bluuebunny/crossref_metadata_2025 huggingface dataset:
Trauma clinic follow-up: Predictors of nonattendance and patient-reported reasons for no show
Authors: Prescher Hannes , Haravu Pranav , Silva Amanda K , Reid Russell R , Wang Frederick
Published: January 2022

Introduction

The objectives of this study were to identify factors associated with nonattendance to follow-up in patients seen for traumatic hand and facial injuries at an urban Level 1 trauma center and to elucidate patient-reported reasons for nonattendance.

Methods

A retrospective chart review was performed for all patients seen for hand and facial trauma at our institution over a 2-year period. Demographic data, including race, insurance status, and incomes based on zip code data, were collected for all patients. Injury patterns, interventions, and patient disposition were analyzed. A binomial multivariate logistic regression was conducted to identify predictors of nonattendance to follow-up. All patients who were lost to follow-up over the last 12-month period were contacted via phone to identify reasons for nonattendance to determine whether they had followed up with another provider and to analyze long-term injury sequelae.

Results

After exclusion criteria were applied, there were 889 patients included in the analysis, with 31% of patients lost to follow-up. Factors significantly associated with follow-up nonattendance included patients who sustained injuries from gunshot wounds or assault, had no insurance or were out of network, and who received no acute intervention for their injuries. Forearm, wrist, and fingers fractures; facial fractures and lacerations; performing a procedure in the ED or operating room; and commercial insurance were all independent predictors of clinic attendance. The most common reasons for nonattendance cited by patients were “did not feel the need” (28%), lack of transportation (20%), and scheduling conflicts (19%).

Conclusions

Clinic follow-up for patients sustaining hand and facial trauma at a Level 1 trauma center is impacted by the socioeconomic factors that make this patient population particularly vulnerable to injury.
Topology design and equivalent mechanical properties of a three-dimensional star-shaped auxetic structure
Authors: Wang Weiwei , Dai Shijuan , Zhao Wanzhong , Wang Chunyan , Zhang Ziyu
Published: January 2022

Topology design is the most important method of obtaining optimal material distribution that is directly related to the mechanical properties of structural materials. Aimed at improving the accuracy and efficiency of topology design, this paper explores an innovative topological technique that integrates a sigmoid-rational approximation of material properties approach, with a modified optimality criteria algorithm. Furthermore, a three-dimensional (3D) star-shaped auxetic structure, based on the sigmoid-rational approximation of material properties approach and a modified optimality criteria technique is proposed. The unit cell structural parameters are extracted, and the mechanical properties of the 3D star-shaped structure, including the relative density, equivalent elastic modulus, and equivalent Poisson's ratio, are investigated using mechanical derivation, numerical, and experimental methods. The subsequent results demonstrate that the sigmoid-rational approximation of material properties approach and a modified optimality criteria technique provides a feasible novel idea for multicellular structure development and that the advantageous 3D star-shaped auxetic structure has great potential within the field of structural safety.
Numerical simulation of ballistic impact on multilayer ceramic backed fibre reinforced composite target plate
Authors: Biswas Krishna , Datta Debasis
Published: January 2022

Fibre reinforced polymer composites have been established as potential materials for making body armours. The present work depicts estimation of ballistic resistance of multilayer ceramic backed fibre reinforced composite target through 3D numerical simulation using Ansys/Autodyn software. The present numerical and material models have been validated against the results available in the literature. After that, the velocity–time history of the projectile is examined for impact velocities ranging between 330 to 1200 m/s. Here, the study has been focused on predicting the progressive damage and failure modes of the ceramic-composites target plate under impact. Also, the variation in residual velocities, time of penetration/perforation with different incident velocities, damage pattern in the deformable projectile and the kinetic energy of the impactor is studied. Finally, the trend of variation of ballistic limit velocity with different masses and diameter of the impactor has also been investigated.
A vibration-based approach for damage identification and monitoring of prefabricated beam bridges
Authors: Han Fei , Dan Danhui , Xu Zhaoyuan , Deng Zichen
Published: January 2022

As one of the most sophisticated structural types in rapid industrialized bridge construction technology, the fabricated beam bridge has been widely used in road network system for a long time. The prominent disease of this type of structure is the degradation of the lateral cooperative capability, that is, the deterioration of the hinge joint stiffness. This paper proposes a monitoring and evaluation method for the lateral connection stiffness based on the multiple-beams theory, which has the concise physical meanings and can be easily implemented. On this basis, a new damage identification method and index extracted from the mode shape information of the system is proposed in this paper. To verify the effectiveness of the proposed indicator ARCR, Shanghai Tongji Road viaduct is taken as the engineering background. Results shows that the theoretical analysis results are consistent with physical truth, the proposed indicator can reasonably reflect the degradation degree of the joint and locate the damaged joint.
Using Social Media for More Engaged Users and Enhanced Health Communication in Diabetes Care
Authors: Gong Zijian H. , Lyford Conrad
Published: January 2022

