bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative Neurophysiological Monitoring for Intradural Extramedullary Spinal Tumours
Authors: Baig Mirza Asfand , Vastani Amisha , Syrris Christoforos , Boardman Timothy , Ghani Imran , Murphy Christopher , Gebreyohanes Axumawi , Vergani Francesco , Mirallave-Pescador Ana , Lavrador Jose P. , Kailaya Vasan Ahilan , Grahovac Gordan
Published: November 2022

Study Design

Retrospective cohort study.

Objectives

Intraoperative neurophysiological monitoring (IONM) is widely used in spinal neurosurgery, particularly for intramedullary tumours. However, its validity in intradural extramedullary (IDEM) spinal tumours is less clearly defined, this being the focus of this study.

Methods

We compared outcomes for patients that underwent resection of IDEM tumours with and without IONM between 2010 and 2020. Primary outcomes were postoperative American Spinal Injury Association (ASIA) scores. Other factors assessed were use of intraoperative ultrasound, drain placement, postoperative complications, postoperative Eastern Cooperative Oncology Group (ECOG) score, extent of resection, length of hospital stay, discharge location and recurrence.

Results

163 patients were included, 71 patients in the IONM group and 92 in the non-IONM group. No significant differences were noted in baseline demographics. For preoperative ASIA D patients, 44.0% remained ASIA D and 49.9% improved to ASIA E in the IONM group, compared to 39.7% and 30.2% respectively in the non-IONM group. For preoperative ASIA E patients, 50.3% remained ASIA E and 44.0% deteriorated to ASIA D in the IONM group, compared to 30.2% and 39.7% respectively in the non-IONM group (all other patients deteriorated further). Length of inpatient stay was significantly shorter in the IONM group ( P = .043). There were no significant differences in extent of resection, postoperative complications, discharge location or tumour recurrence.

Conclusions

Research focusing on the use of IONM in IDEM tumour surgery remains scarce. Our study supports the use of IONM during surgical excision of IDEM tumours.
Idiopathic Intracranial Hypertension: An Unusual Cause of Headache in a Patient With Sickle Cell Disease
Authors: Terwilliger Toby , Hall Mary Ann Kirkconnell , Galante Eric
Published: November 2022

Idiopathic intracranial hypertension (IIH) is a rare cause of headache and visual disturbance with no known association with sickle cell disease (SCD). We present a patient with SCD with gradual onset of a severe headache and visual changes. Brain magnetic resonance imaging, angiography, and venography were nondiagnostic. Lumbar puncture established a diagnosis of IIH, and the patient had rapid improvement with large-volume lumbar puncture and acetazolamide. To our knowledge, this is the first case of IIH in a nonobese adult with SCD taking hydroxyurea, suggesting an association between SCD or hydroxyurea use and IIH. Furthermore, her clinical course demonstrates the complexities of treating IIH in patients with SCD.
Suspected Cannabis Vaping–Induced Pericardial Effusion
Authors: Maharaj Nicole , Swarath Steven , Seecheran Rajeev , Seecheran Valmiki , Seecheran Naveen Anand
Published: November 2022

Pericardial effusions refer to an excess accumulation of fluid within the pericardial cavity. The etiology is diverse, with most cases being idiopathic in nature. We report a case of suspected cannabis vaping–induced pericardial effusion in a 31-year-old South Asian patient, which was successfully managed with high-dose aspirin, colchicine therapy, and cannabis vaping cessation.

Key Clinical Message: Clinicians should be aware of the possible cardiovascular complications of cannabis vaping.
Quality of Recovery After Rotator Cuff Repair With Interscalene Liposomal Bupivacaine Versus Interscalene Nerve Catheter
Authors: Schoenherr Jay W. , Gonzalez Michael , Serrano Ricardo , Park Meredith , Lee Zachary , Cobb Kathryn , Howard Christopher , Flynn David , Li Quefeng , Grant Stuart , Bullard Ty
Published: November 2022

Background:

Interscalene nerve catheters have been proven to be effective in managing pain after rotator cuff repair (RCR) surgery. Liposomal bupivacaine is a newer approved therapy for use around the interscalene brachial plexus, but its analgesic efficacy has limited supporting data in various patient populations.

Purpose/Hypothesis:

The purpose of this study was to investigate the quality of recovery after arthroscopic RCR in patients who received either single-injection interscalene liposomal bupivacaine or an interscalene peripheral nerve catheter. It was hypothesized that interscalene peripheral nerve catheters would provide more reliable analgesia and improved patient satisfaction 48 hours after surgery.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Enrolled were 93 consecutive patients who underwent arthroscopic rotator cuff surgery at a single ambulatory surgery center between October 2020 and June 2021. Of these patients, 13 were lost to follow-up; thus, 80 patients were included in statistical analysis. One group of patients (n = 48) received a preoperative interscalene nerve block placed with 10 mL 0.5% bupivacaine and 10 mL 1.3% liposomal bupivacaine. The second group (n = 32) received a preoperative interscalene catheter with an initial bolus of 20 mL 0.25% bupivacaine and a 0.2% ropivacaine infusion by an elastomeric pump set at 10 mL/hr for 48 hours. The primary outcome was the difference between preoperative and 48-hour postoperative quality of recovery-15 (QoR-15) scores. Secondary outcomes included visual analog pain scores, opioid use, and patient satisfaction. Complications and adverse effects were also noted. The Kruskal-Wallis test was used to analyze means and standard deviations for continuous endpoints; Fisher exact test was used to analyze counts and proportions for categorical endpoints.

