bluuebunny/crossref_metadata_2025 huggingface dataset:
Scope Assisted Ankle Arthrodesis in a Young Male with Hemophilic Arthritis: A Case Study
Authors: Hyer Christopher F. , Malloy McCoy Antonio M. , Nguyen Kevin N. , Consul Devon
Published: January 2022

Category:

Ankle Arthritis; Arthroscopy

Introduction/Purpose:

Arthritis is a debilitating condition that negatively affects an individual's ability to carry out activities of daily living. While osteoarthritis is a term many have become familiar with, as it is the most common form of arthritis encountered, hemophilic arthritis is a condition not frequently seen or discussed. Hemophilia is a congenital bleeding disorder caused by the absence or decrease of clotting factor VIII (Hemophilia A) or XI (Hemophilia B). When severe, this X-linked disease commonly results in intra-articular bleeding which, can progress to joint destruction1-4. This subsequently leads to the progressive destruction of articular cartilage and bone6-7.

Methods:

Arthroscopic assisted ankle arthrodesis with calcaneal autograft was performed. Calcaneal autograft was acquired through a small linear incision along the lateral wall of the calcaneus, a power graft harvester was introduced into the medullary bone to procure the graft. The left lower extremity was then placed into a non-invasive Gould Ankle distraction system and the standard anteromedial and anterolateral ankle scope portals were established. A scope and shaver were utilized to extensively debride all visualized hemorrhagic synovium. The shaver was then exchanged for a burr following debridement to remove the articular cartilage to both the talus and tibia. Following adequate preparation of the joint margins for fusion, the ankle joint was filled with the calcaneal autograft and rhPDGF-BB.

Results:

Various treatments have been described for patients suffering from hemophilic arthritis. While the use of clotting factor concentrations (CFCs) may reduce the risk of hemarthrosis, the risk of bleeding cannot be completely avoided2. Arthroscopic or open synovectomies has been described to remove the pathogenic synovium. Chemical or radioisotopic synoviorthesis is an option for less severe cases, but the treatment of choice is joint fusion or arthrodesis for advanced stages of arthropathy3.

Conclusion:

In patients with hemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. The pathogenesis of hemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Our case report presents a unique pathology and the successful outcome that can be accomplished through surgical intervention and a multidisciplinary treatment approach.
Opioid Usage after Hallux Valgus Correction Surgery
Authors: Jackson J.B. , Thier Zachary T. , Barfield Matthew E. , Altobello Kenna C. , Gonzalez Tyler A.
Published: January 2022

Category:

Bunion; Other

Introduction/Purpose:

More than 200,000 surgeries for hallux valgus correction occur annually in the United States. Due to the post-operative pain associated with the procedure, opioids are often prescribed to help manage pain. Given the lack of objective data on opioid use and the difficulty of addressing a patient's post-operative pain, we sought to quantify, through a prospective analysis, patient's narcotic use after hallux valgus surgery. The purpose of our study was to determine the average quantity and type of post-operative opioids consumed after hallux valgus surgery and to assess potential predictive factors for increased opioid consumption.

Methods:

Adult patients undergoing primary hallux valgus surgery were recruited from two foot and ankle fellowship trained orthopedic surgeons at a single institution. At the pre-operative visit, patients were consented and completed a demographical questionnaire. Data was collected from the operative and PACU record, as well as the 2, 6, and 12-week post-operative visits. A statistical analysis was performed to determine the average quantity of opioid and non-opioid pain medication consumed post- operatively, as well as any statistically significant correlations.

Results:

For the 58 subjects who completed treatment and data collection in the PACU, 53 consumed opioids. Initial prescriptions for these patients included Hydrocodone, 39 (73.58%) Oxycodone, 13 (24.52%) and Meperidine, 1 (1.89%). The average number of opioid pills collectively consumed at the two-week and 12-week post-operative visit was 19.99 and 22.52, respectively. At the two-week postoperative visit, only patient BMI showed a statistically significant association with increased opioid use.

Conclusion:

On average, patients consumed 22-24 narcotic pain pills after hallux valgus reconstruction surgery. If a physician prescribed 24 narcotics pills after surgery to patients that are not currently utilizing narcotic pain medication, there is a 95% chance they will not need additional pain medication during the two-week postoperative period.
Diagnostic Accuracy of MRI in Diagnosing Plantar Plate Tear About Metatarsalgia: Incidental Finding of A Tear on Routine Magnetic Resonance Imaging
Authors: Kachooei Amir R. , Shakked Rachel J. , Roedl Johannes B. , Pedowitz David I.
Published: January 2022

Category:

Lesser Toes; Midfoot/Forefoot

Introduction/Purpose:

This study aimed to assess the rate of plantar plate tear finding on MRI study of symptomatic versus asymptomatic patients. We secondarily aimed to determine the correlation between PP tear grading and symptoms and to assess the diagnostic accuracy of MRI.