Background: Recent literature identified social media message features predictive of user engagement. Desired information from a patient perspective and use of social media information from a provider perspective in diabetes care is less clear. Purpose: Our study analyzed diabetes patients’ desired information from social media and how such information could be used in conjunction with doctor–patient communication to enhance compliance with recommended care. Methods: A survey examined diabetic patients’ interests in searching for various diabetes information on social media and assessed the potential impact of social media sourced information on doctor–patient communication. This survey was followed by a content analysis of major US diabetes organizations’ Facebook pages, which were considered for effectiveness in their communication with diabetes patients. Results: Survey participants were most interested in diabetes management recommendations. Diabetes knowledge positively correlated with interests in diabetes management recommendations but negatively correlated with prior use of social media for diabetes information. 70.9% of patients had discussed information from social media with their doctor. The content analysis showed narrative evidence and updates on diabetes-related research findings, and medical policies generated a higher level of user engagement. Conclusion: While survey participants showed greatest interests in health recommendations and tips, only 11.7% of the analyzed social media posts included such information. Posts that included diabetes-related information led to higher engagement than posts that emphasized social values. Patients in general have asked doctors about information received on social media which suggests that social media can be a useful platform for communicating diabetes care information.
A topology optimization method for collaborative robot lightweight design based on orthogonal experiment and its applications
Authors: Liu Bin , Sha Liansen , Huang Kun , Zhang Wenbin , Yang Hongbo
Published: January 2022

Topology optimization is an effective method for the lightweight of collaborative robots. The extreme working conditions of the robot for the existing topology optimization approach are usually determined by design experience, which may cause mismatch between the chosen load boundary condition of the parts to be optimized and the actual maximum one. In this article, a kind of topology optimization method based on orthogonal experiment was proposed to avoid this mismatch. For this method, the extreme working condition of robots was determined by finding out the combination of robot joint angles when the stress of the part was maximum based on orthogonal experiment. And then, the structure of the part was optimized with the objective of minimizing mass and the constraint of the maximum end displacement of the robots. Finally, the proposed method and the existing method were applied to the lightweight design of a 7 degree of freedom upper limb powered exoskeleton robot, and the results demonstrated that the presented approach can reduce 6.78% maximum end displacement of the robot on average compared with the existing one. It can be concluded that the proposed method in this article is more reasonable and applicable to the structure optimization of collaborative robots.
Using sport science data in collegiate athletics: Coaches’ perspectives
Authors: Rauff Erica L , Herman Augustine , Berninger Douglas , Machak Sean , Shultz Sarah P
Published: January 2022

Limited research has examined American collegiate coaches’ perceptions of collecting data for informing training practices. The purpose of this study was to examine collegiate coaches’ perspectives and needs for collecting data from their athletes using a qualitative approach. Four focus groups were conducted with NCAA Division I coaches ( N  =  13) at a mid-sized liberal arts university. Coaches were asked how they could benefit from collecting data from their athletes, how they would use the data to answer questions about athletes’ performance, what data they would want to collect, and what concerns they had regarding data collection. Principles of thematic analysis were used to analyze the interviews. Most coaches (54%) felt that collecting data would provide evidence needed to support training methodologies, and they would benefit (i.e. make improvements to coaching and athlete training) from monitoring progress in their athletes (61%). Regarding performance questions, coaches were interested in utilizing a biomechanist to conduct movement analyses (23%) and assessing athletes’ mental and emotional states (23%). Coaches wanted to monitor athletes’ fatigue, recovery, mental health states, and health behaviors (i.e. sleep and diet; 15%). Coaches expressed concerns over finding an optimal time to test athletes (8%) and effective presentation of data to athletes (23%) while limiting body composition assessments due to athlete discomfort (15%). Findings from these focus groups suggest that coaches would like to collect data to learn more about athletes’ physical and mental states, but several logistical and practical concerns still exist regarding how to efficiently collect and utilize the data.
Extended incremental non-linear control allocation (XINCA) for quadplanes
Authors: Karssies H.J. , De Wagter C.
Published: January 2022

Hybrid UAVs have gained a lot of interest for their combined vertical take-off & landing (VTOL) and efficient forward flight capabilities. But their control is facing challenges in over-actuation and conflicting requirements depending on the flight phase which can easily lead to actuator saturation. Incremental Non-linear Control Allocation (INCA) has been proposed to solve the platform’s control allocation problem in the case of saturation or over-actuation by minimizing a set of objective functions. This work demonstrates INCA on quadplanes, an in-plane combination between a quadrotor and a conventional fixed-wing, and proposes an extension to control the outer loop. The novel controller is called Extended INCA (XINCA) and adds the wing orientation as a force-generating actuator in the outerloop control optimization. This leads to a single controller for all flight phases that avoids placing the wing at negative angles of attack and minimizes the load on hover motors. XINCA has low dependence on accurate vehicle models and requires only several optimization parameters. Flight simulations and experimental flights are performed to demonstrate the performance.
Between hyperboles and litotes: The middle passage of everyday cartographic nationhood
Authors: Lo Presti Laura , Rossetto Tania
Published: January 2022