Results:

The liposomal bupivacaine group had a mean reduction of 3.9 in their postoperative QoR-15 scores, and the catheter group had a mean reduction of 25.1 in their postoperative QoR-15 scores, indicating a significantly worse functional recovery period compared with liposomal bupivacaine within the first 48 hours ( P < .001). Patients who received liposomal bupivacaine also had significantly lower pain scores on the second postoperative day, improved quality of sleep, and improved satisfaction with analgesia ( P < .05 for all).

Conclusion:

The use of interscalene liposomal bupivacaine demonstrated significantly improved quality of recovery when compared with interscalene nerve catheter after RCR.
Getting to the Root of the Problem: Supporting Clients With Lived-Experiences of Systemic Discrimination
Authors: Bartlett Amy , Faber Sonya , Williams Monnica , Saxberg Kellen
Published: November 2022

For many marginalized people, coping with discrimination is not a temporary condition. Rather it is endemic to living in a discriminatory society and a source of ongoing stress. In this paper, we explore the need to provide people struggling to cope with the skills to tackle not just the personal consequences of discrimination, but also to understand and address the root causes of their pain, and specifically the ones that lie outside of themselves. We propose using the concept of social capital to bring greater awareness among clients, clinicians, and society in general about the need to pair the treatment of personal distress with concurrent practices to understand and tackle larger systemic issues impacting their mental health. People with marginalized identities are often expected to find ways to cope with oppression and then sent back into a broken world, perhaps with stronger coping skills, but often ones which do not address the root cause or source of the pain, which is social injustice. We propose that it is therapeutically important to problematize, pathologize and address the systems and narratives that discriminate and cause people to need to cope, instead of focusing therapeutic interventions only on the internal resources of the person doing the coping.
A Comparison of Different Techniques for Measuring the Hindfoot Moment Arm on Weight-Bearing CT: An Inter and Intra-Observer Reliability Study
Authors: Sempson Sera , Zhu Mingjie , Gu Wanjun , Wang Chao , Sun Songmin , Zhang Ming-Zhu , Hunt Kenneth J. , Myerson Mark S. , Li Shuyuan
Published: November 2022

Category:

Hindfoot; Ankle

Introduction/Purpose:

The Hindfoot Moment Arm (HMA) has been used to evaluate the hindfoot alignment with the Saltzman weightbearing XRay images (1), and was recently introduced into the field of weightbearing CT (WBCT) by Saltzman et al (2). The authors of this study have noticed that when using the Saltzman WBCT HMA technique, it is very difficult to determine the specific 'one' image in coronal plane scans with the widest tibial diaphyseal to draw the long axis of the tibia. The purpose of this study was to introduce a modified technique of measuring HMA in WBCT scans and compare the inter and intra-observer reliabilities between the modified and the Saltzman WBCT HMA techniques.

Methods:

WBCT scans of ten healthy limbs were loaded in CubeVue software. The foot was aligned in the correct orientation in the transverse plane based on the 2nd ray and the heel and the HMA was evaluated using the modified and Saltzman techniques. Using the modified technique, the sagittal plane thickness of one scan cut was increased to include the full width and length of the tibia and the axis of the distal tibia was identified by connecting two circles tangential to both cortices of the tibia. The weightbearing point of the calcaneus was located and the HMA was evaluated by measuring the perpendicular distance of the calcaneus weightbearing point to the axis of the distal tibia with varus a negative and valgus alignment a positive value. Intraclass correlation coefficient (ICC) model was used to assess the intra- and interobserver reliability of the two HMA techniques in SAS 9.4.

Results:

Both techniques had excellent intra- and interobserver reliability (Saltzman WBCT HMA intra-observer ICC=0.97, Saltzman WBCT HMA inter-observer ICC=0.94, the modified WBCT HMA intra-observer ICC=0.99, the modified WBCT HMA inter-observer ICC=0.91) (Table 1).

Conclusion:

The modified WBCT HMA was equivalent to the Saltzman technique in both inter and intra-observer reliabilities. The authors found that the modified technique was easier and less time consuming to perform in identifying the axis of the tibia since the modified technique uses multiple cuts to restore the full thickness of tibia, which not only reduces potential error, but also saves time during measurements. Compared with a relatively shorter tibia in one cut, the reconstructed tibia provides a longer and clearer shaft to work with, which allows both proximal and distal circles to be drawn with higher precision (Figure 1). 1. Saltzman, C. L., & El-Khoury, G. Y. (1995). The hindfoot alignment view. Foot & Ankle International, 16(9), 572-576. 2. Arena, C. B., Sripanich, Y., Leake, R., Saltzman, C. L., & Barg, A. (2021). Assessment of hindfoot alignment comparing weightbearing radiography to weightbearing computed tomography. Foot & Ankle International, 42(11), 1482-1490.
Anterior Structures at Risk During Antegrade Subtalar Fusion: A Cadaver Study
Authors: Shah Ashish , Littlefield Zachary , Young Sean M. , Sanchez Thomas , Sankey Turner , Mihas Alexander K. , Young Matthew , Willis Chad B.
Published: November 2022

Category:

Hindfoot

Introduction/Purpose:

Talocalcaneal arthrodesis is the gold standard treatment for severe arthritis and has a wide range of techniques that have been described to achieve fusion. However, there is a lack of the complications associated with guide wire placement for the screw construct described in the literature. The aim of this study was to assess the proximity and structural damage to the various structures of the anterior foot resulting from guide wire placement in a top down subtalar arthrodesis procedure.

