bluuebunny/crossref_metadata_2025 huggingface dataset:
How Far Is Progress? Gender Dimensions of Student Enrollment in Higher Education in Ghana: The Case of Kwame Nkrumah University of Science and Technology
Authors: Quarshie Amanda Nkansah , Nkansah Godfred Bonnah , Oduro-Ofori Eric
Published: December 2023

Despite the World Declaration on Higher Education for the 21st Century that education is the ultimate support of human rights, and that access and participation remain key catalysts to accelerating equal educational opportunities for all, females continue to trail their male counterparts in educational outcomes across sub-Saharan Africa. This study focuses on the Ghanaian context and assesses the gender dimensions of student enrollment in higher education, highlighting the disparities therein. We adopt a typical case study design, and a mixed method approach, involving quantitative analysis of student enrollment data, qualitative interviews, and focus group discussions with administrators and students at the Kwame Nkrumah University of Science and Technology. We find generally low female participation across all colleges of the university, except for the College of Health Sciences. We also find low female participation across three dimensions: qualified applicants, admissions, and enrollment. The causes of disparity in the dimensions of student enrollment are rooted in four main factors: institutional, socio-cultural, economic, and awareness of STEM policy and opportunities. The present findings have implications for the implementation of STEM and other gender policies at both the pre-tertiary and tertiary levels of education across sub-Saharan Africa.
Knowledge Base for Classroom Preparedness: Analyzing Initial English Language Teacher Education in Kyrgyzstan
Authors: Kazakbaeva Roza
Published: December 2023

This study examines the extent to which the Initial English Language Teacher Education (IELTE) program curriculum facilitates the development of the necessary knowledge base to ensure prospective English language teachers’ classroom preparedness. Data were collected through curricular analysis of four IELTE programs and semi-structured interviews with four program directors and 10 early career English teachers to evaluate IELTE program effectiveness to prepare teachers, at least, entry-level teaching. Findings indicate that contextual factors such as rigid national policy documents, teacher educators’ limited competencies and their role in curriculum development and implementation, the status of the IELTE programs within the universities, lack of collaboration between IELTE programs and schools contributed to the inefficiency of IELTE programs to ensure prospective English teachers’ classrooms preparedness. Thus, English teachers were not prepared to carry out their jobs effectively because the knowledge base that prospective teachers acquire and develop through the IELTE program did not correspond to what they need in their classrooms for effective teaching.
Do International Trade Frictions Influence the Competitiveness of Entity Enterprises? Evidence from the Perspective of Financialization
Authors: Yu Haiyan , Li Shan , Liu Yiyuan , Liu Qiuping , Lu Yuxin
Published: December 2023

International trade frictions have changed the business environment of enterprises. However, how do these changes influence the behavioral decisions of enterprises, and will this further affect enterprise competitiveness? Exploring these questions will help determine the influencing mechanism of external negative impacts, such as international trade frictions, on the competitiveness of entity enterprises. In this study, the influences of China-U.S. trade friction, which served as an exogenous research event, on the competitiveness of entity enterprises were empirically analyzed via a difference-in-difference (DID) model with semiannual report information of Chinese nonfinancial A-share listed companies in 2016 to 2020 as research samples. Research results show that the China-U.S. trade friction promotes enterprises to enlarge their financial asset investment by changing the business environment of enterprises. Moreover, this friction further weakens the enterprise competitiveness, an essential element of industrial investments. As revealed by further heterogeneity analysis, the China-U.S. trade friction has generated heterogenous influences on enterprise competitiveness in the aspects of investment motives, industry, competition status, and internal governance mechanism. In this study, two types of enterprise competitiveness elements—environment and resources—were included into the same research framework, and the category of theoretical research on the connotation of enterprise competitiveness was expanded. Moreover, this research provided new scenes and evidence for identifying the causal relationships of the impacts of exogenous negative events with the financial behaviors and competitiveness of entity enterprises, Furthermore, it rendered countermeasure paths and policy suggestions for scientifically coping with international trade frictions and enhancing the competitiveness of entity enterprises.

Subject Classification Codes: F51; G31; G32; L25
The Association between Caring Behavior and Death Anxiety among Iranian Nurses Working in Covid-19 Wards
Authors: Seyedfatemi Naiemeh , Abbasi Zahra , Bahrami Raheleh , Siah Mansour Khorin Zahra
Published: December 2023

Introduction

Nurses who are at the forefront of the fight against Covid-19 have faced problems such as anxiety and stress due to the high contagiousness of this disease and the challenges of providing services to infected patients. Death anxiety and the resulting fear following the Covid-19 pandemic can affect caring behaviors and the quality of nursing care services.

Objective

The present study was conducted with the aim of determining the association between caring behaviors and death anxiety among Iranian nurses working in COVID-19 wards.

Methods

This cross-sectional study was conducted in 2021 in Tehran. The participants consisted of 233 nurses who were purposively selected from university hospitals in Iran. Data collection tools included Demographic Information Form, Death Anxiety Scale, and Caring Dimension Inventory (CDI-25). Data analysis was done using SPSS (version 16).