In receiving the constructive commentaries on our article, we would like to gratefully reply through an invitation to remain in a sort of middle passage between hyperbolic and litotic attitudes towards map theory and research on mapping practices. While thinking hyperbolically functions to destabilise both cartographic representation and nation as categories, thinking litotically becomes a way to reason (and empirically investigate) in terms of contingency, contextuality, circulation, materiality, and affectivity. Embracing a post-representational and everyday perspective on both mapping and nationhood, we acknowledge both the high risk and potential of this style of thinking and researching maps and nations.
The dangerous intensifications of surplus alienation, or why platform capitalism challenges the (more-than-)human
Authors: Büscher Bram
Published: January 2022

This response gratefully acknowledges and engages with the commentaries on my article ‘The nonhuman turn: Critical reflections on alienation, entanglement and nature under capitalism’. It highlights the importance of further defining key concepts like anthropocentrism, ‘the human’, more-than-life and others in discussions of the more-than-human. It challenges desires for ‘returning’ to idealised forms of relationality or animism or the idea that historical, ‘basic alienation’ between humans and the rest of nature rests on some notion of ‘The Fall’. Overall, it aims to reemphasize one of the core arguments in the original article, namely the dangerous intensifications of historical capitalism, how this is critical for both non-human turn scholars and their critics and how this may provide common ground for opening up space for postcapitalism. Central to this argument is a further elaboration of the dangers of intensified surplus alienation due to contemporary platform capitalism for the (more-than)human but also, more specifically, for academic exchange.
Engagement of older adults in regional health innovation: The ECOTECH concept mapping project
Authors: McNeil Heather , McMurray Josephine , Byrne Kerry , Grindrod Kelly , Stolee Paul
Published: January 2022

Objectives:

Regional health innovation ecosystems can activate collaboration and support planning, self-management and development and commercialization of innovations. We sought to understand how older adults and their caregivers can be meaningfully engaged in regional health innovation ecosystems focused on health and aging–related technology innovation.

Methods:

A six-phase concept mapping technique gathered data over six time points across Canada. Brainstorming conducted online and in person identified engagement ideas. Statements were sorted by similarity and rated by participants on importance and feasibility. Qualitative approaches and multidimensional scaling, hierarchical cluster analysis, descriptive statistics and t tests were used for analysis.

Results:

Sixty-two unique ideas were assembled into a seven-cluster framework of priorities for engagement in regional health innovation ecosystems including public forums, co-production and partnerships, engagement, linkage and exchange, developing cultural capacity, advocacy and investment in the ecosystem.

Conclusions:

This study identified a framework of priorities for directions and strategies for older adult and caregiver engagement in regional health innovation ecosystems. Next steps include collaborations to develop regional health innovation ecosystems that actively engage older adults and their caregivers in health and aging–related technology innovation.
A Computer-Based Text Analysis of Al Jazeera, BBC, and CNN News Shares on Facebook: Framing Analysis on Covid-19 Issues
Authors: Hossain Aftab , Wahab Juliana Abdul , Khan Md. Saidur Rahman
Published: January 2022

This study is a comparative text analysis of Al Jazeera English, BBC News, and CNN on the Coronavirus pandemic. Only the text-based news from April 13 to April 20, 2020, were collected from the official Facebook pages of the respective news organizations. Based on the framing theory, the computer-based text analysis using MAXQDA software was used to conduct the research. The study found how these internationally recognized media outlets frame their news using word frequency, the combination of multiple words, and semantic relationships among the news published on their Facebook pages. A total of 105 news were selected out of 185 and 89,465 words were analyzed to observe how they framed the Novel Coronavirus crisis. Six individual frames were found and the results revealed four similarities and two differences among the frames. The similarities and differences were discussed based on different approaches to framing including proximity and political agendas.
Other-Regarding Behaviors and Attitudes toward Asylum Seekers
Authors: Sonmez Burak , Iacono Sergio Lo
Published: January 2022

Previous studies predominantly examined self-reported attitudes toward economic migrants and refugees along with different types of public concerns. Few of these studies used behavioral measures to analyze how asylum seeker inflows may sway public preferences toward them. However, the literature remains largely silent on the issue as to how correcting misperceptions of asylum seeker inflows may improve a host population’s support for them. The authors’ research addresses this gap, using a lab experiment to examine how providing factual information on asylum seeker inflows changes other-regarding behaviors and attitudes of a host population toward asylum seekers, depending on people’s political leanings. Specifically, the authors examine whether factual information provided by a nonpartisan source may ease or backfire giving behaviors and unwelcoming attitudes toward asylum seekers through the moderation of partisanship. The findings suggest that providing accurate information about the number of asylum seekers counteracts low-level giving behaviors and unwelcoming attitudes of right-wing-leaning citizens.
Factors Influencing the Nonunion Rate Following First Metatarsophalangeal Joint Arthrodesis
Authors: Kachooei Amir R. , Raikin Steven M. , Daniel Joseph N.
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

The choice of fixation, biomechanical stability, and hardware density might influence the union after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to assess the influencing factors on the union rate and fixation failure after MTP-1 arthrodesis.