Methods:

Seven fresh-frozen below-the-knee cadaver specimens were randomly assigned to receive either a percutaneous or mini open approach for an antegrade subtalar screw placement. Blunt dissection was performed after each screw placement to determine the proximity of the anatomical structures of interest [superficial peroneal nerve (SPN), deep peroneal nerve (DPN), dorsalis pedis artery (DPA), dorsalis pedis vein (DPV), extensor hallucis longus (EHL), and the tibialis anterior (TA)] to the inserted hardware. The mean, standard deviation, and range for distances were calculated for all structures. Analysis of variance (ANOVA) was used to determine statistical significance.

Results:

Antegrade subtalar screw placement was performed percutaneously in four specimens and via a mini-open approach in three specimens. The guidewire was touching an anatomic structure of interest in the three specimens in the percutaneous groups and one specimen in the mini-open group. For the mini-open approach, the DPN, DPA, DPV, and EHL were uninjured but touching the guidewire on one cadaver. For the percutaneous approach, the DPN was uninjured but touching the guidewire on two cadavers, the DPA was uninjured but touching the guidewire on one cadaver and penetrated on a different cadaver, the DPV was uninjured but touching the guidewire on two cadavers and penetrated on a different cadaver, and the EHL was uninjured but touching the guidewire on one cadaver and penetrated on a different cadaver. Distance from each structure of interest to the screw head can be found in Table 1.

Conclusion:

This study shows the potential risks to anterior structures when placing an antegrade subtalar screw during fusion. We suggest that orthopedic surgeons exercise caution when performing critical steps of the procedure to minimize avoidable injury to structures of importance that may increase the morbidity of the patient.
Factors Affecting Patient Reported Outcomes after Surgical Fixation for a Lisfranc Injury
Authors: Shah Ashish , Young Sean M. , Littlefield Zachary , Prahad Srihari R. , Luque-Sanchez Kevin S. , Reed Logan , Young Matthew
Published: November 2022

Category:

Bunion; Other

Introduction/Purpose:

Hallux valgus is a common deformity the foot and ankle surgeon will encounter that tends to have a progressive nature with a predilection for females. There are many operative techniques to appropriately treat HV however, there is limited literature focused on patient-reported outcomes for these procedures. In particular, we intend to compare patient- reported outcomes for those who had early (2 weeks postoperatively) vs standard weight-bearing (SWB) (6 weeks postoperatively) postoperative protocols after hallux valgus correction via the Lapidus procedure.

Methods:

A retrospective analysis of patients that underwent hallux valgus correction at our facility from 2010-2021 was conducted. Patients were selected if they underwent this correction via the Lapidus procedure. Basic patient demographics, preoperative and post-operative hallux valgus angles and intermetatarsal angles were recorded, type of hardware used for fixation, postoperative weight bearing protocol, complication rate, deformity recurrence, duration of symptoms, and any adjunctive procedures were all recorded utilizing the electronic medical record. Early weight-bearing (EWB) was defined as beginning a protected weight-bearing protocol at the two week visit. To evaluate outcomes, we utilized the Foot and Ankle Ability Measure (FAAM) survey as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey.

Results:

A total of 77 patients met criteria for this study with 20 patients having completed both the FAAM and PROMIS score surveys. The average time point at which the outcomes were collected was 5.65 years postoperatively ranging from 2.43 to 11.5 years. There were 35 patients in the EWB cohort and 42 in the SWB protocol. The average PROMIS physical function, pain interference, and depression scores for the EWB population was 45.96, 54.66, and 47.48 respectively vs 47.10, 48.34, and 50.21 in the SWB group. Patients in the EWB group reported their average activities of daily living (ADLs) via the FAAM subscale to be at 57% vs 62% in the SWB group. For the FAAM Sports Subscale, both groups reported fairly low numbers at 44% and 36% respectively. In this study, 1 patient experienced wound infection, 3 patients experienced nonunion (2 EWB, 1 SWB), and 1 patient experienced deformity recurrence.