Results

Most of the participants were female (79.4%), had less than 5 years of work experience (50.6%), and had bachelor's degree (88.8%). Based on the results, the level of death anxiety among nurses was moderate (7.05 ± 3.85) and their caring behavior was at optimal level (103.03 ± 13.15). Among the subscales of caring behavior, physical-technical behaviors with mean of 46.43 ± 6.20 got the highest score, and unnecessary behaviors with mean of 4.39 ± 0.73 got the lowest score compared to other subscales. Based on data analysis findings, caring behavior and its dimensions had no significant correlation with nurses’ death anxiety ( p = 0.111).

Conclusions

Our results showed that despite having a moderate level of anxiety, nurses try to provide good care behaviors to patients with covid-19. However, reducing nurses’ anxiety can improve caring behaviors.
Evaluating Failure Mechanisms for Total Talus Replacement: A Case Series
Authors: Peairs Emily M. , Anastasio Albert T. , Tabarestani Troy Q. , Krez Alexandra , Shaffrey Isabel , Henry Jensen K. , Demetracopoulos Constantine , Adams Samuel
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

Talar collapse can occur from a variety of etiologies and may pose a unique challenge to the foot and ankle surgeon due to the complexity of the deformity and associated adjacent joint degenerative change. Total talus replacement (TTR) has emerged as an attractive option to help patients return to activities sooner than with arthrodesis and improve pain and joint mechanics postoperatively. However, there is limited long-term data on the most recent generation of implants. In this multi- institution case series, we present the severe complications that can occur after TTR, including instability, infection, and adjacent joint osteoarthritis.

Methods:

We present three cases from Duke University Hospital in Durham, North Carolina, and the Hospital for Special Surgery In New York City, New York. All three patients were treated with a total talus replacement (TTR) during their clinical course and experienced subsequent complications. Clinical data and radiographs were collected from chart review under an IRB-exempt protocol.

Results:

Case 1 demonstrates the risk of ligamentous insufficiency leading to dislocation following placement of a TTR. This case highlights the posterior instability due to soft tissue mobilization and division. Case 2 highlights the risk for adjacent joint degeneration with TTR. Case 3 presents an instance of non-union following a total ankle and total talus replacement (TATTR) with subtalar arthrodesis. To our knowledge, this represents the first case of nonunion following TTR in the literature. Finally, we discuss our institution’s experience with infection following TTR and possible contributing factors to this specific procedural risk.

Conclusion:

TTR shows promise in the properly selected patient with end-stage talar collapse. However, heterogeneous surgical techniques, implant composition, indications, and patient demographic variables complicate the interpretation of the literature. Moreover, few studies report mid-to long-term outcomes after this procedure and the occurrence of adjacent joint OA is likely underreported in the literature. Thus, until further, high-quality studies with long-term follow-up validate the positive early outcomes of TTR, we urge extreme caution in patient selection, choice of implants, and surgical techniques.
Evaluation of Mechanical Stress Distribution Across the Calcaneus following Calcaneal Autograft: A Finite Element Analysis
Authors: Azam Mohammad T. , Parody Nicholas , Mosquea Thelma R. Jimenez , Butler James J. , Ubillus Hugo A. , Kennedy John G. , Walls Raymond J.
Published: December 2023

Category:

Other

Introduction/Purpose:

The purpose of this study was to utilize finite element analysis to evaluate progressive bone removal from the calcaneus at various angles and its effect on the mechanical stress distribution at the calcaneus, and potential increase in fracture risk.

Methods:

A calcaneus CT scan was imported into Autodesk Fusion360 (Autodesk, v.2.0.14569). After rendering the initial mesh body using tetrahedral elements, a copy of the calcaneus was made. A simulated force equal to the average weight of person (876N) was applied to the middle and posterior talus facets while the calcaneus was oriented in the heel strike position during gait, with constraints applied around the heel. The initial harvest site was modelled as a 6mm diameter 30mm deep cylinder. From this center point, the diameter of the harvest site was increased to 8, and 10mm, with the depth being adjusted such that there was no risk of breaching the cortex on the opposite side. For each iteration, the safety factor, stress (MPa), and strain were recorded. This was repeated at an angle of 90°, 45° and a combination of 45° and 90°.

Results:

The 90° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress across the calcaneus. The number of cycles to failure (fracture) for all diameters was 10^6-10^7. The 45° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress applied across the calcaneus with a corresponding decrease in stress at the harvest site. The number of cycles to failure increased from 10^3 at 6mm to 10^4-10^5 at 10mm. The combination of the 45°-90° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress applied across the calcaneus. The cycles to failures decreased as the diameter of the harvest site increased.