Methods:

Based on the physical examination report, patients were divided into Symptomatic and Asymptomatic groups. Data from the MRI reports were extracted for the second to fifth plantar plates. All MRIs were studied again by a musculoskeletal radiologist to measure the inter-rater agreement and MRI reports' reliability. MRI finding of the plantar plates was categorized as torn vs. intact. We used the anatomical grading system (AGS) to assess the plantar plate tear grading correlation with symptoms

Results:

There was an excellent inter-rater agreement (Kappa=0.92). Calculating the odds ratio reveals that the odds of finding intact PP in a symptomatic patient is 16 times more than finding a tear in the same patient. Diagnostic accuracy of MRI shows that PP tear finding on MRI is highly specific and has a low sensitivity meaning that the chance of incidental finding of a PP tear is extremely low.

Conclusion:

MRI is specific for diagnosing plantar plate tear and is suggested to confirm the diagnosis and plan for the surgery when the diagnosis is highly probable concerning the clinical examination.
First Metatarsophalangeal Joint Fusion with Orthogonal Memory Staple Fixation
Authors: Kasture Sarang P. , Walsh Anna S. , Sugathan Hari , Dalal Rakesh
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

First metatarsophalangeal joint (MTPJ) fusion is one of the most commonly performed procedure for painful symptomatic arthritis. The implants used for osteosynthesis are variable and depend on surgeon preference. The aim of this paper was to study the outcome of first MTPJ fusion surgery using fixation with orthogonal shape memory alloy (Nitinol) staples.

Methods:

75 consecutive patients who underwent first MTPJ fusion with orthogonal memory staples were included in the study. All patients underwent surgery using standard surgical technique with fixation of the arthrodesis with two 20 mm shape memory alloy (Nitinol) staples (Memo staples, Ortho Solutions Inc). The first staple placed medially and the second staple placed dorsally in orthogonal plane. The arthrodesis surfaces were prepared and temporarily fixed with K wire. Once the position and bone approximation was confirmed satisfactory under image intensifier guidance, a flat staple bed was prepared with saw blade to make sure the staples are not proud after fixation. All patients also received standard postoperative care with heel weight bearing shoe for six weeks and follow-up at 3,6 and 12 weeks as standard regimen. Patient demography, time to clinical and radiological union, early/late complications, rate of non-union, revision surgery and implant removal were noted.

Results:

Average age was 64.6 years. 42 patients had severe radiologic arthritic changes while 27 patients had associated moderate to severe hallux valgus deformity. Five patients were known to have inflammatory arthritis. The average follow-up was 18.3 weeks. There were two early complication of superficial infection treated successfully with oral antibiotics. Average clinical union was 7.2 weeks and radiological union at 12 weeks. Five patients (6.6%) had radiological non-union of which four underwent revision surgery with plate fixation. One patient had delayed union while one had dorsal staple back-out but did not warrant removal. None required staple removal from hardware prominence. There was no significant difference in union or complication rates with regards to gender or presence inflammatory arthritis.

Conclusion:

This study demonstrates that the outcome of 1st MTPJ fusion with two memory staples in orthogonal position is comparable with other modalities of fixation in terms of rate of union and resurgery. It is safe, simple and easily reproducible technique. Besides, none of the patients in this series required implant removal for hardware related complications. This could be advantageous compared to fewer other modalities like plate fixation, though larger studies are needed to confirm it.
Analyzing Risk Factors for Sequential Above Knee Amputation after Below Knee Amputation in Surgical Treatment of Ischemic and/or Infectious Foot Disease
Authors: Kim Ki Chun , Kim Sung-Jae , Sung Il-Hoon , Young Kiwon , Lee Kyung-tai , Lee Hong S.
Published: January 2022

Category:

Diabetes

Introduction/Purpose:

Some patients with below knee (BK) amputation for treatment of ischemic and/or infectious foot disease eventually further progress to above knee (AK) amputation. We aimed to analyze predictors for sequential AK amputation after BK amputation.

Methods:

We retrospectively reviewed medical records and find 55 patients with BK amputation for surgical treatment of ischemic and/or infectious foot from 2013 to 2018. Twelve patients with sequential AK amputation after BK amputation were designated as group I, and 43 patients successfully treated with BK amputation only were designated as group II. Two groups were compared for various demographic, laboratory and physical state. Then, multivariate logistic regression analysis was done to find predictors for sequential AK amputation after BK amputation.

Results:

In univariate analysis between two groups, only 'knee contracture' showed significant difference between two groups (p= 0.003). In multivariate logistic regression analysis performed with variables showing p <0.1 during univariate comparison, knee contracture was found to be predictor for sequential AK amputation after BK amputation (odds ratio= 34.740, p= 0.041).

Conclusion:

Patients with intractable ischemic and/or infectious foot disease with knee contracture, optimal level of amputation may be above knee level. Careful decision on amputation level can reduce surgical burden for intractable ischemic and/or infectious foot patients.
Percutaneous Tarsometatarsal Arthrodesis of the Lesser Ray with Autograft using a Cannulated Screw
Authors: Kurashige Toshinori
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Tarsometatarsal (Lisfranc) joint arthritis can be a painful condition caused by primary osteoarthritis, inflammatory, and posttrauma. When conservative treatment failed, tarsometatarsal arthrodesis is indicated. There has been no study on percutaneous tarsometatarsal arthrodesis previously. The purpose of this study is to report our percutaneous tarsometatarsal arthrodesis technique and the results of case series.