Conclusion:

Preliminary results suggest equivalent results for EWB and SWB postoperative protocol for patients undering the Lapidus procedure. We plan to increase the power of our study for a more thorough investigation as well as conduct a more intensive statistical analysis to gain more insight on patient related factors and their effect on outcomes. We expect a higher number of patients to complete the PROMIS and FAAM surveys as we continue to reach out to these patients.
Factors Affecting Patient Reported Outcomes after Surgical Fixation of Lisfranc Injury
Authors: Shah Ashish , Young Sean M. , Littlefield Zachary , Kothari Ezan A. , Young Matthew , Luque-Sanchez Kevin S. , Prahad Srihari R.
Published: November 2022

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

The Lisfranc joint accounts for a small percentage of all fractures and is typically caused by trauma, high falls, or from athletic injuries. The treatment can be divided into operative and non-operative management based on the extent of the injury. Currently, as to the best of our knowledge, there is no literature that assesses patient reported outcomes after surgical intervention for Lisfranc injuries. This study provides an overview of the relationship between PROMIS scores and overall outcomes of patients who underwent surgical management for Lisfranc injury.

Methods:

A retrospective analysis was conducted for patients that underwent Lisfranc surgical repair at our facility from 2010- 2020. Using the electronic medical record (EMR), basic patient demographics, mechanism of injury, presence of rheumatoid arthritis, osteopenia/osteoporosis, time from injury to surgery, type of intervention utilized (ORIF, pinning, arthrodesis), use of bone grafting, and surgical complications were recorded. To evaluate outcomes, we used the Patient Reported Outcomes Measurement Information System (PROMIS) survey and Foot Function Index (FFI) scores.

Results:

A total of 248 patients met the criteria for our study with 80 participants completing both the PROMIS and FFI surveys. The average PROMIS physical function, pain interference, and depression scores were reported as 43.2, 55.4, and 45.4, respectively. The average FFI scores in this population are as follows: FFI pain- 37.1, FFI disability- 34.2, FFI activity limitation- 12.35, and the average FFI total score was 30.95. There was a significant decrease in postoperative pain scores when compared to preoperative pain from 5.23 to 1.85 (p=0.046). Complications were fairly low in this population with 4 patients experiencing surgical site infection, 36 patients described problematic hardware, and 45 patients underwent revisional surgery.

Conclusion:

Preliminary results suggest surgical intervention for Lisfranc injuries may be viewed as satisfactory amongst patients. Further analysis to compare patient reported outcomes based on the type of surgical intervention, hardware used for fixation, and whether any patient demographic factors have any influence on these outcomes are being conducted. Our fairly large patient population has a time from surgery date ranging from 1.5 years to 11.2 years. We believe further analysis will also provide quality information on the long-term outcomes regarding Lisfranc injuries
Five-Year Minimum Patient-Reported Outcomes Following Isolated Gastrocnemius Recession for Plantar Fasciitis and Achilles Tendinopathy
Authors: Shah Ashish , Young Sean M. , Littlefield Zachary , Boyd Brandon , Murali Sudarsan , Young Matthew , Luque- Sanchez Kevin S.
Published: November 2022

Category:

Hindfoot; Other

Introduction/Purpose:

Plantar fasciitis and Achilles tendinopathy are common foot and ankle overuse conditions encountered in clinical practice. Treatment modalities for these diagnoses vary however, isolated gastrocnemius recession may be a viable treatment option for these conditions when conservative management has failed. There is little published on the long-term outcomes of this procedure with very few studies able to report on the five-year reported outcomes in these patients. Here, we assess patient-reported outcome in those with a minimum of five-year follow up that underwent isolated gastrocnemius resection for the above indications.

Methods:

A retrospective analysis of patients that underwent gastrocnemius recession at our facility from 2011 to 2018 was conducted. Patients were selected if they underwent an isolated gastrocnemius recession specifically due to Achilles tendinopathy or plantar fasciitis. Patients were excluded if they had a history of musculoskeletal disorders of a history of previous recession. Basic patient demographics, chronic use of fluoroquinolones and NSAIDs, duration of symptoms, presence of rheumatoid arthritis, history of previous foot and ankle operations, and surgical complications were all recorded. To evaluate outcomes, we utilized Foot Function Index (FFI) scores as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey.

Results:

A total of 141 patients met inclusion criteria with all individuals completing both the PROMIS survey and 115 completing the FFI survey. The average time point at which outcomes were collected was 6.6 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function, pain interference, and depression scores for this population was 45.67, 50.87, and 41.20, respectively. The mean FFI scores were 28.58 for pain, 36.11 for disability, 21.11 for activity limitation with an average total FFI of 31.40. Six patients developed surgical site infection, 36 patients reported postoperative symptoms of sural neuropathy with 12 reporting complete resolution of the neuropathy, and four patients required revisional surgery.

Conclusion:

With the limited data regarding the long-term outcomes of gastrocnemius recession, we sought to explore patient- reported outcomes in terms of pain, disability, physical function, depression, and pain interference. Our results prove that gastrocnemius recessions for Achilles tendinopathy and plantar fasciitis can lead to long term satisfaction for patients and can expect relatively low complication rates during the process. Additionally, the high retention rate of patients answering all required patient surveys further strengthens the findings reported here.
Long-Term Clinical and Patient-Reported Outcomes Following the Brostrom-Gould Procedure
Authors: Shah Ashish , Young Sean M. , Sanchez Thomas , Sankey Turner , Littlefield Zachary , Wordekemper Jordan , Boyd Brandon , Luque-Sanchez Kevin S. , Young Matthew , Prahad Srihari R.
Published: November 2022

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

Chronic ankle instability (CAI) is a commonly encountered condition amongst foot and ankle surgeons and is characterized by loss of function and stability of the ankle following multiple or poorly healed ankle sprains. The Brostrom- Gould procedure is a widely accepted method of addressing CAI and has been seen to produce favorable outcomes in terms of regaining ankle function and stability. While long-term clinical results of the Brostrom-Gould procedure exist in the literature, there is little published on long-term patient-reported outcomes.