Conclusion:

This finite element analysis demonstrated that an increase in the diameter of the harvest site led to an increase in stress along the calcaneus. There was variation in the correlation between size of the diameter and the number of cycles to failure depending on the angle of the harvest. The greatest amount of stress applied at the calcaneus was with the 45°-90° model. It was determined that harvesting at an angle of 45° at 6mm produced the lowest number of cycles to failure.
Evaluation of Patient-Reported Outcome Measures in Patients Receiving Bio-Integrative Screws for Lisfranc Injuries: A Case Series Study
Authors: Ebrahimi Alireza , Lucaciu Andreea R. , Sohn Sora , Ashkani-Esfahani Soheil , Kwon John , Waryasz Gregory
Published: December 2023

Category:

Midfoot/Forefoot; Midfoot/Forefoot

Introduction/Purpose:

Lisfranc injury consists of a spectrum of injuries affecting the tarsometatarsal joint. Various fixation methods are used to treat Lisfranc injuries and each show different outcomes. Metal implants have been used for open reduction and internal fixation (ORIF) of Lisfranc injuries routinely. However, other than the complications in these patients, such as non- anatomical reduction, implant loosening, breakage, and arthrosis, most of these patients will undergo a second surgery for implant removal. Using bio-degradable and bio-integrative materials in these implants reduces the need for these re-operations; however, whether other complications reported for metal implants occur by using bio-integrative materials has yet to be proven. The aim of our study is to assess patient-reported outcome measures (PROMs) and complications in patients received bio-integrative screws for Lisfranc fixation.

Methods:

The inclusion criteria were 1) ≥ 18 years old, and 2) had ORIF for Lisfranc injury using bio-integrative (OSSIOfiber ™) screws. The patients’ charts were reviewed, and the variables were gathered, including the type of injury, pain score, and PROMs. The questionnaires used to evaluate PROMs were Patient-Reported Outcome Measurement Information System (PROMIS) surveys for physical function, pain interference, pain intensity, and depression. We also reported the average scores for these PROMs among a randomly sampled population of patients who had ORIF with metal screws for Lisfranc injuries for comparison (n=12).

Results:

We recruited 12 patients for this study. The minimum follow-up time of the patients in this study was three months. Out of 12 patients, 1 patient showed non-union. The mean (SD) PROMIS scores for physical function, pain interference, pain intensity, and depression were 43.9 (14.9), 56.1 (13.9), 45.9 (10.1), and 43.5 (4.9) in patients who received bio-integrative screws, respectively. In the sampled population treated with metal screws, these PROMs were 42.1 (9.5), 55 (10.1), 46.4 (8.1), and 44.4 (6.4) for physical function, pain interference, pain intensity, and depression, respectively. No significant difference was observed between the two groups regarding physical function (P=0.72), pain interference (P0.82), pain intensity (P=0.88), and depression (P=0.69).

Conclusion:

The current report showed promising patient-reported outcomes after Lisfranc ORIF with bio-integrative screws. However, longer term follow-ups, as well as comparison with a larger population for both types of instruments, bio-integrative and metal, will shed light on the pros and cons of both materials. Moreover, cost-effective studies are highly suggested to assess the usefulness of these implants against their costs for the healthcare system and the patients.
How Does Alcohol Use Disorder Impact Morbidity, Readmission Rates, and HealthCare Expenditures Following Open Reduction and Internal Fixation of Bimalleolar Fractures?
Authors: Monas Arie , Chatad Derrick , Rodriguez Ariel Nicolas , Lam Aaron , Abdelgawad Amr , Razi Afshin
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

Bimalleolar ankle fractures are a common injury that can be treated with open reduction and internal fixation (ORIF). However, there is a paucity of literature evaluating the impact of patients with alcohol use disorder (AUD) on postoperative complications following ORIF of bimalleolar ankle fractures. Therefore, the purpose of this study is to investigate whether patients with AUD undergoing ORIF of bimalleolar ankle fractures have higher odds of (1) morbidity; (2) readmissions; and (3) costs of care.

Methods:

A retrospective query of the PearlDiver nationwide claims database was performed between January 2010 and October 2020. Baseline demographics were analyzed using Pearson’s Chi-Square Analyses. Multivariate binomial logistic regression was utilized to calculate the effect of AUD on 90-day medical complications. Costs of care were compared using Welch’s t-tests. A P value less than 0.001 was considered to be statistically significant.

Results:

The query yielded 64,563 patients within the study (AUD = 8,177; control = 56,386). Patients who have AUD were found to have significantly higher incidence and odds of developing 90-day medical complications (59.35% vs. 18.77; OR: 2.30; 95% CI: 2.16 to 2.46; p < 0.0001). AUD patients were found to have higher incidences of 90-day readmissions (9.14% vs. 5.56; OR: 0.95; 95% CI: 0.86 to 1.05; p=0.361); however, this failed to reach statistical significance. Patients with AUD also incurred significantly higher day of surgery costs ($4,433.33 vs. $3,979.85, p< 0.0001) and 90-day episode of care costs ($8,523.40 vs. $6,976.95, p< 0.0001).

Conclusion:

AUD patients have higher odds of 90-day postoperative complications and costs of care following ORIF of bimalleolar ankle fractures. The findings of this study can be used by orthopaedic surgeons to reduce healthcare costs as well as improve postsurgical outcomes by educating patients who have AUD on the potential complications that they may encounter after their procedure.
Incidence of Acute vs Chronic Post-op Complications Following TAA: Are They Preventable?
Authors: Nam Hannah H. , Martinazzi Brandon J. , Staub Jacob , Milne Indigo G. , Alwine Shelby , Kim Raymond Y. , Aynardi Michael
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) is becoming an increasingly common procedure with high patient satisfaction and improved outcomes. Although previous studies have explored various patient outcomes, there is variability in reporting methods and acute and chronic complications following TAA are poorly described. The purpose of this study was to evaluate the acute and chronic postoperative complications in patients undergoing TAA at our institution.

