Essential elements of physical fitness analysis in male adolescent athletes using machine learning.

Physical fitness (PF) includes various factors that significantly impacts athletic performance. Analyzing PF is critical in developing customized training methods for athletes based on the sports in which they compete. Previous approaches to analyzing PF have relied on statistical or machine learning algorithms that focus on predicting athlete injury or performance. In this study, six machine learning algorithms were used to analyze the PF of 1,489 male adolescent athletes across five sports, including track & field, football, baseball, swimming, and badminton. Furthermore, the machine learning models were utilized to analyze the essential elements of PF using feature importance of XGBoost, and SHAP values. As a result, XGBoost represents the highest performance, with an average accuracy of 90.14, an area under the curve of 0.86, and F1-score of 0.87, demonstrating the similarity between the sports. Feature importance of XGBoost, and SHAP value provided a quantitative assessment of the relative importance of PF in sports by comparing two sports within each of the five sports. This analysis is expected to be useful in analyzing the essential PF elements of athletes in various sports and recommending personalized exercise methods accordingly.

Isolated Subtalar Repositional Arthrodesis Compared With Triple Arthrodesis for the Treatment of Progressive Collapsing Foot Deformity.

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.

Multilocus sequence typing and antibiotic resistance of Aeromonas isolated from freshwater fish in Hebei Province.

Aeromonas spp. are the opportunistic pathogens that infect both aquatic and terrestrial homeotherms. They were commonly present in aquatic environments, including effluent, tap water, marine, river, and lake, where they are often isolated from aquatic animals, including fish, molluscs, and crustaceans. The Aeromonas infections can cause sepsis, ulcer, and other symptoms, resulting in the death of massive aquatic animals. Therefore, the prevention and control of Aeromonas is of great significance for the healthy development of aquaculture. In this study, we used modern molecular methods to enhance disease control of Aeromonas isolates from freshwater fish in Hebei Province. A total of 130 Aeromonas spp. isolates were isolated from freshwater fish farms in Hengshui, Handan, and Shijiazhuang and all 130 Aeromonas spp. isolates were sequenced for species identification. Of the 130 Aeromonas spp. isolates, 104 isolates were successfully sequenced, and BLAST analysis showed that Aeromonas veronii was predominant in freshwater fish farms in Hebei Province. In addition, 26 antibiotic resistance profiles were obtained from 102 fully cultured isolates among the 104 Aeromonas spp. isolates whose species was primarily identified, and 44 multidrug-resistant bacteria among the 102 isolates were identified using an antibiotic susceptibility test. Using the Multilocus Sequence Typing (MLST) method, 33 out of 44 multidrug-resistant isolates with 14 non-Aeromonas reference strains were selected for phylogenetic and MLST analysis, and all 33 multidrug-resistant isolates were A. veronii. A total of 30 new Sequence Types (STs) were obtained by comparing concatenated sequences (gyrB-groL-gltA-metG-ppsA-recA) on PubMLST website. Furthermore, recombination event analysis detected using RDP5 and ClonalFrameML software 42 and 49 recombination events, respectively, and 22 recombination events were validated by four or more algorithms. Since mutation and recombination events increase clonal diversity and single housekeeping gene sequence alignments are limited for identifying species, we propose the use of multiple concatenated sequence loci to increase discriminatory power. In addition, we propose that the MLST method is an appropriate technique to study and develop the resistance mechanisms of multidrug-resistant Aeromonas and to identify Aeromonas systematically in complex samples obtained from the environment.

Treatment of intractable septic ankle arthritis with a continuous closed irrigation system.

OBJECTIVES: The study aimed to evaluate the efficacy of a continuous closed irrigation system (CCIS) after open debridement for patients with intractable septic ankle arthritis. PATIENTS AND METHODS: The retrospective study analyzed the intractable septic arthritis of 12 (6 males, 6 females; mean age: 64.1±14.7 years; range, 33 to 80 years) patients managed by CCIS between July 2015 and July 2020. All patients had previously undergone operations to treat septic ankle arthritis without resolution of the infection. After open debridement, the CCIS was usually equipped with two outflow tubes and one inflow tube. Saline inflow was about 1 L per day. RESULTS: The mean follow-up period was 30.8±14.9 (range, 15 to 70) months. The CCIS was maintained for a mean of 5.1±2.1 (range, 3 to 7) days. The mean number of operations the patients had previously undergone was 2.83±1.5 (range, 1 to 6). For 11 (91.6%) out of 12 patients, infection did not recur after one-time CCIS, and laboratory test results remained normal. Six patients had previously undergone total ankle replacement arthroplasty. These patients underwent antibiotics-mixed cement arthroplasty after CCIS. For five of six with infected total ankle replacement arthroplasty, infection did not recur after CCIS. However, one patient without the removal of both implants experienced recurrence at the same site after four postoperative months. In the reoperation, after the removal of both implants and the application of antibiotics-mixed cement arthroplasty, the infection was cleared. CONCLUSION: Use of CCIS after open debridement for intractable septic ankle arthritis is a good treatment option since it is relatively simple and safe, with good results.

