bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Health Coaching in Early-Stage Chronic Kidney Diseases in Patients With Diabetes
Authors: Lin Ching-Ling , Chang Yao-Tsung , Huang Li-Chi , Chen Ruey-Yu , Yang Shwu-Huey
Published: December 2024

This study aimed to look into the effectiveness of a 6-month health coaching intervention on kidney function in treating patients with type 2 diabetes and early-stage chronic kidney disease (CKD). It was conducted via a two-armed, randomized-controlled trial involving 92 diabetic patients who were regularly followed under the shared care system at a medical center in Taiwan. The intervention group had health coaching and usual care, while the control group had usual care only. During the 6 months, there was a significant improvement in kidney function in those patients who experienced significant worsening of eGFR prior to enrollment. The intervention group significantly improved their eGFR up to 7.92 ( SD = 8.32, p = .003) and 7.63 mL/min/1.73 m2 ( SD = 9.71, P < .001) within the 3-month and 6-month coaching, respectively, and the control group, neither eGFR nor urinary albumin/creatinine ratio (UACR) changed significantly during the trial. In addition, concurrent use of nutrition supplements at baseline is an essential factor in the effectiveness of intervention in this study. Based on the results of this study, health coaching may help protect kidney function for some patients with type 2 diabetes with early-stage CKD. It should raise awareness and attention to early-stage CKD and public education on the proper use of healthy nutrition supplements. Further studies on this issue with higher-quality evidence and a larger sample size are needed.
Neighborhood social contact and cohesion mediate the relationship between subjectively perceived artificial light at night and mental wellbeing
Authors: Li Hansen , Yang Ying , Liu Qian , Zhang Xing , Yin Mingyue , Zhang Guodong , Cao Yang
Published: December 2024

Artificial Light at Night (ALAN) may improve health by promoting increased social activity. However, this hypothesis still lacks empirical evidence. In this study, we conducted an online survey to investigate the relationship between both subjective and objective measures of artificial light at night (ALAN) and mental wellbeing among 646 adults across 27 provinces in China. Additionally, we explored the potential mediating role of social contact and social cohesion within neighborhoods. Objective ALAN data were obtained through remote sensing technologies, while subjective ALAN exposure, social contact, and social cohesion were assessed via pre-established survey instruments. We found a non-linear relationship between subjective ALAN and mental wellbeing: subjective ALAN scores within the range of 6–11 (out of a total of 11) were positively correlated with mental wellbeing. This association was largely explained by neighborhood social contact and social cohesion, particularly among men. These results underscore the bright side of ALAN and provide a mechanism for understanding the health benefits of ALAN.
The association between adult attachment and quality of life in stroke patients: The mediating roles of fear of disease progression and stigma
Authors: Fan Jun-Ying , Zhao Qing , Jiang Shu-Min , Zhu Lin-Lin , Guo Yu-Fang
Published: December 2024

This study, conducted in China, aimed to investigate the association between adult attachment and quality of life in stroke patients, and to explore the underlying mechanisms. Questionnaires were administered using the Experiences in Close Relationships Inventory, Fear of Progression Questionnaire-Short Form, Stroke Stigma Scale and World Health Organization Quality of Life-BREF. The sample consisted of 242 participants, with a mean age of 60.33 years; 81 were women and 161 were men, and 92.98% had an ischaemic stroke. The results indicated that attachment avoidance was negatively associated with the quality of life in these patients. Additionally, fear of disease progression and stigma mediated the association between adult attachment and patients’ quality of life. These findings contribute to a deeper understanding of the psychological factors associated with quality of life in stroke patients, offering valuable insights for developing clinical practices and intervention strategies.
Towards necessities and challenges of implementing translanguaging pedagogy in secondary EFL education in China
Authors: Wang Fei , Ai Bin
Published: December 2024

Translanguaging pedagogy has drawn increasing attention from language educators worldwide, and its underlying ideologies and pedagogical affordances and challenges have been strongly debated. In this article, the researchers examined the perceptions of a cohort of pre-service teachers of English as a foreign language (EFL) at a teachers’ university in inland China to explore the necessities and challenges of implementing translanguaging pedagogy in secondary EFL education. Drawing upon data from interviews, focus group interviews, group discussion, reflective essays, and classroom observation, researchers found that these pre-service teachers readily accept the concept of translanguaging pedagogy, which demonstrates their usage-based and decolonial stance towards English education. However, most participants’ understanding of translanguaging pedagogy remains spontaneous rather than at the strategic level. Participants report challenges to this pedagogy, particularly from the high-stake, examination-oriented EFL education system and stakeholders’ pervasive monolingual ideology. The article concludes with a call to reform the examination-oriented EFL education system toward a usage-based and holistic language education to initiate policies to legitimize translanguaging pedagogy, and to design a systematic translanguaging-oriented curriculum, activities, and assessment for EFL education.
Optimization of strength properties of bamboo mesoparticles reinforced polyamide 6 using Box–Behnken approach
Authors: Adel Salih Abeer , Zulkifli Rozli , Azhari Che Husna
Published: December 2024