Methods:

Following institutional board approval, a retrospective chart review was conducted for all patients who underwent TAA from 2002-2017 at our institution. Patients were followed from the time of surgery to their 1 year follow-up. Demographics and post-op complications were recorded at 2 weeks, 6 weeks, and 1 year following surgery.

Results:

At our institution from 2002-2017, a total of 187 patients underwent TAA. The mean age of our cohort was 62.8 (Range 20-68). In our cohort, 106 were male and 81 were female, and the mean patient BMI was 31.6 (Range 33-89). At 4 weeks post- operatively, the most common acute complication was superficial infection (4.8%). Within 6 weeks post-operatively, 1 patient had a VTE (0.53%). The highest chronic complication following TAA was post-operative pain – 12.3% patients reported significant post-operative pain 1 year following surgery. 9.6% patients required hardware removal greater than 1 year following TAA.

Conclusion:

At our institution the most common acute complication at 4 weeks following TAA was surgical site infection (4.8%). The most common chronic complication was post-operative pain (12.3%). Further investigation is needed to understand the greatest contributing factors to these complications and future studies will focus on methods to minimize surgical site infection and post-operative pain following TAA.
Lateral Joint Distraction through Distal Fibula Lengthening Osteotomy for Lateral Compartment Ankle Osteoarthritis
Authors: Im Je-Min , Lim Jung-Won , Jung Hong-Geun
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

Lateral compartment ankle OA, commonly due to trauma such as ankle fracture, is not very rare. However there’s no definite established surgical treatment option. In this study, we suggest distal fibula lengthening osteotomy for lateral joint distraction as one of treatment surgical option. We have experienced favorable clinical outcome for 3 cases of post-traumatic lateral compartment ankle OA with joint space narrowing treated with distal fibula distraction osteotomy. We report the case series with the surgical technique and the clinical- radiological outcome.

Methods:

From April 2016 to August 2021, three ankles which underwent distal fibula distraction osteotomy were included in this study. All three ankles had a history of OR/IF due to fractures in the ankle joint and were diagnosed with lateral compartment OA. We defined lateral compartment OA when clinical symptoms and radiologic findings were consistent. Clinically, the point of pain was characterized as the lateral compartment of the ankle joint, not the syndesmosis or peri fibular area. Radiologically, joint space narrowing is showed in X-ray, and CT arthrography or MRI confirmed cartilage denudation of the lateral compartment.

Results:

1) Clinical outcomes Case 1: The AOFAS score improved from 69 preoperatively to 93 postoperatively, and the Pain vas score improved from 7 to 0. According to patient’s subjective expression, daily activity became 'Boxing available' from 'Hard to run'. Case 2: The AOFAS score improved from 73 preoperatively to 91 postoperatively, and the Pain vas score improved from 5 to 0. According to patient’s subjective expression, daily activity became 'No pain on daily activity' from 'Hard to walk'. 2) Radiologic outcomes Lateral joint space, talocrural angle, talar tilt angle and tibia axis-talar dome angle were all changed close to the contralateral ankle index after surgery.

Conclusion:

Painful ankle OA localized to the lateral compartment in young age is uncommon and there is no definite surgical method. Distal fibula distraction osteotomy is reasonable surgical method that does not burden patients and surgeon. In our study, distal fibula distraction osteotomy showed favorable clinical-radiological outcomes. So, we recommend this method for painful lateral compartment OA in young ages.
Lateral Talar Subluxation Measurements in Non-Operatively Managed Weber B Ankle Fractures
Authors: Ge Laurence , Talusan Paul G , Holmes James , Walton David
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

Isolated Weber B ankle fractures are common orthopedic injuries; however, indications for surgical management can be controversial. Stress radiographs have been utilized to evaluate the competence of the deltoid ligament, and recently lateral talar subluxation (LTS) has been described as a measurement tool for evaluating these injuries. It has been suggested that LTS >4mm on gravity stress radiographs may be utilized to determine need for surgical intervention. In this study we review the LTS measurements in a cohort of non-operatively treated isolated Weber B fibula fractures to determine its utility as a tool to potentially guide treatment decisions and its association with patient outcomes.

Methods:

Our group previously presented a novel algorithm for non-operative management of isolated Weber B ankle fractures and enrolled a cohort of patients. Outcome scores were reported including American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, Olerud-Molander (OMA), Foot and Ankle Ability Measure for Activities of Daily Living (FAAM/ADL), and Visual Analog Scale (VAS) scores. All patients achieved union of their fracture. For each patient we measured LTS on the injury gravity stress view x-rays as well as the un-injured contralateral side which has not been previously reported. A Kruskal-Wallis non-parametric test was used to determine whether there was any association of outcomes with extent of LTS.