Effects of joint mobilization combined with acupuncture on pain, physical function, and depression in stroke patients with chronic neuropathic pain: A randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of joint mobilization (JM) combined with acupuncture (AC) for the treatment of pain, physical function and depression in poststroke patients. METHODS: A total of 69 poststroke patients were randomly assigned to the JM+AC group (n = 23), the JM group (n = 23), and the control group (n = 23). Patients in the JM+AC group and the JM group received JM for 30 minutes, twice a week for 12 weeks, and the JM+AC group received AC for 30 minutes separately once a week. The control group did not receive JM or AC. Pain (visual analog scale, shoulder pain and disability index, Western Ontario and McMaster universities osteoarthritis index), physical function (range of motion, 10-m walking speed test, functional gait assessment, manual function test, activities of daily living scale, instrumental activities of daily living scale), and depression (center for epidemiologic studies depression scale, Beck depression inventory) were assessed for each patient before and after the 12 weeks of intervention. RESULTS: Pain and physical function were improved significantly in the JM+AC group compared with the JM and control groups. Physical function and depression were improved significantly in the JM+AC and JM groups compared with the control group. CONCLUSION: The treatment of JM combined with AC improved pain, depression, and physical function of poststroke patients with chronic neuropathic pain in this study. This valuable finding provides empirical evidence for the designing therapeutic interventions and identifying potential therapeutic targets.

Excision with Temporary Interphalangeal Joint Pin Fixation for Toe Ganglion Cysts.

Background: Toe ganglion cysts are often symptomatic and recurrent. Communicating lesions between ganglion cysts and the interphalangeal joint (IPJ) or tendon sheath make it difficult to prevent a recurrence. Temporary restriction of the joint and tendon motion can facilitate surgical site healing. This study analyzed the clinical results of temporary pin fixation of the IPJ after toe ganglion cyst excision. Methods: Sixteen patients with symptomatic toe ganglion cysts underwent surgical treatment. Excision alone was initially performed on 10 patients. Six patients underwent temporary pin fixation of the IPJ after ganglion cyst excision. Repeat excision with pin fixation was performed for recurrence in two patients after excision only. Clinical evaluations and postoperative complications were analyzed. Results: Fourteen of 16 toe ganglion cysts were located near the IPJ. Two cysts not adjacent to the joint completely healed after excision alone. Seven of 14 cysts near the joint recurred after initial excision alone and required repeated reoperation. Eight cysts did not recur after excision with pin fixation, including 2 that recurred after excision alone. Conclusions: Temporary IPJ pin fixation after excision for ganglion cysts can be effective for preventing the recurrence of ganglion cysts adjacent to toe IPJ.

Relationship Between Hallux Valgus Recurrence and Sesamoid Position on Anteroposterior Standing Radiographs After Distal Chevron Metatarsal Osteotomy.

BACKGROUND: Recurrence of the hallux valgus deformity has various causes, and the incomplete reduction of sesamoids may be one of the important issues. However, we have seen several patients with postoperative lateral sesamoid displacement on anteroposterior (AP) standing radiographs who did not experience hallux valgus recurrence. Therefore, we hypothesized that lateral displacement of the sesamoid on AP standing radiographs does not cause hallux valgus recurrence. METHODS: The study included 269 feet (185 patients) with hallux valgus treated with distal chevron metatarsal osteotomy. Mean patient age was 64.26 (range, 15-80) years. Patients were followed up for an average of 33.85 (range, 12-228) months between April 2002 and December 2019. The patients were divided into 4 groups, according to the presence or absence of hallux valgus recurrence and sesamoid reduction. RESULTS: During outpatient follow-up, we discovered 99 feet (42.1%) in which hallux valgus did not recur despite lateral sesamoid displacement (grade IV-VII) on AP standing radiographs. Hallux valgus angle (HVA, 2.7 to 7.9 degrees), intermetatarsal angle (IMA, 4.6 to 6.2 degrees), and sesamoid grades (2.1 to 3.5) all deteriorated over time after surgery, and each indicator was statistically significantly altered, and changes in the 3 indicators had a statistically significant positive correlation. Changes in HVA and IMA between feet with and without sesamoid reduction on AP standing radiographs increased over time, with the differences in HVA (2.9 degrees) and IMA (0.9 degrees) being significant at final follow-up (P < .05 for each). Regardless of whether sesamoid reduction was achieved on AP standing radiographs, the final analysis showed that HVA and IMA in both groups worsened over time. Further, there were no differences between the 2 groups in the patterns of change over time. CONCLUSION: In our cohort, postoperative sesamoid position on AP standing radiographs was not associated with hallux valgus recurrence based on radiographic criteria. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Urinary Metabolomics in Young Soccer Players after Winter Training Season.