Methods:

In this retrospective cohort study, we included 359 patients with 378 feet from the practice of two foot and ankle surgeons. The surgical technique was identical. The providers randomized patients to receive either the locking plate or cross screws, which comprised 187 (50%) plate fixation and 191 (50%) cross screw fixation. Radiographic union was assessed at three months and the final follow-up and was further categorized as symptomatic versus asymptomatic nonunion.

Results:

Accounting for potential interaction between variables using multivariable logistic analysis, plate fixation (P=0.018), and diabetes (P=0.044) were significantly associated with a higher nonunion rate. At three month follow-up, 15 (8.3%) patients in the locking plate group and 5 (2.5%) patients in the cross screws group showed nonunion. Of 15 nonunion with plate fixation, 6 (40%) underwent a second surgery because of device failure, while none of the screw fixations required a second surgery (P<0.001). In comparison to asymptomatic nonunion, remaining symptomatic at three months follow-up was a significant risk factor for developing a nonunion with possible device failure at the final follow-up requiring intervention.

Conclusion:

Cross screw fixation is significantly associated with a lower nonunion, device failure, and secondary surgery rate than plate fixation, which might be related to contact surfaces and biomechanical stability. Besides, the cost saving is more with the cross screws than plate and screws. Diabetic patients should be counseled about the higher nonunion rate.
10 Year Outcomes of Unilateral vs Bilateral (Staged) Total Ankle Replacement
Authors: Abdul Nicole G. , Ramaskandhan Jayasree Ramas , Smith Karen , Alkhreisat Mohammad A. , Bennett Adam P. , Siddique Malik S.
Published: January 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Comprehensive long-term outcomes of total ankle replacement (TAR) help guide clinicians when they are deciding on the management of patients with more than single joint arthritis. Some patients will only require unilateral TARs, while others will need bilateral TARs. When deciding on treatment plans for patients, it is important to know the long-term surgical outcomes of both of these groups before treatment can be recommended. Currently there is a paucity of literature on long-term outcomes of unilateral versus bilateral TARs. The aim of the study is to assess long-term outcomes in patients who underwent unilateral vs. staged bilateral TARs.

Methods:

We performed a retrospective review of a prospectively completed hospital registry database for TAR. This consisted of a consecutive series of TARs performed by one senior surgeon from 2006 to December 2010 with 10-years of follow up. Clinical complications, radiological complications (lucency, cysts, and osteolysis), and patient reported outcome measures (WOMAC score, SF-36, general health survey, and patient satisfaction survey) were included for all patients. Outcomes were evaluated pre-operatively and at 1, 3, 5, and 10 years post-operatively. Three component mobile bearing implants were used in all patients.

Results:

There were 132 unilateral TARs (Group A) vs. 24 staged bilateral TARs (Group B). WOMAC scores significantly improved from pre-op to 1 year for pain (45.3 to 77.8; 52 to 76) function (49.1 to 77.8; 53.6 to 76) and stiffness (39.8 to 67.9; 55 to 65) in both groups respectively (p<0.05). At 5 years, Group B reported higher function scores than Group A (79.1 vs. 65.7; p=0.05). At 10 years Group B reported significantly better stiffness scores than Group A (78.5 vs. 59.5; p=0.034). There was no significant difference in SF-36 scores between groups at 5 and 10 years. Group A was 40% dissatisfied with return to recreational activities compared to 30% in Group B (p>0.05). Group A reported 16% dissatisfaction with surgery compared to 10% in Group B (p>0.05). At 5 years there were a higher number of radiological and clinical complications in Group A compared to Group B.

Conclusion:

For patient reported outcomes, staged bilateral TAR patients had more improvement in function at 5 years, and stiffness at 10 years, when compared to unilateral TAR patients. Unilateral TAR patients had higher rates of complications compared to staged bilateral TAR patients at 5 years.A limitation of this study was the smaller size of Group B patients compared to Group A. We will be able to present a detailed breakdown of outcomes at each time point if the abstract is selected for presentation.
Racial Disparities in Total Ankle Arthroplasty: An Analysis of a Large National Dataset
Authors: Adams Samuel B. , Long Jason , Danilkowicz Richard , Grimm Nathan L. , O'Donnell Jeffrey , Kim Jaewhan
Published: January 2022

Category:

Ankle; Other

Introduction/Purpose:

A significant body of literature exists that documents the racial/ethnic disparities in orthopedics. Previous studies have looked at racial disparities in total ankle arthroplasty and have shown concerning TAA utilization rates. One such study detailed a two fold difference in rate per 100,000 of 0.14 in Whites vs. 0.07 in Blacks in 1998, which continued to worsen and by 2011 the utilization rate was 1.17 in Whites vs. 0.33 in Blacks, a 4-fold difference. The purpose of this study was to update the literature and analyze the utilization rates of TAA by race as well as to detect any differences in outcomes between the groups through the most updated data available in the National Surgical Quality Improvement Program (NSQIP) database.

