specific evaluation of new prognosticators. This study aimed at evaluating preoperative serum creatinine, albumin, and the albumin‐creatinine ratio (ACR) as markers for survival in patients with malignant fibroblastic and myofibroblastic sarcomas. One hundred and thirty‐two patients who underwent sarcoma resection have been included. Statistical analysis comprised uni‐ and multivariable Cox proportional hazard models, competing risk analysis and Kaplan–Meier estimates. The 5‐year overall survival (OS) was estimated at 64.1% (95%CI: 53.7–72.8) and the 5‐year sarcoma‐specific mortality was 19.9% (95%CI: 12.8–28.1). Elevated serum creatinine levels were significantly associated with an impaired sarcoma‐specific survival (SSS) adjusted for tumor stage (subdistribution hazard ratio (SHR) per 1 mg/dl increase: 3.27; 95%CI: 1.87–5.73; p < 0.0001). Low serum albumin levels were associated with a shorter recurrence‐free survival (RFS) experience (HR per 10 g/L increase: 0.62; 95%CI: 0.41–0.94; p = 0.024). The ACR emerged as an AJCC‐stage‐independent prognosticator of SSS (SHR per 1 unit increase: 0.94; 95%CI: 0.90–0.98; p = 0.003). In conclusion, serum albumin and creatinine have been confirmed as predictive biomarkers for disease‐specific outcomes in myofibroblastic and fibroblastic sarcomas.

Anatomical Footprint of the Tibialis Anterior Tendon: Surgical Implications for Foot and Ankle Reconstructions

This study aimed to analyze precisely the dimensions, shapes, and variations of the insertional footprints of the tibialis anterior tendon (TAT) at the medial cuneiform (MC) and first metatarsal (MT1) base. Forty-one formalin-fixed human cadaveric specimens were dissected. After preparation of the TAT footprint, standardized photographs were made and the following parameters were evaluated: the footprint length, width, area of insertion, dorsoplantar location, shape, and additional tendon slips. Twenty feet (48.8%) showed an equal insertion at the MC and MT1, another 20 feet (48.8%) had a wide insertion at the MC and a narrow insertion at the MT1, and 1 foot (2.4%) demonstrated a narrow insertion at the MC and a wide insertion at the MT1. Additional tendon slips inserting at the metatarsal shaft were found in two feet (4.8%). Regarding the dorsoplantar orientation, the footprints were located medial in 29 feet (70.7%) and medioplantar in 12 feet (29.3%). The most common shape at the MT1 base was the crescent type (75.6%) and the oval type at the MC (58.5%). The present study provided more detailed data on the dimensions and morphologic types of the tibialis anterior tendon footprint. The established anatomical data may allow for a safer surgical preparation and a more anatomical reconstruction.

Comparison of Plantar Pressure Distribution and Functional Outcome after Scarf and Austin Osteotomy

To investigate the changes of plantar pressure distribution in patients who underwent either Austin or Scarf osteotomy and underwent a postoperative rehabilitation program.

C-reactive protein: An independent predictor for dedifferentiated chondrosarcoma: CRP PREDICTS THE DEDIFFERENTIATED CHONDROSARCOMA

Dedifferentiated chondrosarcoma is a rare primary bone malignancy with a very poor prognosis. The aim of the study was to identify pretreatment serum markers as prognostic factors for the overall survival (OS) of patients with dedifferentiated chondrosarcoma. We retrospectively reviewed 33 patients with histologically confirmed dedifferentiated chondrosarcoma treated at our department from 1977 to 2015. Kaplan‐Meier estimation, uni‐ and multivariable Cox proportional hazard model were performed to evaluate the association between serum markers such as the C‐reactive protein and OS. In univariable analysis, CRP was strongly associated with OS (HR 1.35; 95%CI 1.13–1.61; p = 0.001). This association prevailed after adjustment for AJCC tumor stage (HR 1.31; 95%CI 1.02–1.57; p = 0.031) in multivariable analysis. In conclusion, our data gave evidence that baseline CRP is an independent predictor for OS in patients with dedifferentiated chondrosarcoma. CRP could be exploited for the clinical prediction of this disease in the future.