During the off-season, soccer players in Korea attend the winter training season (WTS) to build running stamina for the next season. For young soccer players, proper recovery time is needed to prevent injury or muscle damage. In this study, urinary metabolites in young players after 1, 5, and 10 days of the WTS were analyzed using nuclear magnetic resonance spectroscopy (NMR) combined with multivariate analysis to suggest appropriate recovery times for improving their soccer skills. After NMR analysis of the urine samples obtained from young players, 79 metabolites were identified, and each group (1, 5, or 10 days after WTS) was separated from the before the WTS group in the target profiling analysis using partial least squares-discriminant analysis (PLS-DA). Of these, 15 metabolites, including 1-methylnicotinamide, 3-indoxylsulfate, galactarate, glutamate, glycerol, histamine, methylmalonate, maltose, N-phenylacetylglycine, trimethylamine, urea, 2-hydroxybutyrate, adenine, alanine, and lactate, were significantly different than those from before the WTS and were mainly involved in the urea, purine nucleotide, and glucose-alanine cycles. In this study, most selected metabolites increased 1 day after the WTS and then returned to normal levels. However, 4 metabolites, adenine, 2-hydroxybutyrate, alanine, and lactate, increased during the 5 days of recovery time following the WTS. Based on excess ammonia, adenine, and lactate levels in the urine, at least 5 days of recovery time can be considered appropriate.

Improved production of heme using metabolically engineered Escherichia coli.

Heme has recently attracted much attention due to its promising applications in the food and healthcare industries. However, the current titers and productivities of heme produced by recombinant microorganisms are not high enough for a wide range of applications. In this study, the process for the fermentation of the metabolically engineered Escherichia coli HAEM7 strain was optimized for the high-level production of heme. To improve the production of heme, different carbon sources, iron concentration in the medium, pH control strategies, induction points, and iron content in the feeding solution were examined. Moreover, strategies of increasing cell density, regular iron supplementation, and supply of excess feeding solution were developed to further improve the production of heme. In the optimized fermentation process, the HAEM7 strain produced 1.03 g/L heme with productivity of 21.5 mg/L/h. The fermentation process and strategies reported here will expedite establishing industry-level production of heme.

Early Return to Daily Life through Immediate Weight-Bearing after Lateral Malleolar Fracture Surgery.

Lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for weight-bearing has not been standardized. In the present study, we investigated the prognostic difference between immediate and delayed weight-bearing on lateral malleolus fractures. The medical records of matched patients in the immediate and delayed weight-bearing groups (50 and 50, respectively) were reviewed retrospectively. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate with a lag screw. In the immediate weight-bearing group (IWB), tolerable weight-bearing (i.e., what can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight-bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise was permitted in both groups, starting from the day after surgery. Radiographic assessment data and clinical outcomes were reviewed between the two groups. No significant differences in radiographic assessments and complications were found between the two groups. Significant differences in terms of a shortened length of hospital stay and time to return to work with the IWB rehabilitation protocol compared with DWB were confirmed (6.0 vs. 9.2 days, p = 0.02 and 6.1 vs. 8.3 weeks, p = 0.02, respectively). A significant difference in sport factor was observed in the Foot and Ankle Outcome Score at 3 months postoperatively (72.3 vs. 67.4, p = 0.02). We found no significant differences between the two groups concerning postoperative radiological outcomes and complications. The benefits of shortening the time to return to work and length of hospital stay associated with the IWB rehabilitation protocol were confirmed. In conclusion, immediate weight-bearing is recommended in patients with lateral malleolus fracture after anatomical reduction and firm fixation by surgery.