Results:

42 patients were included, with minimum 1 year follow-up. The average age was 49 years (range 19 to 72). On injury gravity stress radiographs, mean medial clear space (MCS) was 4.45 mm (SD = 0.93), superior clear space (SCS) 3.46 mm (SD = 0.70), and LTS 2.33 mm (SD = 1.57, range 0 – 4.7 mm), with 35 (83.3%) patients having LTS ≤ 4 mm. Contralateral (un-injured) gravity stress mean MCS was 3.39 mm (SD = 0.63), SCS 3.15 mm (SD = 0.50), and LTS 1.30 mm (SD = 1.28, range 0 - 4.8). There was no significant difference in outcome measures based on amount of LTS ( < 2 mm, 2 to 4 mm, >4 mm): AOFAS (p=0.41), OMA (p=0.40), FAAM/ADL (p=0.41), pain VAS (p=0.16).

Conclusion:

All patients in our cohort were successfully treated non-operatively. Most patients had injury LTS ≤ 4 mm, although those with LTS >4 mm had excellent outcome scores as well. Amount of LTS did not correlate with outcomes. We present a large range of LTS measurements in normal ankles, which may be attributed to the high variability of these measurements and sensitivity to ankle rotation on radiographs. LTS may be a useful adjunct in evaluating isolated Weber B ankle fractures but may not be entirely reliable on its own. Further studies are required to validate LTS as a quantitative decision-making tool.
Minority and Lower Socioeconomic Status Patients Receive Ankle Fracture Care at Higher Cost Sites
Authors: Chawla Sagar S. , Ford Samuel , Odum Susan , Yu Ziqing
Published: December 2023

Category:

Ankle; Trauma

Introduction/ Purpose:

Socioeconomic disparities exist in the delivery of orthopedic care. Inequitable outcomes based on socioeconomic status (SES), including income, race, and geography, have been studied in association with outcomes following lower extremity trauma care. As orthopedic surgical care shifts increasingly towards providing care in hospital outpatient departments (HOPD) and freestanding ambulatory surgery centers (ASC), there is an opportunity to address socioeconomic disparities. We aimed to assess the association between patient SES and the outpatient facility type (HOPD versus ASC) where ankle fracture care was performed. We hypothesize: (1) White patients are more likely to receive care at ASCs, (2) Minority and lower income patients are more likely to receive care at HOPDs, and (3) Total charges for care are higher for minority and lower income patients.

Methods:

Data in patients ≥16 years old was sourced from the State Inpatient Database and Healthcare Utilization Project State Ambulatory Surgery Database (SASD) (for Florida, North Carolina, and Wisconsin) from 2016-2019. These 3 states were selected because their SASDs include a variable defining the location of service as a hospital outpatient department (HOPD) or ASC. Cases were identified using CPT codes converted to ICD-10 procedural codes for ankle fracture open reduction and internal fixation (ORIF). 85,749 cases were included: 50,411 (59%) inpatient, 28,536 (33%) HOPD, and 6,802 (8%) ASC, representing approximately 20% of inpatient and 11.5% of outpatient cases performed in the United States. Patient and facility characteristics were abstracted. Appropriate statistical analyses were conducted to describe and compare differences between facility type and patient characteristics.

Results:

Significant race and income disparities exist in outpatient ankle fracture care by facility type. Most patients receiving care were White (71%). Of the patients who received care at an HOPD, 32% were Black compared to 6% at ASCs (OR 0.795, CI 0.728-0.869). Of patients receiving care at an HOPD, 27% were other minorities compared to 9% at ASC (OR 1.213, CI 1.213- 1.309). More patients at HOPDs were in the lowest income level (26%) compared to ASC (18%). Factors found to associated with higher charges for surgery included patient being of minority race, patient of lower income level, and surgery performed at HOPD versus ASC.

Conclusion:

Ankle fractures treated at ASCs were more likely to be White and of higher income. These socioeconomic and racial/ethnic disparities are also associated with receiving care with higher total charges. These data indicate inequitable access to ankle fracture care performed at ASC facilities. More attention to social determinants of health is critical in the context of ankle fracture care to address potential inequitable outcomes and higher cost of care.
Outcomes following Particulated Juvenile Allograft Cartilage for Osteochondral Lesions of the Talus: A Systematic Review
Authors: Butler James J. , Rizlan Muhammad Raziq Mohammed , Azam Mohammad T. , Campbell Hilary T. , Kennedy John G.
Published: December 2023

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates at short-term follow-up following Particulated Juvenile Allograft Cartilage (PJAC) for the management of osteochondral lesions of the talus (OLT).

Methods:

During November 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJAC for the management of OLTs. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed.

Results:

Twelve studies were included. In total, 241 patients underwent PJAC for the treatment of OLT at a weighted mean follow-up of 29.0±24.9 months. The weighted mean lesion size was 138.3±59.6 mm2 and 69.4% of OLTs were located at the medial talar dome. Prior surgical intervention was recorded in 7 studies, the most common of which was microfracture (65.9%). Concentrated bone marrow aspirate was utilized in 66 patients (27.3%). The weighted mean AOFAS score improved from a pre- operative score of 58.5±3.2 to a post-operative score of 83.9±5.3. The weighted mean post-operative MOCART score was 48.2±3.3. The complication rate was 16.5%, the most common of which was graft hypertrophy (7.0%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8±9.6 months following the index procedure.