Bamboo mesoparticles were used as a viable alternative reinforcement in matrix polymers to produce eco-friendly products, and the alternative mesoparticles were used as reinforcement for cheaper processing methods and comparable mechanical properties as nanoparticle. The main factors that influence the mechanical behavior of natural composites are fiber size, fiber loading, and chemical treatment. This study optimized the blending parameters of bamboo mesoparticle/polyamide 6 composites through response surface methodology based on Box–Behnken design. The predicted strength values for these composites as a function of independent variables were obtained from the analysis of variance statistical approach. The analysis of the results showed that fiber size, fiber loading, and alkali concentration variables significantly in quadratic model terms. This model was used to determine the maximum strength, and it was closely in agreement with the experimental finding with the value of R2 = 0.9385. The optimum conditions for tensile strength were identified as fiber size 1 µm, NaOH of 2 wt.%, and fiber loading of 18 wt.%. The optimum conditions for flexural strength were identified as NaOH of 2 wt.%, particle loading of 13 wt.%, and particle size of 0.46 µm.
Combustion system optimization and knock characteristics of a two-stroke rod-less opposed-piston engine
Authors: Zhu Zhaojun , Li Yikai , Xie Yong , Sun Chenghan , Yang Ziming
Published: December 2024

Recently, the use of aviation kerosene in small unmanned aerial vehicles has attracted widespread attention because of it being safer than gasoline during transportation, storage, and use. However, for increased power density, further research is required on (i) detonation under low speed and high load and (ii) combustion instability under high speed and low load. Here, a direct-injection combustion system is designed, then how the fuel injection and spark strategy influence the combustion and knock intensity of a two-stroke rod-less opposed-piston spark-ignition kerosene engine is evaluated under different conditions. The results indicate that the flame propagation speed, equivalence ratio distribution, and flow field interact with each other. The equivalence ratio distribution and flow field influence the ignition and flame propagation processes, while the pressure waves generated during flame development also affect the equivalence ratio distribution and in-cylinder flow field. When the start of injection is at −65° and the spark timing is at −15° crank angle after inner dead center (CA AIDC), the indicated power (8.94 kW) and combustion efficiency (94.1%) are maximum under high speed and low load. The intrinsic mechanism is influenced mainly by the mixture distribution, which further affects flame propagation. Knocking combustion occurs where the flame reaches last, corresponding to the region of reverse swirl near the spark plug due to the higher swirl intensity. In this area, the CH2OH concentration increases, and the mixture undergoes low-temperature spontaneous ignition.
Assessing the influence of EGR on diesel pilot ignition combustion with methane/hydrogen blends in a single-cylinder compression ignition engine
Authors: Tyrewala Daanish S , Rothamer David , Ghandhi Jaal
Published: December 2024

This paper experimentally investigates the impact of EGR on the combustion performance and emissions of methane/hydrogen blends for the diesel pilot ignition (DPI) combustion strategy. Different speed/load cases were evaluated on a single-cylinder compression ignition engine for hydrogen energy shares ranging from 0% to 20%. As hydrogen was added to the premixed mixture, the combustion phasing (CA50) was held constant by either adjusting the pilot start of injection (SOI) timing or using EGR at constant intake pressure (varying premixed equivalence ratio). The experimental results show that the use of EGR at constant intake pressure with methane/hydrogen blends leads to lower unburned hydrocarbon (UHC), carbon-monoxide (CO), and nitric oxide (NO) emissions when compared to the methane-only baseline. Adiabatic flame temperature calculations were used to help explain the observed engine out nitric oxides (NOx) emissions trends. The UHC emissions, however, were significantly higher than the baseline split-injection diesel case due to incomplete combustion and crevice effects. Combustion efficiency improved without a thermal efficiency reduction with hydrogen addition, suggesting that substitution with hydrogen can be beneficial for dual-fuel compression ignition strategies that utilize natural gas. The decay rate for CH4 and H2 was more than linear, which is attributed to the chemical effects of hydrogen addition and EGR.
Multi-modal model updating of miter gates on navigational locks
Authors: Fillmore Travis B. , Wang Shuo , Thurmer Clayton , Eick Brian A. , Spencer Billie F.
Published: December 2024

Navigational locks and dams enable barge traffic, which is critical to the U.S. economy. Unscheduled lock outages are often caused by miter gate failures, which can be prevented with up-to-date structural health information. While strain gages have been deployed on several miter gates for monitoring, intuitively interpreting structural health information from the measurements is difficult. Consequently, some researchers proposed using strain measurements to update a numerical model of the miter gate and employed this updated model to estimate the structural state of the miter gate. However, strain gages alone are often inadequate for effective model updating because strain gages only provide information in the vicinity of the gage; thus, effective model updating would require a dense installation of strain gages, which is prohibitively expensive, both in installation and maintenance costs. Recently, researchers proposed computer vision techniques to collect additional information for model updating. Particularly, an optical flow technique using a sequence of camera images of the miter gate was employed to produce vision-based global displacements for broad regions of the structure. In contrast to a strain gage system, installation and maintenance of a camera system has potentially low costs. While promising, researchers found that the motion of the camera, often experienced during field measurements, limited the accuracy of measurements. Moreover, they did not take advantage of the existing measured strain data. This research proposes a multi-modal model updating strategy that handles camera ego-motion through measurement parameterization. The measured strains are combined with vision-based displacements to provide comprehensive coverage of the structure. The proposed approach is then applied to the miter gate at The Dalles Lock and Dam in Oregon. The results demonstrate the proposed multi-modal model updating strategy provides an effective tool for monitoring the state of miter gates and has the potential to significantly improve the management of navigational infrastructure.
The Effects of Online Parenting Programs on Caregiver Reports of Child Maltreatment: A Systematic Review and Meta-Analysis
Authors: Zhang Huiping , He Hong , Yu Yuehui , Liu Shiqin
Published: December 2024