Methods:

We report 11 joints from 6 feet with painful tarsometatarsal arthritis of lesser ray treated using percutaneous procedure using a wedge burr. The mean age at surgery was 67 years. The mean follow-up period was 12 months. Five feet of 4 patients had TMTj degeneration with hallux valgus. Another patient suffered from painful posttraumatic degenerative arthritis. Through 5-10 mm incision, a 2.9 mm-diameter wedge burr was introduced into the joint. Resection of subchondral bones was performed with the medial, lateral and plantar cortices preserved. The dorsal cortex except the burr insertion point was also remained. The iliac-crest bone grafts were taken using a 6-mm diameter trephine. Preoperatively and at the most recent follow-up visit, we applied the midfoot scale proposed by Japanese Society for Surgery of the Foot (JSSF). The validity and reliability of the JSSF scale has been confirmed in previous studies.

Results:

Though there was one nonunion with screw breakage, we achieved successful results with no need of revision surgery during mean one year follow-up period. Bone unions were achieved in 10 of 11 joints (91%) at the most recent follow-up. JSSF midfoot scale significantly improved from 62 points preoperatively to 89.6 points at the most recent follow-up (p= 0.04).

Conclusion:

Our percutaneous TMTj arthrodesis was achieved a union rate and clinical results comparable to other surgical technique. This procedure was an effective method for treatment of TMTj arthritis.
The Metatarsal Cortical Index as an Indicator of Insufficiency Fracture of the Foot
Authors: Lenz Christopher G. , Raith Constance , Urbanschitz Lukas , Tondelli Timo O. , Eid Karim , Niehaus Richard , Hodel Sandro
Published: January 2022

Category:

Basic Sciences/Biologics; Midfoot/Forefoot

Introduction/Purpose:

The diagnosis of metatarsal stress fractures is challenging. Standard imaging often shows false negative results. The aim of this study was to create reliable radiologic outcome parameters to predict insufficiency fractures of the metatarsals

Methods:

We performed an age- and sex-matched case-control study of patients with (n = 18) and without insufficiency fracture (n = 18) of the foot. To measure the ratio between the outer cortical border and the endosteal diameter, the MCI was developed as a novel radiographic measurement on dorsoplantar images. The MT was divided into thirds, and the width from the outer cortical border to the endosteal diameter was measured at the junction of the proximal to the middle third (proximal), at the midshaft (middle), and at the junction of the middle to the distal third (distal). The metatarsal cortical index (MCI) for each metatarsal was developed to predict an insufficiency fracture. The MTs were sequentially numbered as MT I-V. To correct for potential bias due to MT length, the Coughlin index and Maestro method were used in all patients.

Results:

The MCI of each metatarsal was significantly decreased in the insufficiency fracture group compared with the control group (p <.01). The MCI of the fourth ray yielded the highest area under the curve among the analyzed MCI values (area under the curve, 0.79; 95% confidence interval, 0.61-0.90). A cut-off value of 1.62 for the MCI of the fourth ray yielded a sensitivity of 78% and a specificity of 78% to predict insufficiency fracture of the foot (odds ratio, 12.25; 95% confidence interval, 2.54-58.97), and enabled accurate allocation to the insufficiency fracture group versus the control group in 74% of cases.

Conclusion:

A decreased MCI is associated with metatarsal insufficiency fractures and enables an accurate diagnosis in three out of four cases. Despite the highly variable anatomy and morphology of the MTs, we were able to show that the MCI is a reliable tool to determine insufficiency fracture of the MT on plain radiography. The MCI might aid clinicians in identifying insufficiency fracture, and raise the suspicion of the diagnosis without additional imaging studies.
Does Sagittal Tibiotalar Alignment of TAR Predict Failure?
Authors: Leucht Anna-Kathrin , Salat Peter , Phisitkul Phinit , Amendola Annunziato , Femino John E. , Veljkovic Andrea N.
Published: January 2022

Category:

Ankle Arthritis

Introduction/Purpose:

The long term outcome of total ankle replacement is contingent on restoring the anatomic tibiotalar alignment of the ankle joint. Prior studies have mainly looked at the effect of coronal and hindfoot alignment of TAR on outcome and failure with few studies focusing on the effect of sagittal tibiotalar alignment. From these, we know that sagittal alignment has a greater impact on joint mechanics and that proper positioning of the talar component in the sagittal plane results in greater postoperative pain relief and better functional outcome, especially ankle range of motion. The goal of this study was to define a sagittal radiographic value that predicts failure in TAR.

Methods:

We analyzed the data of a retrospective patient cohort of consecutive TAR patients, which were treated from 2004 and 2011. Patients with two types of prosthesis were included, Salto Talaris (fixed bearing) and STAR (mobile bearing). All measurements were completed by two blinded observers, including the sagittal distal tibial articular angle (sDTAA), the lateral talar station (LTS) and the talar component inclination angle (γ angle). A total of 90 patients were included, 51 were male and 39 female patients. Seventy-seven patients received a Salto and 13 patients a STAR prosthesis. The average age was 63.7 years.