Long-Term Water Quality Patterns in an Estuarine Reservoir and the Functional Changes in Relations of Trophic State Variables Depending on the Construction of Serial Weirs in Upstream Reaches.

Water quality degradation is one of the major problems with artificial lakes in estuaries. Long-term spatiotemporal patterns of water quality in a South Korean estuarine reservoir were analyzed using seasonal datasets from 2002 to 2020, and some functional changes in relations of trophic state variables due to the construction of serial weirs in the upper river were also investigated. A total of 19 water quality parameters were used for the study, including indicators of organic matter, nutrients, suspended solids, water clarity, and fecal pollution. In addition, chlorophyll-a (CHL-a) was used to assess algal biomass. An empirical regression model, trophic state index deviation (TSID), and principal component analysis (PCA) were applied. Longitudinal fluctuations in nutrients, organic matter, sestonic CHL-a, and suspended solids were found along the axis of the riverine (Rz), transition (Tz), and lacustrine zones (Lz). The degradation of water quality was seasonally caused by resuspension of sediments, monsoon input due to rainfall inflow, and intensity of Asian monsoon, and was also related to intensive anthropic activities within the catchment. The empirical model and PCA showed that light availability was directly controlled by non-algal turbidity, which was a more important regulator of CHL-a than total nitrogen (TN) and total phosphorus (TP). The TSID supported our hypothesis on the non-algal turbidity. We also found that the construction of serial upper weirs influenced nutrient regime, TSS, CHL-a level, and trophic state in the estuarine reservoir, resulting in lower TP and TN but high CHL-a and high TN/TP ratios. The proportions of both dissolved color clay particles and blue-green algae in the TSID additionally increased. Overall, the long-term patterns of nutrients, suspended solids, and algal biomass changed due to seasonal runoff, turnover time, and reservoir zones along with anthropic impacts of the upper weir constructions, resulting in changes in trophic state variables and their mutual relations in the estuarine reservoir.

Effects of trunk extensor eccentric exercise on lipid profile and glycaemic response.

OBJECTIVES: A number of previous studies reported physiological responses and adaptations after eccentric muscle contraction of limb muscles. In contrast, no study has determined physiological response after eccentric contraction of trunk muscles. The purpose of the present study was to compare the functional and metabolic changes after eccentric or concentric exercises of trunk extensor muscles. METHODS: In this randomised, crossover study, 10 men performed a single bout of 50 maximal voluntary concentric and eccentric contractions of the trunk extensor with an interval of 2 weeks between bouts. The activities of the paraspinal muscles were recorded during concentric and eccentric contractions. Muscle soreness, muscle function, blood lipid profiles and glycaemic responses were measured before, immediately after and at 24, 48, 72 and 96 hours after each bout. RESULTS: The lumbar multifidus and iliocostalis lumborum activities during eccentric contractions were significantly higher than those during concentric contractions (p<0.05). The maximal strength and muscle endurance of the trunk extensor were not decreased even after the eccentric contractions. Compared with concentric contractions, muscle soreness was significantly increased at 24, 48, 72 and 96 hours after eccentric contractions (p<0.05). The TG, TC and LDL-C were significantly lower at 48, 72 and 96 hours after eccentric contractions (p<0.05), while blood glucose levels and HOMA-IR were significantly greater at 48 and 72 hours after eccentric contractions (p<0.05). CONCLUSION: This study indicated that eccentric contractions of the trunk extensor had positive effects on the lipid profile and the glycaemic response.

Metabolic Profiling of Eccentric Exercise-Induced Muscle Damage in Human Urine.

Skeletal muscle can be ultrastructurally damaged by eccentric exercise, and the damage causes metabolic disruption in muscle. This study aimed to determine changes in the metabolomic patterns in urine and metabolomic markers in muscle damage after eccentric exercise. Five men and 6 women aged 19~23 years performed 30 min of the bench step exercise at 70 steps per min at a determined step height of 110% of the lower leg length, and stepping frequency at 15 cycles per min. 1H NMR spectral analysis was performed in urine collected from all participants before and after eccentric exercise-induced muscle damage conventionally determined using a visual analogue scale (VAS) and maximal voluntary contraction (MVC). Urinary metabolic profiles were built by multivariate analysis of principal component analysis (PCA) and orthogonal partial least square-discriminant analysis (OPLS-DA) using SIMCA-P. From the OPLS-DA, men and women were separated 2 hr after the eccentric exercise and the separated patterns were maintained or clarified until 96 hr after the eccentric exercise. Subsequently, urinary metabolic profiles showed distinct trajectory patterns between men and women. Finally, we found increased urinary metabolites (men: alanine, asparagine, citrate, creatine phosphate, ethanol, formate, glucose, glycine, histidine, and lactate; women: adenine) after the eccentric exercise. These results could contribute to understanding metabolic responses following eccentric exercise-induced muscle damage in humans.