Although online parenting programs have been growing fast recently, their effects on child maltreatment remains unknown. This meta-analysis aims to estimate the effectiveness of online parenting programs on child maltreatment-related outcomes and examine potential moderators associated with intervention effects. Seven electronic databases were systematically searched for quasi-experimental and randomized controlled trials published before January 15, 2024. Sixteen studies were included, which yielded 24 effect sizes. The overall effect indicated significant reductions in caregiver reports of child maltreatment (standardized mean difference [SMD] = −0.17, 95% CI [−0.30, −0.04]), with the most substantial effects on improving inappropriate parenting attitudes and cognition (SMD = −0.63 [−1.11, −0.16]). Subgroup analyses revealed that intervention location and sample source significantly moderated the effectiveness of online parenting programs, with studies conducted outside the United States and recruiting participants from primary care clinic settings showing larger effect sizes. Additionally, interventions without human interactions or action tasks, targeting individuals, delivered asynchronously, and with shorter durations showed larger effects. These findings suggest that online parenting program is a promising strategy in preventing child maltreatment, and future research can develop more effective online parenting programs to protect children.
Health Management and Time-Use With Tetraplegia: A Narrative Inquiry
Authors: Balser Amanda E. , Howell Dana M. , Colaianni Donna
Published: December 2024

Little is known about time-use related to health management of individuals with tetraplegia (motor and/or sensory loss originating in the cervical spine) and the influence on participation in occupations. The purpose was to explore the time-use of an individual with tetraplegia to understand factors that contributed to changes in health-management routines over time. Narrative inquiry was used to collect data via observation, time-use log, and interviews. Five interpretive stories emerged: Caregivers, Relationships, and Learning Self-Efficacy; Framing the Morning Routine with Positive Thinking; Caregivers Become My Hands: The Art of Doing; Discovering Meaning and Life-Purpose; and Schedules and Waiting: Disability Shaping Occupation and Time-use. The stories illustrated how situational contexts disrupted his engagement in routines and reliance on caregivers. These findings may help clinicians better understand the lived experience of clients with tetraplegia to design interventions that appreciate the changing nature of disability over time.
Policing harm reduction: A case study of who counts as human
Authors: Snyder Sarah N , Voronka Jijian , Guta Adrian , Pilling Merrick Daniel
Published: December 2024

The debate over whether or not to have police officers carry naloxone was waged long enough in Windsor, Ontario that it became referred to in the local media as “the naloxone issue.” Compared to other cities and towns in the Canadian province, Windsor was slow to equip police officers with the life-saving drug that reverses the effects of opioid overdose. In this paper, we document the unhurried development of this particular harm reduction measure as it unfolded over the course of several years. We draw on theories of human disposability in our analysis of the debates and discussions conveyed through media coverage of the naloxone issue. In doing so, we develop an account for the resistance to a rapid implementation of harm reduction in Windsor, especially given the compounded crises of escalating opioid-related deaths and the COVID-19 pandemic. Examining the logics underpinning major, minor, and left unsaid positions taken in discussions and debates on the naloxone issue as conveyed through press media, we show how, ideologically, the lives of people who use drugs (PWUD) are not only less valued, but made into wasted life. Underlying police and city administrations’ delay in equipping police officers with naloxone is an understanding of PWUD as disposable. The naloxone issue was turned into a controversy, demonstrating that the humanity of PWUD is up for debate. In contrast, the humanity of police officers is regarded as self-evident. We conclude by arguing that the eventual decision to equip all Windsor police officers with naloxone was made in the name of police safety, in particular as a way of protecting police from homeless bodies, constructed as both dangerous and drug-using, thereby revealing that the crux of the controversy was actually about whose life is worth protecting.
Critical assessment of an aging phenomenological model for building materials
Authors: Charaka Achraf , Berger Julien , Belarbi Rafik
Published: December 2024