Results:

The mean sDTAA was 83.9 degrees and the mean γ angle was 21 degrees, both without significant difference in the two different prosthesis designs. A significant association (p=0.03) between post-op LTS as a continuous variable per unit increase and clinical failure was demonstrated, which included all the revision cases, with an odds ratio of 1.25. In addition a significant association (p=0.03) between increased LTS and sDTAA change of >5°, which is indicative of anterior subsidence, was shown. This was associated with an odds ratio of clinical TAR failure of 1.27.

Conclusion:

The abnormal radiographic post-op lateral talar station appears to predict clinical TAR failure and correlates with the abnormal sDTAA; the anterior translated talus loads the anterior tibia leading to anterior subsidence of the prosthesis. Limitation of this study is the inclusion of two different types of prosthesis designs.
Surgical Treatment Outcomes of Achilles Tendon Rupture and Tendinosis Augmented with Synthetic Graft
Authors: Levy Jeffrey A. , Neufeld Steven K. , Sanders Thomas H. , Cuttica Daniel J.
Published: January 2022

Category:

Hindfoot; Sports; Trauma

Introduction/Purpose:

Surgical treatments for Achilles tendon ruptures (ATR) or insertional Achilles tendinitis (IAT) traditionally have prolonged postoperative recoveries. Patients are typically kept non-weight bearing or protected weight bearing on the operative extremity for weeks after surgery to protect the repairs. The purpose of this study is to show that augmentation of typical Achilles tendon repairs with a synthetic scaffold is safe, allows for early weight bearing while preserving functional outcome and has a high patient satisfaction.

Methods:

A retrospective chart review was performed on all patients surgically treated for ATR or IAT from 2018 - 2020. The surgeries were performed by two fellowship trained Foot and Ankle Orthopaedic surgeons. All repairs were augmented with a synthetic scaffold made of polycaprolactone-based polyurethane urea (PUUR). Achilles tendon ruptures were direct end-to-end repairs and IAT repairs were performed with double row biocomposite anchors in the calcaneus after a calcaneus exostectomy. Exclusion criteria included flexor hallucis longus transfer, non-insertional achilles tendinosis, patients undergoing additional surgical procedures, and ATR or IAT repairs not treated with PUUR. Patients were evaluated as a cohort as well as acute ruptures, chronic ruptures (defined as more than 6 weeks old), and IAT subgroups. Primary outcomes were date of weight bearing and patient satisfaction. Secondary outcomes were final strength and ankle dorsiflexion. The Wilcoxon signed-rank test (WSR) was used to compare baseline and final follow-up NRS scores.

Results:

A total of 33 patients met the inclusion criteria with 12 ATR (9 acute and 3 chronic) and 21 IAT. Mean follow-up length was 150 days (43 - 314). Mean weight bearing began on postoperative day (POD) 7.33 (6-13) for acute ruptures, 14.33 (6-19) for chronic ruptures, and 9.9 (5-42) for IAT. Patient satisfaction, based on a binary yes/no response at final followup, was obtained on 27 of 33 patients with 92.6% positive indicating satisfaction with surgical outcome. Final strength averaged 5/5 for 83.9% and 4/5 for 16.1% of all patients. Final active dorsiflexion of at least 10 degrees was obtained in 93.5%. Mean numerical rating scale (NRS) for pain significantly decreased from 5.2 to 0.6 for all patients (WSR p<0.001). No patients had loss of fixation or had a re-rupture. Complications included one patient with sural neuritis and another with minor wound breakdown that did not require surgical intervention.

Conclusion:

Augmentation of Achilles tendon ruptures and insertional Achilles tendonitis with PUUR graft is safe, allows for early weight-bearing, has a high patient satisfaction and has acceptable functional outcomes in regards to strength and motion.
Five-Factor Modified Frailty Index as a Predictor of Complications Following Total Ankle Arthroplasty
Authors: Lewis Lauren , Jupiter Daniel , Panchbhavi Vinod K. , Chen Jie
Published: January 2022

Category:

Ankle Arthritis; Ankle; Other

Introduction/Purpose:

Ankle arthritis can significantly diminish the function and quality of life of affected individuals. Treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA). Ongoing research seeks to identify patient factors associated with a higher risk of post-operative complications following TAA. A 5-item modified frailty index (mFI-5) has been found to predict adverse outcomes of multiple orthopaedic procedures. The aim of this study was to evaluate the suitability of the mFI-5 as a risk stratification tool for patients undergoing TAA.

Methods:

A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed on patients undergoing TAA between the years of 2011 and 2017. Data on patient demographics, post-operative complications, and length of stay were collected. Bivariate analysis and multivariate logistic regression were subsequently performed to investigate frailty as a possible predictor of post-operative complications.

Results:

1035 patients were identified (mean age = 63.9 years). Complication rates significantly increased with increasing mFI-5 score, from 5.24% in patients with no mFI-5 variables to 19.38% in patients with two or more mFI-5 variables present (P <0.0001). When comparing patients with an mFI-5 score of 0 to patients with an mFI-5 score of 2, 30-day readmission rate increased from 0.24% to 3.1% (P> 0.017), length of stay increased from 1.79 days to 2.18 days (P >0.007), adverse discharge rate increased from 3.81% to 15.5% (P <0.0001), and wound complications increased from 0.24% to 1.55% (> 0.02). After controlling for demographic factors, length of stay, and operative time, mFI-5 score remained significantly associated with patients' risk of developing any complication and 30-day readmission rate.