Treatment of complex regional pain syndrome using free-flap surgery: a case report.

Complex regional pain syndrome is a chronic progressive illness with sensory, autonomic, trophic, and motor abnormalities. Treatment is difficult and controversial. We report the results of free-flap and vein wrapping of the superficial peroneal nerve surgery to treat complex regional pain syndrome.

Nonweightbearing Radiographs in Patients With a Subtle Lisfranc Injury.

BACKGROUND: A midfoot sprain can be easily missed because of minimal findings on initial radiographs, which are almost universally nonweightbearing. We investigated preoperative nonweightbearing plain radiographic images in patients who were found to have unstable subtle Lisfranc injuries. METHODS: We retrospectively reviewed 51 patients who were operated on between February 2004 and March 2015. Abnormal preoperative radiographic findings and intraoperative instability were compared. The relationship was calculated with Fisher's exact test. RESULTS: Based on intraoperative findings, medial cuneiform (C1)-second metatarsal (M2) instability was observed in 50 cases (98%), which was the most common. Thirty-nine cases (76.4 %) had multiple joint (at least 2) instability. In the preoperative radiologic findings, C1-M2 diastasis was the most common abnormal finding, in 46 cases (90.1%). Specificity and positive predictive value were 1.0 in C1-M2 avulsion, diastasis, and C1-intermediate cuneiform (C2) diastasis. Abnormal findings of C1-C2, C1-M1, and C2-M2 showed a significant relationship with intraoperative instability ( P < .05). CONCLUSION: C1-M2 avulsion and diastasis and C1-C2 diastasis were definite preoperative predictors of instability. In unstable subtle Lisfranc injuries, 90% had at least a minor radiographic abnormality at the C1-M2 joint on nonweightbearing radiographs. However, caution should be exercised to identify instability without radiographic abnormality in the C1-M2 joint. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Debridement and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair.

BACKGROUND: An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon as well as the thin surrounding soft tissue. For treatment of an infected Achilles tendon following tendon repair, we first focused on complete debridement and then promoted fibrous scar healing of the Achilles tendon using functional treatment. METHODS: We retrospectively reviewed all of the medical records of 15 tertiary referral patients with postoperative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, 22 to 97 months). The infected tissue and the necrotic tendon were debrided, and the ankle was placed in a short leg splint for 2 weeks. The splint was then replaced with an ankle brace for the next 4 weeks. Partial weight-bearing was allowed immediately, and full weight-bearing was allowed at 2 weeks postoperatively. We assessed and recorded the physical parameters such as the range of motion, calf circumference, ability to perform a single-limb heel rise, patient satisfaction, and Arner-Lindholm scale. Laboratory tests, postoperative ultrasonography, and isokinetic plantar flexion power tests were also performed. RESULTS: At a mean time of 17 days (range, 8 to 30 days) after debridement, infection signs such as discharge from the wound, redness, and local warmth resolved. The wound had healed and the stitches were removed at a mean of 17 days following the wound repair. At the time of the latest follow-up, there were no signs of active infection. Achilles tendon continuity recovered in all patients by fibrous scar healing. Compared with the contralateral side, there was no difference in the ankle range of motion in 8 patients. According to the Arner-Lindholm scale, 9 of the 15 results were excellent and 6 were good. Ten patients were able to perform a single-limb heel rise. Eleven of 15 patients returned to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity was observed on the ultrasonographic examination. CONCLUSIONS: In this retrospective series, radical debridement, combined with antibiotic therapy and functional rehabilitation, was successful in eradicating infection and maintaining function in patients with postoperative infection following Achilles tendon repair. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Enhanced muscle activity during lumbar extension exercise with pelvic stabilization.