Methods:

Patients that underwent the Brostrom-Gould procedure from 2011 to 2015 were identified. The electronic medical record was utilized to collect patient demographics, preoperative and postoperative diagnosis, and clinical outcomes. Patients were then surveyed to obtain PROMIS domain scores (physical function, pain interference, and depression), resiliency scores, foot and ankle ability measure (FAAM) scores, pain level, and ability to return to work postoperatively. Criteria for inclusion in our study was the successful collection of survey data.

Results:

50 patients were successfully surveyed for long-term postoperative patient-reported outcomes. Patients were surveyed at least 5 years after their original date of surgery with a median time of 6.7 (IQR 1.89) years. Four patients experienced complications including wound complications, sural nerve injury, and reflex sympathetic dystrophy. Four individuals had recurrence of instability with a median of 11.3 months (IQR 8.8) and six patients underwent reoperations. There was significant association of prior ankle instability surgery with PROMIS physical function scores (p=0.013) and being an athlete with PROMIS pain interference scores (p=0.042). Increased age was correlated with lower PROMIS functional scores (p=0.047) and lower FAAM ADL scores (p=0.044). Longer time to survey was significantly associated with an increased FAAM sports score (p=0.048). Longer time to survey was non-significantly associated with increased PROMIS functional scores (p=0.17), decreased PROMIS pain interference scores (p=0.52), and increased FAAM ADL scores (p=0.45).

Conclusion:

Patient-reported outcomes are important to measure to gain insight into the patient experience following the procedure and may be helpful in preoperative counseling. Our preliminary results suggest that longer time to follow up is associated with more favorable PROMIS domain and FAAM scores. We intend to conduct more surveys to add more power to our study.
Patient Reported Outcomes Following Hindfoot Fusion Utilizing the Triple Arthrodesis Procedure
Authors: Shah Ashish , Young Sean M. , Littlefield Zachary , Luque-Sanchez Kevin S. , Prahad Srihari R. , Young Matthew , Elphingstone Joseph
Published: November 2022

Category:

Hindfoot; Ankle Arthritis

Introduction/Purpose:

Fusions are used as a salvage procedure to improve stability and return patient to regular functions of daily activities. Triple Arthrodesis is a fusion of three joints, talonavicular, subtalar, calcaneocuboid. There is limited literature on the patient-reported long-term outcomes for this procedure. The aim of this study is to quantify the patient-reported outcomes for the Triple Arthrodesis procedure.

Methods:

A retrospective analysis was conducted for patients that underwent Triple Arthrodesis at our facility from 2014-2021. Using the electronic medical record (EMR), basic patient demographics, time since surgery, presence of osteoarthritis or rheumatoid arthritis, development of infection, nonunion, hardware failure, and history of previous foot and ankle procedures were all noted. Additionally, we recorded the hardware used during the operation and whether concomitant procedures were performed during the time of surgery. To evaluate outcomes, we used the Patient Reported Outcomes Measurement Information System (PROMIS) survey and Foot Function Index (FFI) scores.

Results:

A total of 132 patients were included in this study with 50 participants completing the PROMIS and FFI surveys. The average time point at which the outcomes were collected was 5.50 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function was 38.35, pain interference was 61.52, and depression was 49.82 for this population. The mean FFI scores were 58.56 for pain, 60.06 for disability, 48.06 for activity limitation. There was a significant decrease in postoperative pain scores when compared to preoperative pain of 5.4 to 2.55 (p=0.023). Four patients experienced wound infection, four patients experienced nonunion, six patients required revisional surgery, and three patients experienced hardware failure.

Conclusion:

Preliminary results Triple Arthrodesis may be beneficial in decreasing pain and lead variable long-term patient satisfaction. We plan to include further statistical analysis comparing the various types of fixation techniques used and the resultant PROMIS and FFI scores. Additionally, we are currently continuing patient calls to collect more completed PROMIS and FFI reports.
Surgical Fixation of Maisonneuve Fractures with a Screw Suture Fixation Device: Results of 10 Cases
Authors: Swords Michael P. , Schepers Tim , Tomlinson Matthew P. , Shank John R.
Published: November 2022

Category:

Trauma; Ankle; Sports

Introduction/Purpose:

Maisonneuve fractures consist of a fracture of the fibula in the proximal third with associated syndesmotic injury. Surgical management generally involves restoration of fibula length, reduction of the syndesmosis, and stabilization of the syndesmosis. Flexible fixation devices have gained popularity for syndesmotic fixation over the last several years. Current flexible fixation devices are not reliable for fixation of length unstable patterns of injury, like the Maisonneuve fracture. The purpose of the study was to evaluate the results of a new screw- suture syndesmotic device providing aperture fixation of the syndesmosis for fixation of Maisonneuve fractures.