Conclusion:

Frailty as defined by the mFI-5 is associated with adverse outcomes following TAA. Implementing the mFI-5 as a risk stratification tool may assist in identifying patients who are at an elevated risk of sustaining a complication, and may allow for improved informed decision-making and perioperative care when considering TAA.
Anatomic Considerations of the Distal Fibula: A Computed Tomography Guided Analysis
Authors: Locker Philip H. , Waldman Leah , Michalski Max
Published: January 2022

Category:

Ankle; Basic Sciences/Biologics; Trauma; Other

Introduction/Purpose:

Ankle fractures are a common injury in the general population with nearly sixty thousand operations performed in California for fractures involving the tibiotalar joint over a 10-year span. Reestablishing anatomic fibular alignment after fracture reduction leads to improved patient outcomes by restoring ankle mortise congruence. An in-depth understanding of fibular morphology may aid in fracture reduction, preoperative planning, plate positioning and intra-operative contouring. The goal of this study is to perform quantitative morphologic analysis of distal fibular anatomy using computed tomography (CT).

Methods:

Using Nuance mPower Clinical Analytics software, a database of CT tibia-fibula reports for patients ages 18 through 35 performed at our institution were searched for the term 'normal.' Inclusion criteria was absence of any reported osseous pathology. Examinations were excluded if the fibula was incompletely imaged. Twenty CTs were collected and analyzed. Measurements were performed at 5 mm increments from the tip of the fibula extending proximally to 10 cm. At each level the following measurements were obtained: lateral and posterior border lengths, lateral to medial (LM) bicortical distances at ¼, ½, and ¾ the length of the lateral border, posteroanterior (PA) bicortical distance at the center of the posterior border, and the angles of the lateral and posterior borders relative to the PA axis of the tibia (figure 1). The location of the maximal bicortical distance in the LM direction was recorded at each level.

Results:

The posterior border of the fibula broadens from an apex distally to 8.4+-1.6 mm at 10 cm proximal while rotating an average of 97.5 degrees. The lateral border of the fibula rotates 6.3 degrees from distal to proximal and begins with a width of 12.8+-3.1 mm and comes to an apex at 9 cm. In the distal fibula, the ratio of the maximal LM to PA bicortical length is 0.56. By 3 cm proximal, the ratio approaches 1 and is 1.6 at 10 cm. The distal 1 cm of the fibula has the largest LM diameter anteriorly and medially but from 1.5 cm to 10 cm proximal the posterior ¼ has the largest LM diameter.

Conclusion:

The fibula has a complex distal geometry which changes with progression from the distal tip to 10 cm proximal. The posterior border of the fibula broadens and rotates over 90 degrees to become the lateral border proximally. The lateral border distally is broad but comes to an apex proximally with minimal rotation. The ratio of bicortical distances changes from distal to proximal as the distal posterior border rotates to face in a LM direction proximally. This information may aid in surgeons' understanding of the complex distal fibular morphology and assist with intra-operative decision making regarding hardware size, placement and manipulation.
Complications of Calcaneal Osteotomy: Are They Equal Between Different Osteotomy Types?
Authors: Madeley N. Jane , Senthil Kumar Chinnasamy , Alenezi Alia
Published: January 2022

Category:

Hindfoot; Other

Introduction/Purpose:

Calcaneal osteotomy is regularly performed as part of the surgical management of a number of conditions. Complication rates are thought to be low, however are these risks the same for different osteotomy types? In our institution a Lateralising Closing wedge osteotomy is performed for Cavus foot correction and Varus alignment with instability, whilst Lateral Column Lengthening Osteotomy and Medialising Displacement Calcaneal Osteotomy (MDCO) are performed for Pes Planus with and without forefoot abduction respectively. In severe Pes Planus deformities both may be utilised. The purpose of this study was to examine complication rates in each group.

Methods:

This is a retrospective case series of consecutive calcaneal osteotomies performed at our institution between January 2010 and December 2019. The primary outcome measures were healing of the osteotomy, metalwork removal and any other reported complications related to the calcaneal osteotomy including infection and wound problems. Patient demographics, associated procedures, indication for surgery, incision, and fixation method were also recorded.