The description of aging of construction materials represents a significant issue. According to previous studies, aging is addressed by using experimental approaches which consist in submitting materials to accelerated aging designs in the laboratory. Then, the effect is highlighted by performing measurements at different stages of material aging. These discrete configurations are considered to evaluate the impact of aging at the building scale. Within this context, this research proposes a phenomenological model that describes the aging of a material over time. It assesses the variation in porosity depending on drying and imbibition loads, each expressed by means of an indicator. Also, a cumulative and a moving approach are used to express each load. Afterwards, the model unknown parameters are estimated by solving an inverse problem. The results of the estimation are obtained based on experimental observations of an aging experimental design on hemp concrete. For each load approach, it is shown that the model fits good most of porosity measurements. In particular, the moving approach is better adapted to study the aging of materials. Further, the model of porosity is integrated into equations of heat and mass transfer within porous media. The objective consists in evaluating the impact of aging, with a continuous approach, on the energy efficiency of the material at the wall scale. Based on a case study, the impact is evaluated by assessing the energy efficiency for a first configuration without aging and a second with. Computations of sensible and latent heat fluxes reveal that thermal losses through the wall are underestimated by about 30% when aging effects are neglected. This finding highlights the significance of this phenomenon and encourages its consideration in future building energy simulations.
Outcomes According to Remnant Ligament Tissue Quality after Arthroscopic All-Inside Anterior Talofibular Ligament Repair for Chronic Ankle Instability
Authors: Hyun Lee Sung , Hun Lim Gyeong
Published: December 2024

Category:

Sports; Arthroscopy

Introduction/Purpose:

Arthroscopic all-inside techniques have gained prominence in the treatment of chronic ankle instability (CAI), offering effective solutions. However, arthroscopic treatment of CAI with poor remnant ligament-tissue quality is still controversy. This study aims to evaluate the outcomes of the arthroscopic all-inside anterior talofibular ligament (ATFL) repair, according to the quality of remnant ligament.

Methods:

A retrospective analysis was conducted on consecutive CAI patients who underwent arthroscopic ATFL repair, with a follow-up period of at least two years. Patients were categorized into two groups based on arthroscopic ATFL grade: Group G, characterized by good to moderate tissue quality with distension or discontinuity of the ATFL; and Group P, characterized by poor tissue quality with a hypoplastic ATFL. Patients with irreparable absent ATFL were excluded. Subjective outcomes were assessed using the visual analogue scale score, Foot and Ankle Outcome Score (FAOS), and the Karlsson ankle functional score. Objective outcomes included posturographic analysis and radiological evaluations, such as stress radiographs and axial view magnetic resonance imaging (MRI).

Results:

Among 163 patients, 22 were excluded based on predefined criteria, leaving 141 patients for analysis (Group G, n = 77; Group P, n = 64). Patients had a mean age of 32.1 years, and the average follow-up duration was 31.6 months. Both groups exhibited postoperative improvements in subjective and objective clinical outcomes (all p < 0.05). Significantly, Group P demonstrated lower FAOS scores in the sports unit (p = 0.016), an increased fall risk as determined by posturography at the final follow-up (p = 0.019), and a higher retear rate on axial view MRI (10.9%, 7/64) compared to Group G (2.6%, 2/77) (p = 0.044).

Conclusion:

Arthroscopic all-inside ATFL repair is an effective treatment for CAI, regardless of the quality of the remnant ligament. However, patients with poor ligament quality showed inferior clinical outcomes, especially in sports-related activities and proprioception. Additionally, they experienced a higher retear rate. These findings highlight the significance of performing arthroscopic all-inside ATFL repair selectively for CAI, considering the patient's activity level and the quality of the remaining ligament tissue.
Outcomes of Minimally Invasive Surgery for Severe Hallux Valgus Deformity: A Systematic Review and Meta-Analysis
Authors: Xi Kasia Chua Chen , Tan Chin Yik , Thevendran Gowreeson
Published: December 2024

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

The use of minimally invasive (MIS) techniques in hallux valgus correction has been established in mild to moderate hallux valgus. However, there has been no clear consensus on the outcomes of MIS techniques in severe hallux valgus. This paper presents a systematic review and meta-analysis to determine the clinical and radiological outcomes of patients with severe hallux valgus who underwent MIS corrective osteotomy.

Methods:

The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies that presented patients with severe hallux valgus, defined as Hallux Valgus Angle (HVA) ≥ 40 ° and/or Intermetatarsal Angle (IMA) ≥ 16 °, with clinical and/or radiological outcomes after MIS surgery were included.

Results:

16 studies were included with 1170 feet. The average preoperative HVA was 36.0° and IMA was 16.9°. Post-operatively, all studies reported significant improvement in AOFAS score with a mean difference of 41.1 (95% CI 33.58, 48.67). All studies reported improvement in radiological parameters: HVA mean improvement of 23.8° (95% CI 19.73, 27.86), IMA mean improvement of 8.22° (95% CI 6.14, 10.29).4 studies reported patient satisfaction postoperatively with a pooled average of 92.3% over 415 patients. 11 studies reported superficial and/or deep infection postoperatively with a pooled average of 2.3% over 798 patients. 13 studies reported malunion, delayed union or non-union with a pooled average of 2.9% over 981 patients. 6 studies reported loss of correction postoperatively with a pooled average of 8.8% over 531 patients.