Conclusion:

This systematic review demonstrated a moderate improvement in subjective clinical outcomes following PJAC for the treatment of OLT at short term follow-up. However, post-operative MOCART scores were reported as poor. In addition, a moderate complication rate (16.5%) and a moderate failure rate (12.4%) was observed, calling into question the efficacy of PJAC for the treatment of large OLTs. Further studies are warranted to identify the optimal role of PJAC in the management of OLTs.
Outcomes following Surgical Intervention for Hallux Varus deformity: A Systematic Review
Authors: Butler James J. , Joudi Rakan , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates following surgical intervention for hallux varus deformity.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for hallux varus deformity. Data regarding study characteristics, patient demographics, osteoarthritis severity, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed.

Results:

Twelve studies were included. In total, 168 patients (186 feet) underwent surgical intervention for hallux varus deformity. at a weighted mean follow-up of 49.6±36.6 months. The weighted mean AOFAS score improved from a pre-operative score of 60.5±18.4 to a post-operative score of 83.9±9.0. The weighted mean hallux valgus angle improved from a pre-operative angle of 16.9±6.5° of varus to a post-operative angle of 5.9±6.6° of valgus. The weighted mean inter-metatarsal angle improved from a pre- operative angle of 12.7±10.0° to a post-operative angle of 7.7±3.4°. The complication rate was 21.5%, the most common of which was 1st MTPJ joint pain and stiffness. Eleven failures (5.9%) were observed at a mean time of 25.0 months following the index procedure.

Conclusion:

This systematic review demonstrated improvements in subjective clinical outcomes together with a low failure rate following surgical intervention for hallux varus deformity at mid-term follow-up. A high complication rate was recorded. However, the marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions. Further research with a longer follow-up is warranted to determine the optimal surgical technique for hallux varus deformity correction.
Prospective Study of the Destabilization Maneuver in Inversion for the Treatment of Acute Ankle Ligament Injury: Case Series
Authors: Galati Danilo Antonio , Mansur Nacime Salomao Barbachan
Published: December 2023

Category:

Ankle; Sports

Introduction/Purpose:

Ankle sprains are highly prevalent injuries in athletes, whether amateurs or professionals. It is estimated that they cause around 5,000 sprains a day in the UK, while American data point to around 23,000 cases daily (1/10,000 individuals). The most current literature has pointed to early diagnosis followed by functional strategies as the approach with the highest success rate for lateral ankle sprains, thus contributing to the prevention of chronic instabilities. offering better quality of life and safety to patients are necessary. Objective: The objective of this work is to present the clinical results obtained from the prospective observation of a series of patients with lateral ankle sprains treated with the destabilization technique in Ankle Inversion added to the conventional treatment.

Methods:

Design: Comparative prospective study in a single center without a control group Location: The study was carried out at Hospital São Paulo – University Hospital of UNIFESP (HSP-UNIFESP), at the Orthopedics Ambulatory of the Department of Orthopedics and Traumatology (DOT)/EPM-UNIFESP. Inclusion criteria -Over 18 years old of both sexes; -Complaint of ankle sprain within 48 hours -Complete or partial injury to any of the ligaments of the lateral ankle complex; -Isolated or associated ligament injuries; Non-Inclusion Criteria -Past history of surgery on the affected foot or ankle; -Previous complaint in the ankle region; -Any fracture associated with sprains or injuries that influence; -Any condition that is a contraindication to the proposed therapies; -Refusal to participate in the study Sample size: 100 Individuals

Results:

We conclude that statistically we have a higher percentage of No Re-sprains with 94% against 6% of Re-sprains. This index has a CI (confidence interval) of 4.7%, that is, we have that the Reentorse index was 6.0% ± 4.7% which is the same as saying that the index can vary from 1 .3% to 10.7% with 95% statistical confidence.

Conclusion:

Based on the findings of the present study, we concluded that in a 12-month follow-up, the ankle inversion destabilization maneuver proved to be effective in preventing new episodes of lateral ankle sprains. and in order to compare the maneuver described in the study with techniques already described in the literature and used by physiotherapists in their clinical practice, should be performed.
Racial, Socioeconomic, and Payer Status Disparities in Utilization of Total Ankle Arthroplasty Compared with Ankle Arthrodesis
Authors: Schmerler Jessica , Dhanjani Suraj , Wenzel Alyssa , Kurian Shyam J. , Srikuaran Uma , Ficke James
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle arthroplasty is increasingly being used for the treatment of ankle osteoarthritis when compared to arthrodesis. However, there has been limited investigation into disparities in utilization of these comparable procedures. This study examined racial/ethnic, socioeconomic, and payer status disparities in the likelihood of undergoing total ankle arthroplasty compared with ankle arthrodesis.

