Duration of Type II DM, HbA1C Levels, TNF-α and IL-10 as Risk Factors for Level Charcot Joint Foot and Ankle in Type II DM Patients

Introduction: Type II Diabetes Mellitus has complications including disorders of the musculoskeletal system or what is often called diabetic charcot joint or charcot neuroarthropathy. Various risk factors are thought to increase the incidence of Charcot joint foot and ankle. Various studies have been made to assess these risk factors with the aim of reducing the occurrence of these complications. Material and Methods: The study used an analytical observational design with a case study and control approach to determine whether Type II DM II ≥ 10 years, HbA1c levels II ≥ 7%, TNF-α levels II ≥ 1.0 ng/L and IL-10 levels ≤ 255 pg/mL as factors. risk of Charcot joint foot and ankle in Type II DM patients. Where the sample involves 24 case groups and 24 control groups. Then a descriptive analysis was performed, bivariate inferential analysis using the chi-square test and an assessment of the risk factor odds ratio (OR). Then multivariate analysis was performed to assess the strength of the influence of risk factors using logistic regression test Results: There is a significant difference between Type II DM II ≥ 10 years, HbA1c levels II ≥ 7%, TNF-α levels II ≥ 1.0 ng/L, and IL-10 levels ≤ 255 pg/mL which are risk factors for the occurrence of charcot joint foot and ankle in Type II DM patients. The duration of type II DM II ≥ 10 years had the strongest relationship while IL-10 ≤ 255 pg/mL had the weakest relationship for the occurrence of Charcot joint foot and ankle in Type II DM patients. Conclusion: Increased duration of Type II DM, HbA1c level and TNF-α level above certain level and low IL-10 amount are risk factor for Charcot joint foot and ankle in Type II DM patients, with the duration of type II DM being the strongest risk factor. Key words: Diabetes mellitus type II, charcot joint foot and ankle, risk factors.

Evaluating the Validity and Reliability of the Persian Version of American Orthopedic Foot and Ankle Society Midfoot Scale

Background The use of a valid and reliable outcome scoring system is crucial for evaluating the result of different treatment interventions. The aims of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system into the Persian language and assess its validity and reliability. Method In total, 57 patients with midfoot injuries were enrolled. Forward-backward translation and cultural adaptation methods were used to develop the Persian version of AOFAS midfoot scoring system. Reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach’s alpha. The discriminant and convergent validities of the scoring system were assessed using the total score of the mental and physical component of SF-36. Results The mean age of the participants was 46.2 ± 16.3 years. The intra-observer reliability of the totals core of the Persian version of AOFAS midfoot scoring system was 0.96 (confidence interval [CI]: 0.92-0.97) and the inter-observer reliability of the scoring system was 0.90 (CI: 0.86-0.95). The Persian version of AOFAS midfoot scoring system had acceptable convergence with physical component scoring system of SF-36 and its subscales (0.57); moreover, it had acceptable discriminant validity with the mental component of SF-36 and its subscales (0.36). Conclusion The Persian version of AOFAS midfoot is a reliable and valid instrument and could be used by Persian language clinicians and researchers. Level of Clinical Evidence: 3

Comparison of the kinematics, repeatability, and reproducibility of five different multi-segment foot models

Background Multi-segment foot models (MFMs) for assessing three-dimensional segmental foot motions are calculated via various analytical methods. Although validation studies have already been conducted, we cannot compare their results because the experimental environments in previous studies were different from each other. This study aims to compare the kinematics, repeatability, and reproducibility of five MFMs in the same experimental conditions. Methods Eleven healthy males with a mean age of 26.5 years participated in this study. We created a merged 29-marker set including five MFMs: Oxford (OFM), modified Rizzoli (mRFM), DuPont (DFM), Milwaukee (MiFM), and modified Shriners Hospital for Children Greenville (mSHCG). Two operators applied the merged model to participants twice, and then we analysed two relative angles of three segments: shank-hindfoot (HF) and hindfoot-forefoot (FF). Coefficients of multiple correlation (CMC) and mean standard errors were used to assess repeatability and reproducibility, and statistical parametric mapping (SPM) of the t-value was employed to compare kinematics. Results HF varus/valgus of the MiFM and mSHCG models, which rotated the segment according to radiographic or goniometric measurements during the reference frame construction, were significantly more repeatable and reproducible, compared to other models. They showed significantly more dorsiflexed HF and plantarflexed FF due to their static offset angles. DFM and mSHCG showed a greater range of motion (ROM), and some models had significantly different FF points of peak angle. Conclusions Under the same conditions, rotating the segment according to the appropriate offset angle obtained from radiographic or goniometric measurement increased reliability, but all MFMs had clinically acceptable reliability compared to previous studies. Moreover, in some models, especially HF varus/valgus, there were differences in ROM and points of peak angle even with no statistical difference in SPM curves. Therefore, based on the results of this study, clinicians and researchers involved in the evaluation of foot and ankle dysfunction need an understanding of the specific features of each MFM to make accurate decisions.

Tips and Tricks in surgical reduction of the posterior column of AO/OTA C3 pilon fractures

Background Accurate posterior column reduction remains a challenging and controversial topic in the management of complex pilon fractures (AO/OTA C3). We aim to report the outcomes of surgical treatment for 22 AO/OTA C3 pilon fracture cases between January 2015 and May 2017 and highlight some traps and tips. Methods Three patients underwent two-stage early plating on the posterior column through a posterolateral approach. The remaining 19 patients were treated with two-stage delayed plating on the posterior column: 11 patients were treated with a posterolateral approach, five patients with a modified posteromedial approach, and three patients with a single anterior approach. The reduction of the posterior column was evaluated according to the Burwell-Charnley’s radiographic criteria, and functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scores. Results Posterior column malreduction occurred in five cases, including in one case that was re-adjusted immediately and in another case that was re-adjusted during a two-staged delayed operation. According to Burwell-Charnley’s criteria, the satisfactory rate of fracture reduction was 81.8%. After 1 year, the mean AOFAS score was 81.9 (81.9 ± 9.9); the outcome was excellent in three (20.0%), good in nine (60.0%), and fair in three (20.0%). Excellent or good outcomes were noted in 12 patients (80.0%). Conclusions The combined anterior and posterior approach is suggested in the second stage of plating so that the posterior column fragments can be re-adjusted intraoperatively, if necessary. Following these procedures, satisfactory reduction and recovery of good ankle function can be anticipated.