Methods:

10 consecutive patients with Maisonneuve injuries were treated with indirect restoration of fibula length, open reduction of the syndesmosis, and stabilization of the syndesmosis with the screw suture device. Talocrural angle and medial clear space was measured and recorded at time of injury, post operatively and 6 months. Rate of hardware removal was recorded.***2 patients are 2 months short of 6 months. both have healed their proximal fibula fractures so no changes to data are anticipated ***

Results:

There were 5 males and 5 females. 5 patients slipped on ice, 4 patients fell on uneven walking surfaces, 1 patient was in a motorcycle accident. 2 patients had associated posterior malleolus fractures, 1 was fixed with a posterior plate. 1 patient had a medial malleolus fracture repaired with 2 screws. 9 devices were placed independently. 1 device was inserted through a 4 hole 1/3 tubular plate. Average time to surgery was 12.3 days (range 5-24 days). Talocrural angles averaged 8.92 (4.8-14.5mm) on injury films, 13.8mm (10.6-17mm) post operatively and 13.5mm (10.6-16.6) at 6 months. Medial clear space measurement averaged 5.68mm (2-10mm) on injury films, 2.06mm (1.9-2.3mm) post operatively and 2.1mm (2-2.3mm) at 6 months. No devices required removal during the study period.

Conclusion:

The screw-suture device provided length stable fixation for treatment of Maisonneuve fracture patterns.
Osteotomies Around the Knee Interfere with Alignment of the Hindfoot: A Systematic Review of Biomechanical and Clinical Studies
Authors: Van Oevelen Aline C. , Burssens Arne , Krahenbuhl Nicola , Barg Alexej , Audenaert Emmanuel , Hintermann Beat , Victor Jan M.
Published: November 2022

Category:

Hindfoot; Ankle

Introduction/Purpose:

Several emerging reports suggest an important involvement of the hindfoot alignment in the outcome of knee osteotomy. At present these studies are scattered across the literature and lack a comprehensive overview. Therefore, we aimed to systematically review all biomechanical and clinical studies investigating the role of the hindfoot alignment in the setting of osteotomies around the knee.

Methods:

A systematic literature search was conducted on following databases: Pubmed, EMBASE, Cochrane Library and Web of Science. Search terms consisted of 'knee osteotomy' combined with 'hindfoot/ankle alignment'. Inclusion criteria were all English language studies analyzing the association between knee osteotomy and hindfoot alignment comprising biomechanical or clinical outcomes. Exclusion criteria consisted of knee osteotomy performed in conjunction with total knee arthroplasty and level V studies. A quality assessment was conducted using the Quality Appraisal for Cadaveric Studies (QUACS) - and modified methodologic index for non-randomized studies (MINORS) scales. This protocol was performed according to the PRISMA guidelines and registered on PROSPERO (CRD42021277189).

Results:

Eighteen studies were confirmed eligible and consisted of a cadaveric (n=3) -, retrospective cohort (n=14) - and case- control (n=2) study design. Following knee osteotomy, biomechanical hindfoot characteristics were also positively affected (n=4), except in rigid subtalar joint (n=1) or talar tilt (n=1) deformity. Patient symptoms and/or radiographic alignment (Fig. 1a) at the level of the hindfoot did also improve after knee osteotomy (n=13). However this did not apply in case of a small pre-operative lateral distal tibia- and hip knee ankle (HKA) angulation (Fig. 1b) or in case of a large HKA correction (>14.5°). Additionally, a pre- existent hindfoot deformity (>15.9°) was associated with undercorrection of lower limb alignment following knee osteotomy. The mean QUACS score was 61.3% (range: 46-69%) and mean MINORS score was 9.2 out of 16 (range 6-12) for non-comparative and 16.5 out of 24 (range 15-18) for comparative studies.

Conclusion:

Osteotomies performed to correct knee deformity have also an impact on biomechanical and clinical outcomes of the hindfoot. In general, these are reported to be beneficial, but several parameters were identified that are associated with newly onset - or deterioration of hindfoot symptoms following knee osteotomy. These results should be interpreted in light of the moderate methodological quality of the included studies. Therefore, further prospective studies are warranted to assess how diagnostic and therapeutic algorithms based on the identified criteria could be implemented to optimize the overall outcome of knee osteotomy in relation to the foot and ankle.
Validation of the Foot and Ankle Outcome Score (FAOS) for Ankle Osteochondral Lesions
Authors: Walls Raymond J. , Azam Mohammad T. , Ellis Scott J. , Kennedy John G.
Published: November 2022

Category:

Sports; Ankle

Introduction/Purpose:

Subjective patient-reported outcome scores are routinely used to evaluate the efficacy of surgical interventions however to date none have been validated for ankle osteochondral lesions (OCL's). The foot and ankle outcome score (FAOS) is a 42 item subjective questionnaire consisting of 5 domains: pain, symptoms, function in daily activities, function in sports, and quality of life. It has been recently validated for flatfoot deformity and hallux valgus correction. The aim of this study was to validate the FAOS for ankle OCL's.