Conclusion:

In the treatment of severe hallux valgus, the use of minimally invasive surgical techniques provides significant improvement in clinical and radiological parameters with low rates of complications.
Results of Hallux Valgus Surgery in Diabetic Patients with Percutaneous First Metatarsal Osteotomy and K-Wire Fixation
Authors: Yang Ding Cheng
Published: December 2024

Category:

Diabetes; Bunion

Introduction/Purpose:

Diabetes is a rising global prevalent disease. Patients with diabetes mellitus (DM) have potential neurovascular changes in their feet and ankles, which makes them vulnerable to surgical wound infection, as well as delayed healing of bones and wounds. Whether diabetes affects the outcomes of hallux valgus surgery is unknown. This study aims to investigate the impact of diabetes on the outcomes of hallux valgus surgeries using the minimally invasive surgery (MIS) technique.

Methods:

A total of 319 patients were included in this study, and 342 MIS Hallux Valgus procedures were performed from 2018 to 2023 at our institutions. Patients were divided into diabetic (DM-HV) and non-diabetic (NDM-HV) groups. DM was defined by elevated glycated hemoglobin A1c (HbA1c), blood glucose values, and medication history. MIS hallux valgus correction was performed with minimal surgical incisions of less than 2cm in length. Percutaneous Chevron first metatarsal osteotomies using the Shannon burr and Kirschner wire fixation were guided under fluoroscopy. The DM-HV group included 46 feet of 45 patients, and the NDM-HV group included 296 feet of 274 patients. Clinically, the preoperative and final follow-up American Orthopedic Foot & Ankle Society (AOFAS) score, radiographic hallux valgus angle (HVA), and first intermetatarsal angle (IMA) were evaluated. Procedure durations and patient complications were also assessed.

Results:

In the DM-HV group, the patients ranged from 51 to 87 years with a mean age of 73 (male 14, female 32). In the NDM-HV group, the patients ranged from 34 to 97 years, with a mean age of 58 (male 49, female 247). The mean AOFAS score improved from 41.42 preoperatively to 93.10 postoperatively in the DM-HV group, and from 42.50 to 94.38 in the NDM-HV group. 4.3% of complications in the DM-HA group and 4.7% in the NDM-HA group were in this study. Surgical complications included: K-wires broke, hallux varus, under correction, transfer metatarsalgia, medial incision dehiscence, and adhesion. There was no difference between DM-HV and NDM-HV groups in improved AOFAS scores, radiological deformity correction, durations of surgery, complications, and reoperation rates.

Conclusion:

Chevron osteotomy using the Shannon burr with Kirschner (K)-wire fixation is a safe, effective, reliable procedure on both non-diabetic patients and diabetic patients. Hallux Valgus MIS surgery with the K-wire fixation on diabetic patients has no high complication rate. Minimally invasive surgery for hallux valgus correction resulted in improved AOFAS scores and radiological outcomes, fewer complications, and a shorter duration of surgery. MIS can be a better option for correcting hallux valgus deformities in diabetic patients.
Risk Factors Associated with Subtalar Fusion Within 5 Years Following Calcaneal ORIF
Authors: White Elisabeth , Okoro Sylvester , Tabbaa Ameer , Nicolas Rodriguez Ariel , Sheth Bhavya , Horn Andrew , Razi Afshin , Abdelgawad Amr
Published: December 2024

Category:

Hindfoot; Trauma

Introduction/Purpose:

Calcaneal fractures, commonly caused by high-energy trauma, present significant challenges for orthopedic surgeons. Open reduction internal fixation (ORIF) is a widely used surgical technique for managing these fractures; it can lead to subtalar joint arthritis and pain, requiring subtalar fusion when conservative treatments prove ineffective. Understanding the risk factors associated with subtalar fusion (STF) after calcaneal ORIF is crucial for optimizing patient outcomes and treatment strategies. In this study, we aimed to comprehensively evaluate these risk factors, including patient demographics, medical comorbidities, same day and 90-day reimbursement data.

Methods:

A retrospective analysis was performed using the PearlDiver Mariner 157 national claims database from January 1st, 2010 to October 31st, 2021. Patients who underwent calcaneal ORIF, identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) codes, were queried for 5-year rates of STF and reimbursement data. Patient demographics and comorbidities were recorded, and multivariate logistic regression was employed to determine the association of risk factors with STF. A p-value of less than 0.001 was considered significant after performing a Bonferroni correction.

Results:

Patients with STF had a higher proportion of alcohol abuse (21.3% vs. 16.2%), depression (58.1% vs. 43.1%), drug abuse (29.1% vs. 19.7%), obesity (40.3% vs. 28%) and tobacco use (62.2% vs. 50.3%), all exhibiting a p-value of less than 0.001. Those with depression (OR: 1.54; 99% CI:1.29-1.84; p< 0.001) and obesity (OR:1.58; 99% CI: 1.32-1.88; p< 0.001) as comorbidities had a higher odds ratio of association ith STF within 5 years following calcaneal ORIF.