Methods:

Patients with a diagnosis of ankle osteoarthritis from 2006 through 2019 were identified in the National Inpatient Sample, then subclassified as undergoing total ankle arthroplasty or arthrodesis. Multivariable logistic regression models, adjusted for hospital location, total hospital charges, primary or secondary osteoarthritis diagnosis, and patient characteristics (age, sex, infection, diabetes, neuropathy, and Elixhauser Comorbidity Index), were used to examine the effect of race/ethnicity, socioeconomic status, and payer status on the likelihood of undergoing total ankle arthroplasty versus arthrodesis.

Results:

There were 6,966 patients who underwent TAA and 5,681 patients who underwent arthrodesis over the study period. Black and Hispanic patients were 42% and 32% less likely than White patients to undergo total ankle arthroplasty rather than arthrodesis (P <.001). Patients in income quartiles 3 and 4 were 17% and 23% more likely, respectively, than patients in quartile 1 (the lowest quartile) to undergo total ankle arthroplasty rather than arthrodesis (P=.001 and P=0.01, respectively). Privately insured and Medicare patients were 67% and 117% more likely, respectively, than Medicaid patients to undergo total ankle arthroplasty rather than arthrodesis (P <.001).

Conclusion:

Racial/ethnic, socioeconomic, and payer status disparities exist in the likelihood of undergoing total ankle arthroplasty versus arthrodesis for ankle osteoarthritis. More work is needed to establish drivers of these disparities and identify targets for intervention, including improvements in parity in relative procedure utilization.
Radiographic Measurements Associated with Ankle Power Generation During Gait in Patients with Cerebral Palsy
Authors: Choi Yoon Hyo , Lee Dong Yeon , Kyung Min Gyu , Lee Kyoung Min , Lee Kyoung Min
Published: December 2023

Category:

Basic Sciences/Biologics; Ankle

Introduction/Purpose:

Pes planovalgus (PV) deformity accounts for lever arm dysfunction and compromises gait in patients with cerebral palsy (CP). However, the association between ankle power generation and radiographic indices is not yet understood. We aimed to investigate the association between ankle power and radiographic indices during gait in patients with CP concomitant with PV deformity.

Methods:

Patients older than 14 years with ambulatory CP and PV deformity were included. All the patients underwent three- dimensional gait analysis and weight-bearing foot radiography. Gait data were collected, including foot progression angle, tibial rotation, and ankle power generation. Radiographic measurements included anteroposterior (AP) talo-first metatarsal angle, lateral talo-first metatarsal angle, and hindfoot angle. A linear mixed-effects model was used for statistical analysis to identify significant radiographic indices associated with ankle power generation.

Results:

Thirty-one limbs from 15 patients with spastic diplegia and six with spastic hemiplegia were included. Statistical analysis demonstrated that ankle power generation was significantly correlated with the CP type (p=0.01) and AP talo-1st metatarsal angle (p=0.02).

Conclusion:

Ankle power generation was significantly associated with the AP talo-first metatarsal angle. Surgeons might need to pay attention to correcting forefoot abduction to restore ankle power when planning surgeries for pes PV deformities in patients with CP.
Rates of Depression and Post-Traumatic Stress Disorder Differ by Insurance Type in Chronic Ankle Instability Patient
Authors: Allen John R. , Hoch Caroline , Morningstar Joshua L. , Scott Daniel , Gross Christopher E.
Published: December 2023

Category:

Ankle; Other

Introduction/Purpose:

Chronic ankle instability (CAI) is one of the most commonly encountered clinical problems by orthopaedic foot and ankle surgeons, however, little research exists on the impact of insurance status on the incidence and outcomes of CAI. This study aims to investigate the association between psychiatric diagnosis and insurance status in CAI patients to determine if insurance subgroups differ in rate of surgery and postoperative success, as well as identify if psychiatric diagnoses are more common within certain insurance types.

Methods:

A retrospective review was conducted of 276 patients (280 ankles) treated between 2005 and 2021 at an academic medical center by one of three fellowship-trained foot and ankle orthopaedic surgeons, of which 56 (20.0%) underwent surgery, seven (2.5%) underwent reoperation, and 130 (46.4%) had a concomitant psychiatric diagnosis (i.e., anxiety=111, depression=105, post-traumatic stress disorder [PTSD]=19, obsessive-compulsive disorder [OCD]=6, bipolar disorder [BPD]=5). Insurance type was categorized as privately- (n=147) or government-funded (n=121). For further analysis, the government-funded cohort was broken into the following groups: Medicare (n=77), Veterans Affairs (n=20), Worker’s Compensation (n=18), and Medicaid (n=6). Eleven patients (12 feet) were uninsured. Data collected included demographics, conservative and operative treatments, patient- reported outcome measures (PROMs) (e.g., Foot and Ankle Ability Measure [FAAM]), and reoperation rate.

Results:

When examining binomial insurance groups, rate of surgery (private=15.6%, government=24.8%; p=.061) approached, but did not reach, significance and reoperation rate (private=17.4%, government=10.0%; p=.451) did not differ. Postoperatively, PROMs did not differ between private and government insurance types, but FAAM Physical Function (p=.046) and Total (p=.035) scores were best with Medicare insurance when analyzing all insurance groups. Instance of mental illness (p=.111) or certain psychiatric diagnoses did not differ between privately- and government-insured patients, but depression (p=.013) and PTSD (p=.050) were significantly less common among patients with Veterans Affairs insurance.