Methods:

Patients diagnosed with ankle OCL's from 2008 to 2013 were identified through the hospital foot and ankle registry. A retrospective analysis was performed to determine construct validity, where the FAOS subscales were compared with corresponding short form-12 (SF-12) subscales. Correlation was deemed moderate if the Spearman's correlation coefficient was .4 to .7. Preoperative and postoperative scores of 54 patients with OCL's were compared to determine responsiveness. Content validity was prospectively assessed in 20 patients by a separate questionnaire where patients rated the relevance of each FAOS question to their ankle OCL. A score of 2 or more was considered acceptable. Both retrospective analysis and prospective evaluation of 44 patients were used to assess test-retest reliability, which was measured using intraclass correlation coefficients (ICC's).

Results:

All of the FAOS subscales demonstrated moderate correlation with the physical health component of the SF-12. The FAOS symptoms subscale showed the least correlation, demonstrating the foot-specific nature of the questionnaire. Mental health related domains demonstrated poor correlation. All five FAOS domains are significantly responsive to change in postoperative patients (p<0.01). All domains have acceptable content validity overall, with quality of life (QoL) and function in sports the highest. Test-retest reliability was very good for all domains with ICC's above 0.8.

Conclusion:

Patient-based assessments have become increasingly important in evaluating treatment effectiveness. This study has shown that the FAOS has very good construct and content validity, reliability, and responsiveness in patients with ankle OCL's. We support its use and consider it a useful patient-based instrument for the assessment of surgical intervention
Outcomes in Ankle Fracture Surgery: A Systematic Review and Meta-Analysis of Fibular Intramedullary Nail Fixation vs Open Reduction and Internal Fixation in Randomized Controlled Trials
Authors: Walsh John P. , Hsiao Mark S. , LeCavalier Daniel , McDermott Ryland , Gupta Shivali , Watson Troy S.
Published: November 2022

Category:

Trauma; Ankle; Ankle Arthritis; Diabetes

Introduction/Purpose:

What level I evidence exists to support the use of FNF for surgical management of ankle fractures in high risk patients? The purpose of this study was to compare clinical outcomes following fibular intramedullary nail fixation (FNF) and open reduction and internal fixation (ORIF) of ankle fractures.

Methods:

A systematic review of the current literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Certainty of evidence reported according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Our primary hypothesis was that patients undergoing FNF procedures to manage an ankle fracture would have significantly higher patient reported outcome scores (PROs) than patients undergoing ORIF. Primary study outcome measures were validated PROs. Secondary outcome measures included complication rate, secondary surgery rate, and bony union.

Results:

The primary outcome analysis revealed no evidence of a significant effect difference on Olerud and Molander Ankle Score (OMAS) PRO and no evidence of statistical heterogeneity. Secondary outcome analysis revealed a significant 0.30 (0.12-0.74 95CI) relative risk reduction for complications in FNF (P=0.008). No evidence of an effect difference for bony union. No evidence of reporting bias was appreciated. Sensitivity analyses did not significantly alter effect estimates.

Conclusion:

The quality of evidence is reasonably strong and likely sufficient to conclude: (1) there is likely no clinically important difference between FNF and ORIF up to 12 months post-operatively, as defined by OMS (moderate certainty); (2) surgeons may reasonably expect reduced complications in 14 out of every 100 patients treated with FNF (moderate certainty); (3) there is likely no difference in bony union (low certainty). Future studies should investigate more patient-centered outcomes and if short-term findings are durable over time if these findings apply to lower risk populations.
Uncertainty quantification of ground motion time series generated at uninstrumented sites
Authors: Tamhidi Aidin , Kuehn Nicolas M , Bozorgnia Yousef
Published: November 2022

Following an earthquake, ground motion time series are needed to carry out site-specific nonlinear response history analysis. However, the number of currently available recording instruments is sparse; thus, the ground motion time series at uninstrumented sites must be estimated. Tamhidi et al. developed a Gaussian process regression (GPR) model to generate ground motion time series given a set of recorded ground motions surrounding the target site. This GPR model interpolates the observed ground motions’ Fourier Transform coefficients to generate the target site’s Fourier spectrum and the corresponding time series. The robustness of the optimized hyperparameter of the model depends on the surrounding observation density. In this study, we carried out sensitivity analysis and tuned the hyperparameter of the GPR model for various observation densities. The 2019 M7.1 Ridgecrest and 2020 M4.5 South El Monte earthquake data sets recorded by the Community Seismic Network and California Integrated Seismic Network in Southern California are used to demonstrate the process. To provide a tool to quantify the uncertainty of the generated motions, a methodology to develop realizations of ground motion time series is also incorporated. The results illustrate that the uncertainty of the generated motions is lower at longer periods. It is shown that the observation density in the proximity of the target site plays a vital role in both error and uncertainty reduction of the generated time series. To demonstrate the concept, the effect of additional observations from combined recording networks is investigated.
Development of a novel defined minimal medium for Gluconobacter oxydans 621H by systematic investigation of metabolic demands
Authors: Battling Svenja , Pastoors Johannes , Deitert Alexander , Götzen Tobias , Hartmann Lukas , Schröder Eliot , Yordanov Stanislav , Büchs Jochen
Published: November 2022

Background

Historically, complex media are used for the cultivation of Gluconobacter oxydans in industry and research. Using complex media has different drawbacks like higher costs for downstream processing and significant variations in fermentation performances. Synthetic media can overcome those drawbacks, lead to reproducible fermentation performances. However, the development of a synthetic medium is time and labour consuming. Detailed knowledge about auxotrophies and metabolic requirements of G. oxydans is necessary. In this work, we use a systematic approach applying the in-house developed μRAMOS technology to identify auxotrophies and develop a defined minimal medium for cultivation of G. oxydans fdh, improving the production process of the natural sweetener 5-ketofructose.