Methods:

A retrospective cohort study was performed utilizing the National Surgical Quality Improvement Program (NSQIP) database. Patients were identified for inclusion using the Current Procedural Terminology (CPT) codes 27700 and 27702, corresponding to arthroplasty ankle and arthroplasty ankle with implant, respectively. All patient's with known race were included, non-Hispanic White, non-Hispanic Black, Asian, Native American, and Hispanic. A total of 1164 patients met inclusion criteria for this study.

Results:

A total of 1164 patients with known race undergoing TAA from 2012-2018 were included in this analysis. Of these patients 1051 (90.3%) were non-Hispanic white (White), and 113 (9.7%) were non-Hispanic Black, Asian, Native American, and Hispanic (Non-White). The mean patient age for White patients was 63.7 years, compared to 55.3 years for Non-White patients which was statistically significant. (p-value <0.01). There was a similar distribution of males and females in each group, and smoking status and presence of diabetes mellitus was similar in both groups. In the listed postoperative complications, non-white patients were at no increased risk of developing superficial wound infection, deep wound infection, PE, DVT, requiring a blood transfusion, requiring another operation, or requiring readmission to the hospital within 30 days.

Conclusion:

Based on this large national data set, between the years 2012 and 2018 there was nearly 10-fold more non-Hispanic white patient's undergoing TAA when compared to other racial/ethnic groups. This unfortunately highlights the continued, if not worsening racial disparities present in TAA. Additionally, no differences were found in post-operative outcomes based on racial or ethnic group. This indicates that different racial or ethnic groups are doing no worse post-operatively from TAA when compared to Whites.
MTP Arthrodesis: Percutaneous Interfragmentary Screw Placement and Nerve Injury
Authors: Andrews Nicholas A. , Patch David A. , Jacob Roshan , Sutherland Charles R. , Harrelson Whitt , Agarwal Abhinav , Shah Ashish
Published: January 2022

Category:

Basic Sciences/Biologics; Midfoot/Forefoot

Introduction/Purpose:

Iatrogenic cutaneous nerve injury is the most common complication encountered in foot and ankle surgery with limited evidence to inform surgeons on neuroprotective techniques. The purpose of this study was to assess risk for injury to the dorsomedial cutaneous nerve (DCN) during insertion of percutaneous interfragmentary screws used in metatarsophalangeal (MTP) arthrodesis.

Methods:

Ten mid-tibia fresh frozen cadaver specimens were obtained for execution of this study. All cadavers were grossly and radiographically inspected for any evidence of existing pathology or prior operative intervention. Percutaneous placement of interfragmentary screw in both distal to proximal and proximal to distal fashion was performed. Only the skin was incised before reaming and screw placement. After screw placement, dissection of the great toe was conducted. The distance between the screws and the DCN was obtained. The DCN was also inspected for injury.

Results:

A total of 10 cadavers were included. The average age of our population was 64 (+- 12.6). Males represented 80% of our included specimens. Injury to the DCN was not reported using the proximal to distal screw fixation. The mean distance from the dorsal cutaneous nerve using proximal to distal interfragmentary screw fixation was 7.45+- 3.85 mm compared to 4.30+-2.71 mm in the distal to proximal screw. Distal to proximal screw fixation was associated with 10% risk of nerve injury with no nerve injuries occurring at the site of proximal to distal screws.

Conclusion:

In our cadaver study, proximal to distal screw fixation seems to offer neuroprotection in the setting of MTP arthrodesis. The DCN is known to have many anatomic variants, and DCN injuries can be a pretext for painful neuroma formation. Surgeons should consider careful dissection to the joint capsule in effort to decrease the risk of neurogenic injury when placing interfragmentary screws in MTP arthrodesis.
Correlation Between X-Ray and Weight-Bearing Computed Tomography for Imaging Evaluation of Hallux Valgus Deformity
Authors: Aravena Raul M. Espinoza , Chaparro Felipe R. , Ortiz Cristian A. , Carcuro Giovanni M. , Pellegrini Manuel J.
Published: January 2022

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Weight-bearing computed tomography (WBCT) has emerged as a valuable diagnostic tool for foot and ankle pathologies. Hallux valgus deformity values are well described in the literature, but there is a lack of correlation studies between x-rays and WBCT for the most widely used imaging parameters. The role of coronal plane deformity has gained importance in the last few years as a recurrence predictor factor. Most radiological descriptions in this topic are indirect measures of this rotational deformity. WBCT seems more precise to evaluate hallux valgus 3D deformity. Purpose: Correlate Hallux Valgus deformity parameters, metatarsal head morphology, and sesamoids position on x-rays compared to WBCT.