Conclusion:

Our study demonstrates that patients who ultimately required STF within 5 years of calcaneal ORIF had higher rates of alcohol abuse, tobacco use, drug use, obesity, and depression prior to ORIF. In addition, there was no significant difference observed between those with and without STF in average same-day and 90-day reimbursements and demographics. Future patients with a calcaneal fracture along with multiple risk factors listed above should be in consideration for primary surgical fusion over calcaneal ORIF, with additional studies needed to aid orthopaedic surgeons in this decision making.
Risk Factors for Infectious and Soft Tissue Complications in Ankle Fracture Dislocations
Authors: Soni Chirag , Zhuang Adam , Faith Darden Kylee , Wynn Malynda , Benedick Alex , Szatkowski Jan P , Jang Yohan , Natoli Roman , Lopas Luke A
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Ankle fracture-dislocations (AFD) are violent injuries with reported worse prognosis compared to their non-dislocated counterparts. There is limited literature describing the demographic characteristics and risk factors for complications for these injuries. This study analyzed risk factors for deep surgical site infection and wound complications in AFDs.

Methods:

Ankle Fractures from 2013 to 2023 at a single Level I trauma center were reviewed. Patients with complete tibiotalar dislocation defined by absolute articular incongruity in either the lateral or anteroposterior radiographic views were included. Patients with pan-talar dislocations and those who were already successfully reduced at outside institutions were excluded. Successful reduction was defined as near anatomic articular congruity with less than 5 millimeters of medial clear space. Demographic characteristics were recorded. Primary outcomes assessed were deep surgical site infection (SSI), and wound complications. Wound complications were stratified into categories defined as delay in healing, superficial wound dehiscence, and deep wound dehiscence. Demographic and clinical characteristics were compared across primary outcomes using the Chi-Square test for categorical variables and the Student’s t-test, with the Fisher Exact test being used if the data were not normally distributed.

Results:

113 patients were reviewed and met inclusion criteria. 15 had deep SSI. 75 had normal wound healing, 17 had delayed wound healing, 7 had superficial wound dehiscence, and 14 had deep wound dehiscence. Open fracture incidence was significantly associated with older age (p < 0.03). Neuropathy, open fractures, peripheral vascular disease, and polysubstance abuse were associated with deep SSI (p < 0.02, p< 0.05, p< 0.03, p< 0.05, respectively). Open fractures, chronic kidney disease, and polysubstance abuse were associated with overall wound complication occurrence (p < 0.01, p< 0.02, p< 0.04, respectively). Open fractures, neuropathy, and polysubstance abuse were associated with deep wound dehiscence (p < 0.05, p< 0.05, p< 0.05, respectively). There was no association between successful closed reduction and SSI or wound healing complications (p=.98, p=.744, respectively).

Conclusion:

The overall deep SSI prevalence in our cohort was 13%. Open fractures, neuropathy, and polysubstance abuse were significant risk factors for both SSI and wound healing complications. Successful anatomic reduction of ankle fracture dislocation was not associated with SSI or wound healing complications.
Shortening of the First Metatarsal During the Correction of Hallux Valgus: Never Be Allowed?
Authors: Ma Xin
Published: December 2024

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Transfer metatarsalgia is one of the potential complications after hallux valgus correction, of which shortening of the first metatarsal is thought to be an important cause. Thus many surgeons believe that shortening of the first metatarsal should be avoided or kept to a limited extent. However, we found that many patients with first metatarsal shortening did not really develop postoprative transfer metatarsalgia, but instead had easier correction of the hallux valgus in operation and better outcomes and even more benefit in walking due to reduced tension around the metatarsophalangeal joints and improved joint mobility. Up to now, few investigations have truly conducted large-scale long-term follow-up on this issue, and little is known about the appropriate level of first metatarsal shortening.

Methods:

This retrospective study included 835 feet in 712 patients who were treated with first metatarsal osteotomies without Weill osteotomies for hallux valgus during the period of January 2013 to January 2023. Standard weight-bearing dorsoplantar and lateral radiographs were collected before and at different time more than six months after surgery. The hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA) were evaluated. The absolute length of the first metatarsal as well as its relative length to the second metatarsal was both measured. Clinical evaluation included preoperative and postoperative symptom assessment, the range of motion (ROM) at metatarsophalangeal joint and AOFAS Scale. The incidence of postoperative complications was also specifically recorded, as well as information on where the metatarsalgia occurred, the nature of the pain, and how the pain occurred and relieved. Patients were divided into different subgroups according to the level of shortening of the first metatarsal.

Results:

The level of shortening of the first metatarsal was positively correlated with the reduction of the HVA, and inversely correlated with the recurrence rate. Those with shortening of 3 mm or more had significantly better first metatarsophalangeal joint mobility compared with those without shortening. Patients with a shortening of 6 mm or more were significantly more likely to have a metatarsalgia under the central metatarsal heads postoperatively (5.88% vs 3.01%). 5 feet (2.67%) developed recurrence of the hallux valgus in patients with a shortening of 6 mm or more, compared with 23 feet (4.07%) in patients with a shortening of 6 mm or less, and 6 feet (7.23%) in patients without shortening.

Conclusion:

Taking into account the correction of HVA, joint mobility, postoperative recurrence and the risk of metatarsalgia, it is recommended that the relative length of the shortening in the first metatarsal osteotomy can be extended up to 6 mm, especially in patients with severe hallux valgus, in order to obtain the easier correction of the HVA in the operation and best therapeutic results and function.
Surgical Costs Associated with Tibiotalar Fusion
Authors: Wagers Kade , Zhang Chong , Presson Angela , Nixon Devon
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

There is growing focus on the surgical costs related to common orthopedic procedures. In this investigation, we studied the costs associated with tibiotalar arthrodesis by comparing different surgical constructs (screws-alone vs. plate-screw fixation).