Conclusion:

CAI patients were not found to have differing need for surgery between insurance types. This was similar for postoperative success, aside from Medicare patients having better reported FAAM scores. Furthermore, patients with a psychiatric diagnosis were not more common to an insurance group, but specific depression and PTSD diagnoses were least common for Veterans Affairs patients.
Relationship Between Hallux Valgus Recurrence and Sesamoid Position on AP Standing Radiographs After Distal Chevron Metatarsal Osteotomy
Authors: Kim Jinkyung , Kim Taehoon , Choi Youngrak , Yu Youngtak
Published: December 2023

Category:

Midfoot/Forefoot; Bunion

Introduction/ Purpose:

Recurrence of the hallux valgus deformity has various causes, and the incomplete reduction of sesamoids may be one of the important issues. However, we have seen several patients with postoperative lateral sesamoid displacement on AP standing radiographs who did not experience hallux valgus recurrence. Therefore, we hypothesized that lateral displacement of the sesamoid on AP standing radiographs does not cause hallux valgus recurrence.

Methods:

The study included 269 feet (185 patients) with hallux valgus treated with distal chevron metatarsal osteotomy. Mean patient age was 64.26 (range, 15–80) years. Patients were followed-up for an average of 33.85 (range, 12–228) months between April 2002 and December 2019. The patients were divided into four groups, according to the presence or absence of hallux valgus recurrence and sesamoid reduction.

Results:

During outpatient follow-up, we discovered 99 feet (42.1%) in which hallux valgus did not recur despite lateral sesamoid displacement (grade IV–VII) on AP standing radiographs. HVA, IMA, sesamoid grades all deteriorated over time after surgery, and each indicator was statistically significantly altered, and changes in the three indicators had a statistically significant positive correlation. Changes in HVA and IMA between feet with and without sesamoid reduction on AP standing radiographs increased over time, with the differences in HVA and IMA being significant at final follow-up. Regardless of whether sesamoid reduction was achieved on AP standing radiographs, the final analysis showed that HVA and IMA in both groups worsened over time. There were no differences between the two groups in the patterns of change over time.

Conclusion:

In our cohort postoperative sesamoid position on on AP standing radiographs was not associated with hallux valgus recurrence based on radiographic criteria.
Safe and Effective Is Not Always Acceptable: The Case for PASS Scores in Foot and Ankle Orthopaedic Surgery
Authors: Mathew Smitha E. , Guyton Gregory P.
Published: December 2023

Category:

Other

Introduction/Purpose:

Determining the success of a clinical intervention can be challenging even with modern patient-reported outcomes. Traditionally studies have used the Minimum Clinically Important Difference (MCID), the smallest difference in an outcome that is felt to have clinical significance. More recently some authors have emphasized the alternative model of the Patient Acceptable Symptomatic State (PASS), the threshold of a PRO defining where patients consider their overall status to be acceptable. PASS scores have not yet seen wide use in the foot and ankle literature, but may add insight to surgical outcomes beyond simply measuring the minimal changes implied by the MCID.

Methods:

The most universal patient-reported outcome in the foot and ankle literature is the simple Visual Analog Pain Scale (VAS), in which a patient rates their pain along an analog scale between 0 to 10 cm. Articles in Foot and Ankle International from December 2020 to August 2022 that reported VAS pain scores and variance following an intervention were included. Although specific PASS thresholds for VAS scores in many conditions in the foot and ankle have not been determined analytically, values ranging from 2.0 to 3.0 are typical for orthopaedic conditions, corresponding to the intuitive statement “I would like my pain to be less than 2 or 3 out of 10.” A PASS threshold of 2.0 has been used previously in the foot and ankle literature. The studies were therefore analyzed against PASS thresholds for the VAS of 2.0, 2.5, and 3.0.

Results:

Twenty-one studies were included. Five had multiple internal groups, yielding a total of 27 total sets of VAS scores.All 27 (100%) showed improvements well beyond the MCID and were considered successful. 17 (81%) of the 21 studies subjectively described their intervention as “reliable”, “good”, “effective” or “satisfactory”. Despite this, 8 (38%) of the 21 studies reported final mean VAS scores for all internal groups above a PASS threshold of 2.0. An analytically calculated weighted average final VAS pain score for all studies was 1.78 +/-1.89. Based upon this, the expected percentages of patients included in FAI studies whose results failed to meet VAS PASS thresholds were 45% for a threshold of 2.0, 35% for a threshold of 2.5, and 26% for a threshold of 3.0.

Conclusion:

Studies in the foot and ankle literature almost universally report positive results, both subjectively in their discussions and by statistically demonstrating improvement of patient-reported outcomes beyond the MCID. PASS threshold analysis yields a much less positive interpretation and emphasizes the number of negative outliers in the population who do not find their outcome acceptable. A fuller picture of the outcome of foot and ankle procedures and overall patient satisfaction can be gained from reporting both changes in the mean and comparing final outcomes to PASS thresholds.