Methods:

Hallux valgus (HVA), intermetatarsal (IMA), interphalangeal (IFA), and the distal metatarsal articular angle of the first metatarsal (DMAA) was measured on standing AP load-bearing radiographs (WBXR) and WBCT by 2 observers in hallux valgus patients. Deformity parameters obtained by both imaging methods were correlated with the Spearman Correlation (SCC) and the Intraclass Correlation Coefficient (ICC). Also, WBXR was analyzed to estimate the first metatarsal head rotation (pronation) by the round sign and sesamoids position. Then, direct pronation measurement was measured on WBCT by obtaining the Alpha Angle (AA) and sesamoids position in relation to the metatarsal head was defined. The Kappa concordance index (KCI) was determined.

Results:

40 feet with Hallux Valgus were evaluated. In WBXR the medians of HVA, IMA, IFA, and DMAA were 24.5, 12, 8.98, and 13.08 degrees respectively. In WBCT the medians were 24.75, 12.93, 6.05, and 13.03 respectively. The SCC was 0.934 for HVA, 0.956 for IMA, 0.713 for IFA, and 0.487 for DMAA, and the ICC was excellent for HVA, IMA, and IFA for both methods, excellent for DMAA in WBXR, but poor for WBCT. For rotation deformity, the correlation between metatarsal head morphology and AA was poor with a KCI of -0.073, and also for the position of the sesamoids between both methods and the KCI was 0.061.

Conclusion:

Evaluated deformity parameters had an excellent correlation between WBXR and WBCT. Both methods are useful for determining HVA, IMA, and IFA in Hallux Valgus patients, but it was poor for DMAA. Also the correlation between first metatarsal head morphology on WBXR (Round sign) with metatarsal head pronation (Alpha Angle) on WBCT was poor, as well as sesamoids position. Given greater WBCT precision to evaluate rotational deformity, we believe it should be considered in the diagnostic process to most accurately understand this complex deformity.
Volume Measurements on Weightbearing Computed Tomography Can Detect Subtle Syndesmotic Instability
Authors: Ashkani-Esfahani Soheil , Bhimani Rohan , Lubberts Bart , Kerkhoffs Gino , Waryasz Gregory R. , DiGiovanni Christopher W. , Guss Daniel
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

The ability to compare the ankle joints bilaterally in a 3D manner under physiologic weight provided by weight-bearing CT has led to a more accurate diagnostic method. While weight-bearing computed tomography (WBCT) allows 3D visualization of the distal syndesmosis, image interpretation has largely relied on 1D distance and, more recently, 2D area measurements. This study aimed to: 1) determine the sensitivity and specificity of 2D area and 3D volume WBCT measurements towards detecting subtle syndesmotic instability, 2) evaluate whether the patterns of changes in the 3D shape of the syndesmosis can be attributed to the type of ligament injury.

Methods:

A total of 24 patients with unilateral subtle syndesmotic instability and 24 individuals with uninjured ankles (controls) with bilateral ankle WBCT were assessed retrospectively. First, 2D areas at 0, 1, 3, 5,10 cm, and 3D volumes at 1, 3, 5, and 10cm above the tibial plafond were measured bilaterally. Secondly, given the volume measurement at the level of 5 cm proximal to the platform as the most sensitive and specific method introduced in this study, the 3D model of the distal tibiofibular space was created based on WBCT in a subset of 8 patients out of 24 in whom the type of ligament injury was recognized via MRI. The 3D model of the injured side was superimposed on the uninjured contralateral side to visualize the pattern of changes in different planes. P<0.05 was considered statistically significant.

Results:

No specific pattern was observed in 2D and 3D models of the syndesmotic space which can be attributed to a specific ligamentous tear. However, in patients with IOL rupture, the volume increased by >=39% at 5 cm height while without IOL injury the volume increased up to 26% (figure 1). The percentage of changes in 2D areas and 3D volumes showed significant differences in areas at 0cm (19.2%; p=0.004), 1cm (24.1%; p=0.002), 3cm (27.3%; p=0.003), 5cm (28%; p=0.002), and 10cm (29.3%; p=0.003) as well as volumes at 1cm (31.2%; p=0.003), 3cm (26.5%; p=0.001), 5cm (25.4%; p<0.001), and 10cm (24.7%; p=0.004) proximal to tibial plafond. Volume up to 5cm showed the lowest p-value, higher sensitivity (95.8%, 95%CI:87.8-100), and specificity (83.3%, 95% CI:68.4-98.2) for detection of syndesmotic instability.

Conclusion:

We suggest 3D volume measurements, best measured up to 5cm proximal to the plafond, as a promising means of diagnosing syndesmotic instability, particularly for subtle cases that are hard to detect.
Modified Brostrom with and without Suture Tape Augmentation: A Systematic Review
Authors: Bedrin Michael D. , Piscoya Andres S. , Lundy Alexander , Eckel Tobin T.
Published: January 2022

Category:

Ankle; Sports

Introduction/Purpose:

The Modified Brostrom (MB) has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data has called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the MB construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. Despite its increasing popularity, the Modified Brostrom with suture tape augmentation (MBA) remains controversial due to a lack of clinical data. The purpose of this study is to determine the differences in clinical outcomes of MB compared to MBA.