Methods:

Patients were retrospectively identified who had undergone primary fusion of the tibiotalar joint based on CPT codes from 2014 to 2020. Utilizing the Value Driven Outcome (VDO) tool implemented at our institution, we conducted an evaluation of both total direct costs and facility-related expenses. The VDO tool encompasses a comprehensive item-level database capable of capturing detailed cost information, which is subsequently presented as relative mean data. Adjustments were made to cost variables to reflect 2022 US dollars, and comparative analysis of costs in relation to treatment groups and other exposure variables was performed using generalized linear models to yield cost ratios along with 95% confidence intervals (CIs).

Results:

Our cohort consisted of 263 patients who underwent primary ankle fusion procedures done by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographic data or total OR time based on surgical construct (screws-alone N =229, plate-screws N =34). Total direct cost for plate-screw constructs were 72% higher than screws alone (ratio in cost =1.72, 95% CI 1.49~2.03, p< 0.001). There was no significant difference in regression analysis between plate-screw vs screws-alone for facility cost (ratio in cost =1.14, 95% CI: 0.99~1.34, p=0.10). For all fusion constructs, every 1 hour increase in total OR time increases total direct costs by 28% (ratio in cost =1.28, 95% CI 1.18~1.40, p< 0.001).

Conclusion:

Enhancing the cost-effectiveness of orthopedic care remains an important objective. Our investigation suggests that screw-only constructs, compared to plate-screw constructs, can notably lower overall total costs by 72%. Many variables are considered when selecting surgical constructs for ankle arthrodesis. When clinically appropriate, screw-only ankle arthrodesis constructs could be considered if there is a need to reduce overall total costs.
Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): 2-year Results of a Novel Press-fit Surgical Treatment for Large Talar Osteochondral Lesions
Authors: Dahmen Jari , Rikken Quinten , Stufkens Sjoerd , M.M.J. Kerkhoffs Gino M
Published: December 2024

Category:

Ankle; Sports

Introduction/Purpose:

The purpose of this study was to present the surgical technique and to evaluate the clinical and radiological outcomes of a new press-fit transplantation technique for large talar osteochondral lesions of the talus (OLTs), Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC).

Methods:

60 patients, mean age 38 years, underwent a press-fit TOPIC procedure. Clinical assessment at 12- and 24-months follow-up included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Short-Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS). Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively.

Results:

All patients were available for two-year follow-up. The AOFAS improved from 48 to 90 (p< 0.05). All NRS scores improved: during rest from 3 to 0 (p< 0.05), during walking from 5 to 1 p< 0.05), and stairclimbing from 5 to 1 (p< 0.05). Both SF-36 components improved. The PCS from 34 to 47 (p< 0.05) and the MCS from 37 to 66 (p< 0.05). All FAOS subscales significantly improved. All patients showed remodeling of the talus and all grafts showed bone ingrowth on the CT scans.

Conclusion:

The TOPIC procedure for large osteochondral lesions of the medial talar dome is an effective technique resulting in significant improvement in pain, as well as other outcomes, with 100% consolidation of the grafts.
The All-Medial Approach in Severe Plano-Valgus Foot & Ankle Deformity with Subtalar Dislocation. Anatomy, Indications, and Outcomes of a Promising New Technique
Authors: Raheman Firas , Budair Basil , Reichert Ines , Ahluwalia Raju
Published: December 2024

Category:

Midfoot/Forefoot; Diabetes

Introduction/Purpose:

The complex challenge of reconstructing severe planovalgus deformity of the foot and ankle, often accompanied by subtalar dislocation, is characterized by a heightened risk of lateral wound complications and significant anatomical distortions. These cases, typically arising from chronic conditions such as diabetes (Charcot neuroarthropathy), rheumatoid arthritis, or congenital deformities, necessitate careful consideration of their underlying anatomical pathology. In this study, we introduce a novel all-medial approach for correcting these deformities and provide insights gleaned from our clinical experience.

Methods:

Retrospective review of prospectively collected data of all patients with severe foot and ankle plano-valgus deformity between May 2014-Jan 2024 treated surgically utilising an all-medial approach. We identified 18-feet in 11 patients with an associated subtalar dislocation and describe the patho-anatomy and a single medial approach encompassing 3 surgical windows to the ankle joint, hind-foot, and mid-foot to reconstruct the deformity and stabilise the foot. Functional, radiological, and surgical outcomes are reported of the newly developed surgical approach.

Results:

The average age of patients undergoing surgery was 58 years (ranging from 47 to 78). The mean follow-up duration was 32.7 months (2.7 years), ranging from 8 to 82 months. In nine feet, the posteromedial neurovascular bundle was displaced inferior-laterally, leading to attrition of the flexor hallucis longus (FHL) tendon in three feet due to entrapment between the calcaneum and talus. Surgical intervention involved pan-talar fusion in 12 feet and medial column extension in nine feet. Only one patient experienced delayed wound healing necessitating the removal of metalwork, yet all patients were ambulatory at the two-year mark, with no instances of limb loss during the study period.