Results:

There were 141 patients in the series. 77 patients underwent a lateralising osteotomy, 55 underwent MDCO and 12 Lateral column lengthening (LCL) with opening wedge osteotomy of the anterior process of the Calcaneus. Fixation was with cannulated screws, or specific purpose locking plates. Patients were followed up for a minimum of three months and discharged from follow-up once a satisfactory level of recovery was reached..One non-union was seen in each of the Lateralising, MDCO and LCL groups. Delayed union was seen in 3 lateralising osteotomies, and 1 MDCO. Metalwork irritation requiring surgery for metalwork removal was 6.5% (4 with screws, 1 plate), 9.1% (all screws) and 0% for Lateralising, MDCO and LCL osteotomies respectively. Wound problems or sural nerve irritation were noted in 11.7%, 3.6% and 8.3% of Lateralising and MDCO and LCL osteotomy respectively. 1 superficial infection was seen in the Lateralising osteotomy group

Conclusion:

One non-union was seen in all groups, with a trend for bone healing to be slower in those having lateralising procedures. Patients should be advised of this possibility if undergoing calcaneal osteotomy. Wound problems and sural nerve irritation were also more common with lateralising procedures. Metalwork removal due to hardware irritation was common (7% overall), and fixation method rather than osteotomy type appears to influence this with 9 cases following cannulated screws and 1 following lateral locking plate fixation. Screw fixation is associated with higher hardware removal rates.
Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard vs Modified Intraosseous Approach: A Cadaveric Study
Authors: Mansur Nacime S. , Martins Fernando S. , Auch Elijah , Giarola Ivan C. , Li Shuyuan , Lalevée Matthieu , Dibbern Kevin N. , Femino John E. , Netto Cesar de Cesar
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Minimally invasive surgery (MIS) of the forefoot has gained popularity as an alternative to traditional open procedures for the treatment of metatarsalgia and hammertoe deformity. Distal metatarsal mini-invasive osteotomy (DMMO) is an extraarticular osteotomy done in a percutaneous manner, with minimal soft tissue dissection that permits elevation as well as shortening. However, there is concern for damage to vital structures due to lack of direct visualization. The objective of the study was to evaluate the structures at risk in standard versus modified DMMO.

Methods:

11 thawed fresh-frozen cadaveric specimens underwent minimally invasive DMMO using both the standard and modified approach. The standard technique was performed by moving the burr in a circular motion with an angle of 45° (right- handed surgeon), which cut sequentially the left, plantar, right and dorsal cortices. It was compared to a modified intraosseous technique requiring less wrist supination while remaining intraosseous. After completion of the procedures, the cadavers were fully dissected and analysed to identify unintentional injury to soft tissue structures and to verify if cuts were completely extraarticular and performed with proper angulation.

Results:

In the standard group the most commonly injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group demonstrated injury to the EDL (27%), while MJC (0%) and EDB (0%) were not damaged. Distances between osteotomies and structures were 6.08 +- 3.99 mm from the dorsal metatarsal head articular surface (DMHAS), 4.85 +- 2.45 mm from EDB and 0.76 +- 1.72 mm from the EDL in the standard group and 9.92 +- 3.42 mm from the DMHAS, 4.71 +- 3.24 mm from EDB and 1.24 +- 1.84 mm from the EDL in the modified group. Statistically significant difference was found among osteotomy site and DMHAS (p=0.02).

Conclusion:

The most frequently injured structure was the EDL tendon with both DMMO techniques used. Intra-articular positioning of the osteotomy was more frequently observed in the standard technique. There was also a statistically significant difference between the distance of the osteotomy site and the dorsal metatarsal head articular surface when comparing the standard group and the modified group. Overall, it appears that the modified method could be a safer, less complex alternative to the standard DMMO technique, especially for the inexperienced surgeons.
Austere Lower Extremity Splinting: A Head-To-Head Comparison of A New Novel 1-Step Spray-On Splint Verse Standard Splinting
Authors: Martin Kevin D. , Webb Tyler , Ly Thuan , Groth Adam T.
Published: January 2022

Category:

Trauma

Introduction/Purpose:

Fracture immobilization in low resource environments is a critical and common aspect of austere medical care. However, there are few studies that critically investigate the efficacy and consistency of current practices. The purpose of this study was to compare austere immobilization techniques for lower extremity fractures while validating a splint application evlauation score sheet.

Methods:

Six orthopaedic surgical residents and 2 medical students participated in a prospective analysis of austere splinting techniques that utilized a cadaveric model with a distal third tibia-fibula fracture. Each participant was observed and scored by 3 Orthopaedic surgeons. All scoring was independent using a Likert scale based on 10 splinting criteria, including quality of radiographic reduction and time to completion. The participants utilized standard equipment that included structural aluminum malleable (SAM) splints and 6-inch ACE wraps in their first attempt. A second immobilization attempt was done with a 1-step spray-on foam splint. After each splinting attempt the reduction was verified with radiographic imaging.

Results:

The 1-step spray-on foam splinting technique was significantly superior (P <.05) in all parameters. Respectively yielding a mean score of 42.3 (range: 38-50), safety 4.7 (range: 3-5), longitudinal traction 4.5 (range: 3-5), time 136 seconds (range: 99-162). The standard splinting resulted in a mean score of 34.2 (22 - 46), safety 2.8 (range: 1- 5), longitudinal traction 4.1 (range: 3-5), time 169.5 seconds (range: 94-254). No catastrophic failures were noted in either group. A strong interobserver reliability was established.