Methods:

A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language articles from 2009 - present discussing outcomes with the MBA technique. Total number of patients, patient demographics, follow-up time, subjective and objective outcome measures, return to sport, recurrent instability, and complications were evaluated.

Results:

A total of 4 studies (2 retrospective cohort studies, 2 case series) involving 156 patients with MBA met inclusion criteria. Average follow-up time was 13.8 months. Of the 3 studies reporting patient-reported outcome measures both pre-and post- operatively, there was a significant improvement in all measures (p<0.05). Two studies compared MB directly to MBA, one of which found a statistically significant difference in the Foot and Ankle Ability Measure (FAAM) in favor of the MBA (93.1 vs 90.5, p=0.027), while American Orthopaedic Foot & Ankle Society (AOFAS) score was not significantly different (p>0.05) between MB and MBA across studies. One study reported a significantly greater rate of return to sport at 12 weeks in the MBA group versus the MB (82% vs 27%, p<.001). There were no significant differences in complications between MB and MBA.

Conclusion:

MBA for chronic lateral ankle instability can produce good short-term clinical outcomes with few complications, comparable to MB. The overall quality of evidence is low, and long-term, prospective, head-to-head comparison data will be needed to determine the clinical efficacy, complication profile, and cost-benefit relationship of the MBA technique as it compares to the MB.
Accuracy of Weightbearing CT vs Non-Weightbearing CT Scans for Patient-Specific Instrumentation in Total Ankle Arthroplasty
Authors: Berlet Gregory C. , McCoy Antonio M. Malloy , Consul Devon , Umbel Benjamin D. , Thompson Mitchell
Published: January 2022

Category:

Ankle

Introduction/Purpose:

Total ankle arthroplasty (TAA) is a popular and viable option for end stage ankle arthritis. Accuracy and reproducibility in placing the implant on the mechanical axis has been shown to be paramount in total ankle replacement. Patient specific pre-operative navigation up until this past year has been based off of non-weightbearing computerized tomography (CT). Our institution has created a protocol to use weightbearing CT in the pre-operative patient specific navigation for TAA using the ProphecyTM system. The purpose of our study was to compare the accuracy and reproducibility of implant alignment and size using WBCT versus prior studies using NWBCT for the Prophecy reports.

Methods:

Patients who underwent TAA using our WBCT protocol for their Prophecy scans had their charts reviewed to see if they met the proper inclusion criteria. Inclusion criteria was a primary TAA with proper follow-up to have first post-operative weightbearing radiographs. The first post-operative weightbearing radiographs were used to measure alignment of the axis of the implant in frontal and sagittal planes comparative to the tibial axis. These results were then compared to the pre-operative prophecy scans to determine reproducibility. The size of the implants components were also recorded for each patient and compared to the pre-operative predicted implant sizes from the patient specific reports. Our results were also compared to previous studies on reproducibility of patient specific navigation when using non-weightbearing CT.

Results:

Ten patients met our inclusion criteria of WBCT ProphecyTM preoperative planning. 100% of the TAA were within the intended target of less than 50 varus or valgus. The average post-operative coronal alignment was an average of 0.844 degrees. Average sagittal plane deformity was 1.88 degrees post-operative. Tibial component size was properly predicted 100% of the time and talar component in all but one patient.

Conclusion:

This data supports superior accuracy and reproducibility in pre-operative patient specific navigation when utilizing WBCT for TAA vs published controls with non-weightbearing CT.
Maintenance of First Ray Length after First Metatarsophalangeal Joint Distraction Arthrodesis Using Allograft Discs: A Statistical Analysis
Authors: Berlet Gregory C. , Malloy McCoy Antonio M. , Thompson Mitchell , Consul Devon , Prissel Mark A.
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

The first metatarsophalangeal joint (MTPJ) is one of the most common locations for arthritis in the foot. When conservative methods fail, two main surgical treatment options exist, fusion or joint implant. For various reasons these surgeries can fail leaving relatively few salvage options. A common salvage option is the first MTPJ distraction arthrodesis. Use of allograft discs to decrease surgical time and donor site morbidity has become an increasingly popular option for MTP distraction arthrodesis. The purpose of this study was to look at the maintenance of the first ray length in first MTPJ distraction arthrodesis using allograft discs.

Methods:

We reviewed 14 patients who underwent first MTPJ distraction arthrodesis, measuring first ray length at the first post- operative weightbearing radiograph and most recent weightbearing radiograph. Average follow up was 12.75 months between radiographs.

Results:

Average shortening was 3 mm on the lateral measurements and 2.3 mm on the AP measurements. CT verified overall nonunion rate was 43% whereas, symptomatic nonunion rate was 21%.

