3D Biometrics for Hindfoot Alignment Using Weightbearing CT

BACKGROUND: Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups. METHODS: In this retrospective cohort study, 135 data sets (57 normal, 38 varus, 40 valgus) from WBCT (PedCAT; CurveBeam LLC, Warrington, PA) were obtained from a specialized foot and ankle unit. 3D coordinates of specific anatomical landmarks (weightbearing points of the calcaneus, of the first and fifth metatarsal heads and the highest and centermost point on the talar dome) were collected. These data were processed with the TALAS system (CurveBeam), which resulted in an FAO value for each case. Intraobserver and interobserver reliability were also assessed. RESULTS: In normal cases, the mean value for FAO was 2.3% ± 2.9%, whereas in varus and valgus cases, the mean was -11.6% ± 6.9% and 11.4% ± 5.7%, respectively, with a statistically significant difference among groups ( P < .001). The distribution of the normal population was Gaussian. The inter- and intraobserver reliability were 0.99 +/- 0.00 and 0.97 +/-0.02 Conclusions: This pilot study suggests that the FAO is an efficient tool for measuring hindfoot alignment using WBCT. Previously published research in this field has looked at WBCT by adapting 2D biometrics. The present study introduces the concept of 3D biometrics and describes an efficient, semiautomatic tool for measuring hindfoot alignment. LEVEL OF EVIDENCE: Level III, retrospective comparative study

Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence?

Introduction: Intramedullary locking devices (ILDs) have recently been advocated as a minimally invasive approach to manage displaced intraarticular calcaneal fractures (DIACFs), to minimise complications and improve outcomes. We reviewed clinical and biomechanical studies dealing with commercially available devices to identify their characteristics, efficacy and safety. Methods: Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting the use of ILDs for treating DIACFs. Biomechanical studies were first evaluated. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies. Results: Eleven studies were identified which investigated two devices (Calcanail®, C-Nail®). Three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Eight clinical studies (321 feet, 308 patients) demonstrated a positive clinical and radiographic outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications, while soft tissue issues (wound necrosis, delayed healing, infection) were reported in 3–5% of cases. Conversion to subtalar fusion was necessary in up to 6% of cases. Four (50%) out of 8 studies were authored by implant designers and in 5 (62%) relevant conflicts of interest were disclosed. Mean (± standard deviation) CMS was 59 ± 9.8, indicating moderate quality. Conclusions: Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short-term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications are less frequent than after open lateral approaches. The quality of evidence provided so far is moderate and potentially biased by the conflict of interest, raising concerns about the generalisability of results. Level of evidence: Level V – Review of Level III to V studies

The Future of Power System Restoration: Using Distributed Energy Resources as a Force to Get Back Online

One of the most critical risks for modern societies is a largescale power system blackout. Critical infrastructure has emergency power supplies (e.g., nuclear power plants, hospitals, or communication infrastructure) to confront power outage situations. However, after about 8 h of a blackout, fuel supplies and battery capacities normally run out. Thus, it is of utmost importance to restore the power system as robustly and quickly as possible. This responsibility lies with the transmission system operators (TS Os), and it is in their best interest to rapidly accomplish it

Functional effects of ankle sprain

Ankle sprain is one of the most common sports-related injuries and can lead to recurrences and chronic ankle instability (CAI). In the acute phase, ankle sprain patients experience mostly pain, limited ankle mobility, and reduced ankle muscle strength. CAI patients have a history of their ankle “giving way” and/or “feeling unstable,” after at least one significant ankle sprain. They continue to suffer from pain and impaired performance during functional tasks. Both acute ankle sprains and CAI have a negative influence on daily life activities such as walking, sports-related activities such as jump landings, as well as on patients’ perception of health and function. Functional deficits should be carefully assessed for appropriate clinical decision making and to propose the most suitable, individualized (physiotherapeutic) intervention. Acute ankle sprains are first treated according to the rest, ice, compression, and elevation (RICE) protocol. Nonsteroidal anti-inflammatory drugs may also be recommended for pain management. A short period of immobilization by means of a lower leg cast can facilitate rapid decrease in pain and swelling. Afterward, functional exercise therapy is recommended. In the case of CAI, patients should wear external ankle support during sporting activities to reduce the risk of recurring sprains and undergo exercise therapy including balance and muscle strengthening exercises. New technologies could be implemented in future rehabilitation programs in order to offer athletes greater flexibility in terms of training time and more varied, sports-related, exercises at home

Management of acute injuries of the tibiofibular syndesmosis

The syndesmosis is important for ankle stability and load transmission and is commonly injured in association with ankle sprains and fractures. Syndesmotic disruption is associated with between 5 and 10% of ankle sprains and 11-20% of operative ankle fractures. Failure to recognize and appropriately treat syndesmotic disruption can portend poor functional outcomes for patients; therefore, early recognition and appropriate treatment are critical. Syndesmotic injuries are difficult to diagnose, and even when identified and treated, a slightly malreduced syndesmosis can lead to joint destruction and poor functional outcomes. This review will discuss the relevant anatomy, biomechanics, mechanism of injury, clinical evaluation, and treatment of acute injuries to the ankle syndesmosis