The purpose of this study was to investigate whether pelvic stabilization affects multifidus (MF) and iliocostalis lumborum (IL) muscle activities during dynamic extension exercise. Nine males (age, 25.1±6.3 yr; height, 176.6±2.4 cm; body mass, 74.9±6.7 kg) performed an isometric lumbar extension strength test and dynamic exercise in an upright seated position with or without pelvic stabilization. The electromyography and muscle strength of the MF and IL muscles were measured when the subjects performed the isometric lumbar extension strength test at the trunk angle 110°, 146°, and 182°. In addition, the trunk extensor muscle activities were measured using 50% muscle strength of maximum isometric strength during a dynamic trunk extension exercise. The MF and IL muscle activities were significantly higher at 110°, 146°, and 182° with pelvic stabilization than that without pelvic stabilization during the isometric lumbar extension strength test (P<0.05) and the dynamic exercise (P<0.05). These results suggest that the lumbar extension exercise with pelvic stabilization may be more effective for MF and IL muscle activity compared to that without pelvic stabilization.

Cement arthroplasty for ankle joint destruction.

BACKGROUND: The aim of this study was to investigate the outcomes of cement arthroplasty used as a primary salvage procedure to treat ankle joint destruction. METHODS: This study included sixteen patients who underwent primary cement arthroplasty from May 2004 to March 2012 because of an ankle disorder, including intractable infection, nonunion, or a large bone defect or tumor. The mean age of the patients was fifty-seven years (range, twenty-three to seventy-four years), and the mean follow-up period was thirty-nine months (range, fourteen to 100 months). The cement spacer position, cement breakage, osteolysis around the inserted cement, and alignment of the joint were evaluated radiographically. American Orthopaedic Foot & Ankle Society (AOFAS) scores and visual analogue scale (VAS) pain scores were recorded preoperatively and at the time of final follow-up. Functional questionnaires were used to assess the duration for which the patient could walk continuously, use of walking aids, sports activity, consumption of pain medication, and the patient's subjective assessment of the percentage of overall improvement compared with before the cement arthroplasty. RESULTS: The cement spacer was retained without breakage for a mean of thirty-nine months (range, fourteen to 100 months). Osteolysis around the cement was observed in one patient at seventy-eight months, and subluxation developed in one patient. The mean AOFAS and VAS pain scores improved from 39 (range, 11 to 71) preoperatively to 70 (range, 47 to 88) postoperatively (p = 0.001) and from 8 (range, 4 to 9) to 3 (range, 1 to 7) (p = 0.001), respectively. At the final follow-up evaluation, nine of the sixteen patients did not require walking aids, ten used no pain medication, and nine were able to walk continuously for more than an hour. One patient complained of persistent pain and was considered to have had a failure of the procedure. CONCLUSIONS: Primary cement arthroplasty might be a treatment option for advanced ankle destruction in elderly and less active patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Calcaneocuboid Joint Subluxation After the Calcaneal Lengthening Procedure in Children.

BACKGROUND: We investigated radiographic changes of calcaneocuboid (CC) joint subluxation following calcaneal lengthening procedure for the treatment of pediatric planovalgus foot deformities. METHODS: This study included 44 cases of planovalgus foot deformities in 24 patients with mean age of 9.7 (range, 8 to 13) years who underwent calcaneal lengthening between 1999 and 2011. The mean follow-up period was 25 (range, 12 to 159) months. Anteroposterior (AP) and lateral radiographs of the weight-bearing view of the foot from immediate postoperative, 3-month postoperative, and last follow-up evaluations were reviewed and also used for trend analysis. Percentage of CC joint subluxations was measured on both AP and lateral view of the foot. Correlations between the percentage of CC joint subluxation and follow-up periods were assessed. RESULTS: All of the feet showed dorsal subluxation of their CC joint on the immediate postoperative lateral plain radiographs. The median percentage of dorsal subluxation of the CC joint improved from 26.0% (range, 10.0 to 67.0) at the immediate postoperative evaluation to 16.5% (range, 7.0 to 47.0, P = .0001) at the 3-month postoperative evaluation and to 11% (range, 2.0 to 30.0, P = .0003) at last follow-up. The trend analysis over time indicated that the CC joint subluxation percentage with calcaneal lengthening generally decreased over time (r s = -.67, P = .001). No patients showed osteoarthritic changes in the CC joint or nonunion at the calcaneal osteotomy site at last follow-up. CONCLUSION: At midterm follow-up, the CC joint subluxation was gradually resolving over time, with no evidence of osteoarthritic change in the CC joint. LEVEL OF EVIDENCE: Level IV, case series.

Congenital lesser toe abnormalities.

The treatment of congenital abnormalities of the lesser toes should be individualized to the pathology present. Goals of treatment include pain relief, proper alignment of the toes, and comfort with wearing shoes. Meticulous surgical technique can minimize complications and optimize clinical outcomes for these patients.