Conclusion:

Amount of shortening and graft size did appear to have a positive correlation. Union rate did not affect shortening of first ray, but revision for a failed implant arthroplasty did correlate with increased shortening compared to revision for a failed first MTPJ fusion. Our data suggests a 2-3 mm shortening of the first ray can be predicted over the first 12 months after a first MTPJ distraction arthrodesis using allograft discs. Longer term studies with larger patient populations, and a comparative study to cortical autograft would provide more accurate insight to outcomes of first MTPJ distraction arthrodesis.
3-D Generated Anatomic Custom Talar Cement Spacers: A Technical Tip and Literature Review
Authors: Broughton Kimberly K. , Chien Bonnie Y. , Stenquist Derek S. , Williams Caroline , Miller Christopher P. , Kwon John Y.
Published: January 2022

Category:

Basic Sciences/Biologics; Hindfoot; Trauma

Introduction/Purpose:

Three dimensional printing is an actively emerging field within the realm of medical devices. This technology expands therapeutic options and customization of implants to individual patients. The ability to create products that replicate normal bony anatomy has been a significant advancement in the setting of difficult clinical scenarios. 3-D generated, custom implants increase the potential for joint and limb salvage with the goal of improving functional outcomes. We present a technical tip for utilizing 3-D printing technology to create custom, anatomically-matched antibiotic cement spacers for limb- salvage applications. We present two illustrative cases and share our experiences, lessons learned, and a succinct review of the pertinent literature merging 3-D printing and the use of antibiotic cement as temporary and permanent reconstructive solutions.

Methods:

While the majority of 3-D printing is done for the purpose of generating devices for implantation, we present a technical tip for designing a 3-D printed mold from which to create an antibiotic cement spacer for implantation. Two case illustrations demonstrate comorbid patients presenting with infected implants, osteomyelitis, bone loss, deformity and wound dehiscense. We describe the process of patient selection, implant design, fabrication, and implantation of a custom molded antibiotic cement talus for the purpose of limb salvage.

Results:

Case illustrations present two successful limb salvage patients while giving a thorough explanation of our technique, learned tips and tricks. This applied technology builds on prior use of antibiotic cement in limb salvage of the lower extremity, most of which is joint sacrificing. 3-D printing the mold for an anatomic talus cement spacer results in a joint sparing limb salvage solution.

Conclusion:

Utilization of currently available 3-D printing technology as applied to production of anatomic cement spacers should be considered to enhance limb salvage. This innovative application of printing technology is merged with current, pertinent literature regarding antibiotic cement to offer surgeons expanded options for temporary or definitive reconstructive techniques in some of the most challenging patients.
Infrequent Adventitious Bursitis Associated with A Palpable Metatarsal Mass: Series of Cases
Authors: Cafruni Virginia M. , Parise Ana C. , Verbner Jonathan M. , Villena Daniel S. , Conti Leonardo A. , Sotelano Pablo , Carrasco Nelly M. , Araujo Maria Gala Santini
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Adventitious bursae are structures that appear in adulthood, as a mechanism for protection. It may develop at sites where subcutaneous tissue (ST) is exposed to friction and high pressure. In the forefoot, adventitious bursitis is usually adjacent to bony prominences of the metatarsal heads and is one of the causes of forefoot pain. There are different stages of the pathology, at the beginning there is a small bursa without cavity, subsequently this cavity will gradually acquire a larger size, until becoming independent. The degeneration of the connective tissue which is the characteristic of the adventitious bursa. Figure 1.We present four cases of adventitious bursitis in patients who complained of a fluctuating mass on the forefoot associated with localized pain on palpation and pressure.

Methods:

We reviewed the cases of 4 patients treated by one of us (MGSA) for forefoot pain associated with a palpable mass. We obtained the information from the medical records: clinical presentation, radiographs, ultrasound, magnetic resonance imaging (MRI), treatment, histological diagnosis (if it was available) and outcomes. Pain was assessed with visual analog scale (VAS).

Results:

The four patients complained of a mass on the forefoot associated with pain. The skin was normal with no signs of infection. Ultrasound and MRI showed heterogeneous images in the ST in high pressure areas. Patients were diagnosed according to the previous studies and treated conservatively. The treatment consisted of cryotherapy and walker boot until they had shoe insoles with metatarsal olive in order to unload the metatarsus. Forefoot pain improved markedly from an initial VAS of 8.5 to 3.5 in the first month and the palpable mass decreased. Except in one patient whose studies were not conclusive and mass does not decrease in size and she required an excisional biopsy. The anatomopathological diagnosis was consistent with adventitial bursitis.

Conclusion:

Adventitious bursitis of the plantar forefoot is not a frequent pathology and it can be confused with a foreign body granuloma, localized infection or a tumoral mass among other possible diagnoses due to the clinical and imaging presentations. It is important to take this diagnosis into account when dealing with metatarsalgia and have fluent communication with the radiologist in order to avoid an unnecessary surgery and to establish the appropriate treatment to improve the symptoms.