Conclusion:

A 1-step spray-on foam splinting technique demonstrated consistent superiority in reducing fracture motion, potential soft-tissue damage, and sustained longitudinal traction as compared to the standard technique. Secondly, our results validate our splinting evaluation criteria allowing for further utilization in training austere splinting.
Quality of Life Improvement Following Reconstruction of Midtarsal Charcot Foot Deformity: A Five Year Follow-Up
Authors: McGregor Patrick C. , Lyons Madeline M. , Pinzur Michael S.
Published: January 2022

Category:

Diabetes

Introduction/Purpose:

Previous data has suggested that patients have significant clinical improvement after reconstruction of diabetes-associated Charcot foot arthropathy at one year postoperatively. The purpose of this study is to re-evaluate a cohort of patients who were previously surveyed pre-operatively and 1 year post-operatively following Charcot foot reconstruction to determine if improvements in quality of life measures were sustained at a 5-year interval post-operatively.

Methods:

Twenty-four patients were contacted to repeat the Short Musculoskeletal Function Assessment (SMFA) 5 years after their index Charcot foot reconstruction. The same cohort of patients had completed the SMFA pre-operatively and at 1 year post-operatively. The response to items were summated to establish scores on the dysfunction and bother indices. The scores were then standardized to range from 0 to 100 with use of the published scoring formula. Poorer function is indicated by higher scores. Descriptive statistics were utilized to analyze the differences between the preoperative and five year data for the group. Sixteen of the initial 24 study patients (66.6%) were successfully contacted and completed the SMFA survey at five years postoperatively; 2 of the 16 had subsequently undergone amputation.

Results:

Fourteen patients who had previously completed the SMFA preoperatively and 1 year postoperatively after Charcot foot reconstruction in a circular frame were contacted and again completed the SMFA instrument. Improvement was noted in all domains measured by the SMFA between preoperative scores and five years postoperative scores; there was a 17-point decrease in the SMFA standardized functional index and a 3.6-point decrease in bother index. Similarly, when looking at individual domains, there was a 8.7-point decrease in difficulty with daily activities, 4-point improvement in emotion, and 5.7-point improvement in mobility. There was a statistically significant improvement in difficulty with daily activities at five years (p = 0.037), All other domains assessed by the SMFA demonstrated improvement between the two time periods, but did not reach significance due to the limited sample size.

Conclusion:

Successful correction of non-plantigrade midtarsal Charcot foot arthropathy is associated with a clinically meaningful improvement in health-related quality of life at both one and five years postoperatively, including independence with daily activities. This further supports the modern paradigm shift towards operative correction of this deformity.
Return to Play and Clinical Outcomes in the Surgical Treatment of Peroneal Tendon Dislocation and Subluxation
Authors: Mercer Nathaniel P. , Gianakos Arianna L. , van Dijk Pim , Mercurio Angela , Kerkhoffs Gino , Kennedy John G.
Published: January 2022

Category:

Ankle; Sports

Introduction/Purpose:

To provide an overview of the available evidence on peroneal tendon dislocation and subluxation as well as the outcomes after surgical intervention.

Methods:

A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after surgical treatment for peroneal tendon dislocation and subluxation within the last 10 years

Results:

Fourteen articles evaluating a total of 321 patients were included in this review consisting of 240 males and 81 females. The weighted mean age of patients was 28.7 years (range 18-47). The weighted mean follow-up was 38.1 months (range 18 - 58). The weighted mean time to surgery was 5.32 months (range 3 - 9.5). Surgical treatments were categorized into 4 groups which comprised 13 of the 14 studies. Eleven studies recorded the AOFAS score with a weighted mean preoperative score of 65.97 and a weighted mean postoperative score of 92.9. Overall, 90% (145/162) of patients reported their satisfaction as either 'excellent' or 'good'. Time to return to play (RTP) was faster for patients who underwent SPR repair alone compared to SPR repair with groove deepening (p=0.001)

Conclusion:

The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon dislocation and subluxation. However, patients who received SPR repair with groove- deepening returned to sport faster than patients who received SPR repair alone.
Research During Foot and Ankle Orthopaedic Fellowship and Association with Careers Following Fellowship
Authors: Patel Tamanna , Williams Benjamin R. , Ellis Scott J.
Published: January 2022

Category:

Other

Introduction/Purpose:

Performing research during fellowship continues to develop vital critical thinking skills for orthopaedic surgeons as they move into their careers. As fellowships and academic careers become more competitive, research plays an important role in fellow selection and future academic appointments. The purpose of this study was to assess if research during fellowship, measured through journal publications, was associated with careers in academic medicine and if those who published early in their training continued to do so into their careers.

Methods:

A list of foot and ankle fellows, from 2008-2013, were collected from the AOFAS website. In February 2021, all collected fellows were searched on pubmed.gov to generate all orthopaedic publications with a PubMed identifier published before residency, during residency, during fellowship and after fellowship. Each publication's 2020 Thomson Reuters 5-Year Journal Impact Factor and fellows first authorship were noted. The collected fellows were searched through Doximity.com for the name of their medical school, residency and fellowship. The fellows were further searched for their current location of employment and whether it was academic or not. An employment location was considered academic if they were listed on a department website that also was involved in teaching residents. The number of publications, journal Impact Factor and number of first authorships were compared between the academic and non-academic groups during their time before residency, during residency, during fellowship and after fellowship.