Results

A rich, defined synthetic medium, consisting of 48 components, including vitamins, amino acids and trace elements, was used as a basis for medium development. In a comprehensive series of experiments, component groups and single media components were individually omitted from or supplemented to the medium and analysed regarding their performance. Main components like salts and trace elements were necessary for the growth of G. oxydans fdh, whereas nucleotides were shown to be non-essential. Moreover, results indicated that the amino acids isoleucine, glutamate and glycine and the vitamins nicotinic acid, pantothenic acid and p-aminobenzoic acid are necessary for the growth of G. oxydans fdh. The glutamate concentration was increased three-fold, functioning as a precursor for amino acid synthesis. Finally, a defined minimal medium called ‘Gluconobacter minimal medium’ was developed. The performance of this medium was tested in comparison with commonly used media for Gluconobacter. Similar/competitive results regarding cultivation time, yield and productivity were obtained. Moreover, the application of the medium in a fed-batch fermentation process was successfully demonstrated.

Conclusion

The systematic investigation of a wide range of media components allowed the successful development of the Gluconobacter minimal medium. This chemically defined medium contains only 14 ingredients, customised for the cultivation of G. oxydans fdh and 5-ketofructose production. This enables a more straightforward process development regarding upstream and downstream processing. Moreover, metabolic demands of G. oxydans were identified, which further can be used in media or strain development for different processes.
Bibliometric analysis of fourth industrial revolution applied to heritage studies based on web of science and scopus databases from 2016 to 2021
Authors: Alviz-Meza Anibal , Vásquez-Coronado Manuel H. , Delgado-Caramutti Jorge G. , Blanco-Victorio Daniel J.
Published: November 2022

Using past material and spiritual remains, cultural heritage examines communities’ identity formation across time. Cultural heritage requires public and private institutions to care about its restoration, maintenance, conservation, and promotion. Through a bibliometric perspective, this study has analyzed, quantified, and mapped the scientific production of the fourth industrial revolution applied to heritage studies from 2016 to 2021 in the Scopus and Web of Science databases. Biblioshiny software from RStudio was employed to categorize and evaluate the contribution of authors, countries, institutions, and journals. In addition, VOSviewer was used to visualize their collaboration networks. As a main result, we found that augmented reality and remote sensing represent the research hotspot concerning heritage studies. Those techniques have become common in archaeology, as well as museums, leading to an increase in their activity. Perhaps, more recent tools, such as machine learning and deep learning, will provide future pathways in cultural heritage from data collected in social networks. This bibliometric analysis, therefore, provides an updated perspective of the implementations of technologies from industry 4.0 in heritage science as a possible guideline for future worldwide research.
On the development of an information system for monitoring user opinion and its role for the public
Authors: Karyukin Vladislav , Mutanov Galimkair , Mamykova Zhanl , Nassimova Gulnar , Torekul Saule , Sundetova Zhanerke , Negri Matteo
Published: November 2022

Social media services and analytics platforms are rapidly growing. A large number of various events happen mostly every day, and the role of social media monitoring tools is also increasing. Social networks are widely used for managing and promoting brands and different services. Thus, most popular social analytics platforms aim for business purposes while monitoring various social, economic, and political problems remains underrepresented and not covered by thorough research. Moreover, most of them focus on resource-rich languages such as the English language, whereas texts and comments in other low-resource languages, such as the Russian and Kazakh languages in social media, are not represented well enough. So, this work is devoted to developing and applying the information system called the OMSystem for analyzing users’ opinions on news portals, blogs, and social networks in Kazakhstan. The system uses sentiment dictionaries of the Russian and Kazakh languages and machine learning algorithms to determine the sentiment of social media texts. The whole structure and functionalities of the system are also presented. The experimental part is devoted to building machine learning models for sentiment analysis on the Russian and Kazakh datasets. Then the performance of the models is evaluated with accuracy, precision, recall, and F1-score metrics. The models with the highest scores are selected for implementation in the OMSystem. Then the OMSystem’s social analytics module is used to thoroughly analyze the healthcare, political and social aspects of the most relevant topics connected with the vaccination against the coronavirus disease. The analysis allowed us to discover the public social mood in the cities of Almaty and Nur-Sultan and other large regional cities of Kazakhstan. The system’s study included two extensive periods: 10-01-2021 to 30-05-2021 and 01-07-2021 to 12-08-2021. In the obtained results, people’s moods and attitudes to the Government’s policies and actions were studied by such social network indicators as the level of topic discussion activity in society, the level of interest in the topic in society, and the mood level of society. These indicators calculated by the OMSystem allowed careful identification of alarming factors of the public (negative attitude to the government regulations, vaccination policies, trust in vaccination, etc.) and assessment of the social mood.