Conclusion:

The novel approach outlined in this study represents a safe and effective technique for reconstructing severe planovalgus foot and ankle deformities accompanied by dislocated subtalar joints. This approach offers predictable radiological and functional outcomes while circumventing the unique complications associated with traditional lateral approaches, thus enhancing patient safety and treatment efficacy.
The Cutting Edge of Charcot Reconstruction: Anatomical Osteotomies Benchmarking Optimal Survivorship in Charcot Reconstruction
Authors: Ahluwalia Raju , Raheman Firas , Kosa Peter , Reichert Ines
Published: December 2024

Category:

Diabetes; Midfoot/Forefoot

Introduction/Purpose:

Charcot neuroarthropathy is a debilitating condition that frequently leads to skeletal instability, deformity and an increased risk of ulceration leading to infection. This often necessitates prolonged periods of immobilization and casting. Nonetheless, opting for reconstruction presents an opportunity for limb preservation and the potential for weight-bearing functionality, contrasting starkly with the higher mortality rates associated with amputation.

Methods:

We present findings from a prospective study involving 102 patients who underwent Charcot reconstruction surgery conducted by two experienced surgeons from May 2014 to Oct 2024. Our approach incorporated advanced techniques such as 3D modeling and standardized osteotomies, including the King’s Cut and ARK osteotomy, to achieve precise anatomical corrections of Meary’s angle, as well as the anterior-posterior and lateral talo-calcaneal angles, along with calcaneal pitch. Additionally, patients underwent either primary or staged reconstruction in cases where osteomyelitis was suspected due to pre-existing ulceration. Definitive stabilization was achieved through internal fixation targeting the stabilization of unstable foot columns. A multivariate analysis was conducted to evaluate potential risk factors associated with failure, with statistical significance determined at P>0.05. Survivorship was defined by the absence of ulceration, catastrophic failure, or the necessity for amputation.

Results:

In the study, 79 feet were analyzed, with 46 undergoing single-stage and 43 two-stage reconstruction. Predominantly male (62.7%) with an average age of 56 years, most patients (89.63%) had type 2 diabetes, 56% hypertension, and 16% chronic kidney disease requiring dialysis. Among single-stage reconstructions, 52.1% had pre-operative ulcers, 13 ischemic heart disease, and 56 peripheral artery disease. 81% achieved normalized angles (P < 0.05); 3.4% required further surgery for infection, 17.9% experienced delayed wound healing. Survivorship rates were 98% at 3 years and 94% at 6 years, higher for those with vascular disease. At final follow-up, all maintained mobility, contributing to an overall 94.4% survivorship at 6 years, with 98% achieving ambulatory weight-bearing in shoes at 2 years.

Conclusion:

Strategic patient selection, multidisciplinary teamwork, and precise anatomic reconstruction, rather than merely achieving a plantigrade foot, are pivotal factors in achieving consistent and predictable outcomes for functional limb salvage. Research evidence underscores the importance of addressing pre-operative vascular compromise, as it significantly influences survivorship rates.
The Effect of Osteoporosis on Postoperative Outcomes Following Total Ankle Arthroplasty
Authors: Kulkarni Ronit , Morningstar Joshua L. , Friedman Richard J. , Gross Christopher E. , Scott Daniel J.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Recent literature, particularly in the fields of total joint arthroplasty, has raised concern for increased perioperative complications following joint arthroplasty in patients with osteoporosis. The purpose of this study is to evaluate the influence of preoperative osteoporosis on 6-month postoperative outcomes following total ankle arthroplasty (TAA).

Methods:

The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 29,705 patients undergoing primary elective TAA. Patients were divided into two cohorts based on the presence of preoperative osteoporosis (as defined by ICD-10 CM codes M81, M80, M80.07XX), with 943 (3.3%) having this diagnosis. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to control for predictors of adverse postoperative outcomes other than preoperative osteoporosis.

Results:

The overall cohort was majority male (54.2%) with mean age of 64.15 (range 17-90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0-12). Patients diagnosed with preoperative osteoporosis patients were statistically significantly older (Osteoporosis=68.72 years; non-osteoporosis=65.03 years; p<.001), more likely to have Medicare insurance (p<.001), and had a higher CCI score (Osteoporosis=0.98; Non-Osteoporosis=0.64; p<.001). Multivariate regression analysis of 180-day postoperative outcomes found that preoperative osteoporosis was significantly predictive of increased risk of any complication (OR=1.428; p<.001), transfusion (OR=3.370; p<.001), pulmonary embolism (OR=5.625; p=.016), Pneumonia (OR=3.872; p<.001), adverse discharge (OR=1.445; p<.001), and extended stay greater than 4 days (OR=1.310; p<.001). Further, the presence of osteoporosis is predictive of nearly a $3,000 increase in total cost of procedure (β= 2980.22; p<.001).

Conclusion:

The presence of osteoporosis was significantly predictive of higher rates of postoperative complications, LOS, and a substantially higher cost of procedure following TAA. Physicians and patients alike should consider this comorbidity when stratifying risk for outcomes following total ankle arthroplasty.