Results:

A total of 246 fellows were included, with a mean (+- SD) of 0.8 +- 1.4 publications per fellow during fellowship. During the years in review, 27% (67/246) of fellows entered a career in academics. Before residency, there was no difference in the number of publications between those that went into academic and those that did not [academics 0.54 +- 1.85, non-academic 0.27 +- 1.05 (p=0.154)]. During residency and fellowship, those that went into academics were statistically significantly more likely to publish than those that did not go into academics [during residency: academic 2.82 +- 4.53, non-academic 1.24 +- 2.00 (p=0.0002); during fellowship: academic 1.10 +- 1.57, non-academic 0.69 +- 1.34 (p=0.038)] as well as more first authorships and in journals with higher impact factors.

Conclusion:

As fellowships and academic positions become more competitive, the quality and number of journal publications are likely to become increasingly more important. This study noted that an interest in academics likely develops during orthopaedic residency. This study may help improve mentorship earlier on to those who are more likely to pursue a career in academics.
Unsolicited Patient Complaints in Orthopaedic Surgery: An Analysis Utilizing a Large National Database
Authors: Sarfani Shumaila
Published: January 2022

Category:

Other

Introduction/Purpose:

Unsolicited patient complaints (UPCs) about surgeons have been shown to correlate with surgical complications and malpractice claims in several specialties. Analysis of UPCs in orthopaedics is limited and using large national databases of UPCs may prove informative to orthopaedic providers and administrators. Our purpose was to 1) Evaluate the differences in the number and distribution of UPCs between orthopaedic surgeons as compared to other surgeons, and non- surgeons. 2) Describe the distribution of UPCs among orthopaedic sub-specialties. 3) Assess for clinical characteristics that may be associated with UPCs.

Methods:

Patient complaint reports recorded at 36 medical centers between January 1st, 2015 through December 31st, 2018 were coded using a previously validated coding algorithm, PARS® (Patient Advocacy Reporting System®). We (1) evaluated the distribution of UPCs across orthopaedic surgeons, (2) compared orthopaedic surgeons’ UPC distribution with those of other surgeons and non-surgeons, and (3) analyzed differences in complaint types across orthopaedic sub-specialties.

Results:

A total of 33,174 physicians had four consecutive years of data across the 36 nation-wide participating medical centers and met other inclusion criteria, including 1,148 orthopaedic surgeons, 6,747 other surgeons, and 25,279 non-surgeons. Orthopaedic surgeons experienced more UPCs per physician than non-orthopaedic surgeons and non-surgeons (5 vs. 2 vs. 1 respectively, p<0.05); the top 20% of orthopaedic surgeons with UPCs accounted for half of all complaints about orthopaedic surgeons received by the organizations in the study. The sub-specialties that had significantly more UPCs compared to general orthopaedic surgeons were Foot and Ankle (OR 2.6 [1.4-4.6], p=.002), followed by Adult Reconstruction (OR 2.2 [1.3-3.8], p=.002), Spine [OR 2.2 (1.3-3.8), p=.005), and Trauma (OR 2.2 [1.2-4.0], p =.01). Surgeons in the midwest were less likely to get complaints that surgeons in the northeast and sex was not a predicting factor.

Conclusion:

Orthopaedic surgeons receive comparatively more UPCs than other surgical and non-surgical specialties. Among orthopaedic surgeons, the subspecialties of Foot and Ankle, Adult, Reconstruction, Spine, and Trauma received the most UPCs. As increased UPCs have been linked to higher risk of malpractice claims, individual orthopaedic surgeons with high numbers of UPCs may benefit from being made aware of their elevated risk status in ways that invite reflection on underlying causes.
Posterior Tibial Transfer to the Lateral Cuneiform in a Young, Active Patient with Foot Drop: A Case Report
Authors: Yoder Robert G. , Lipari Nicholas , Groth Adam T.
Published: January 2022

Category:

Ankle; Midfoot/Forefoot; Sports; Other

Introduction/Purpose:

We report the case of a 23-year-old male who underwent a posterior tibial tendon (PTT) transfer after suffering foot drop secondary to a traumatic knee dislocation five years earlier. The common peroneal nerve is a commonly injured peripheral nerve due to its anatomic location. Peroneal nerve palsy leads to the inability to clear the foot during the swing phase of gait due to paralysis of the tibialis anterior- the strongest dorsiflexor of the foot. In the event that nerve function does not spontaneously return, tendon transfer surgeries are an established definitive treatment. Despite this, the optimal method of tendon transfer has not yet been determined. Thus, pre-operative assessment and planning remains crucial in determining which method is to be used.

Conclusion:

Surgeons must decide which tendon to transfer, which route to utilize, and where to insert in effort to maximize biomechanical outcomes. Careful consideration must be made to ensure maximum strength and optimal forefoot balance to allow patients undergoing tendon transfer to become brace free. Our patient underwent a PTT transfer via the interosseous route to the lateral cuneiform- a common option for those with traumatic peroneal nerve injury. By three months post-operation, our patient achieved adequate dorsiflexion to clear swing phase. By one year post-operation and beyond, our patient has participated in physical activity brace free without any complications.