bluuebunny/crossref_metadata_2025 huggingface dataset:
Jeremy Morris as a pioneer of behavioural epidemiology, social medicine and public health
Authors: Lange Klaus W.
Published: December 2023

Seventy years ago, the Scottish epidemiologist Jeremy Morris published his seminal papers in exercise epidemiology, providing evidence of the positive relationship between physical activity levels and reduced mortality. Today, we may remember Morris’s pivotal role in establishing physical activity as a key factor in preventive medicine and public health. The roots of the role of behavioural epidemiology in modern public health lay in Morris’s research on the association of coronary heart disease with physical activity at work. In consequence, a new focus for public health emerged, with an emphasis on chronic disease as well as modification of lifestyle and individual behaviour. While the immense value of his research on the health benefits of exercise is widely recognised, his influence on the teaching of social medicine is generally less well-known. Morris was involved in the pioneering course of MSc in Social Medicine at the London School of Hygiene, which was emblematic of the redefining of public health in the late 1960s. Morris gave legitimacy to a wide range of issues regarded at that time as soft and second class, including health promotion, sociology and the care of people with disability and chronic conditions. In consequence of his observation of a relationship between socioeconomic status and individual behaviour patterns in regard to exercise, nutrition and smoking, Morris urged that greater attention be paid to inequalities.
Assaults on police officers: A comparison between England and Wales and New Zealand from 2015 to 2022
Authors: den Heyer Garth
Published: December 2023

This research discussed in this article examined assaults on police officers in England and Wales and in New Zealand between 2015 and 2022. Although different sources of data were used to examine the number of assaults on police officers in the three countries, it was found that the number of assaults on police officers in England and Wales and in New Zealand increased during this period. England and Wales experienced a 56% increase in the number of assaults on police officers, while the New Zealand Police experienced a 41% increase. Using the population of each country as a basis there was an increase in the number of assaults of more than 16% in New Zealand and more than 63% in England and Wales. The main limitation of the research was that the information that was available lacked detail, and this would limit the development of policy to minimize the threat to police officers of being assaulted.
Nonoperative management of grade IV liver laceration following blunt abdominal trauma complicated with delayed bilioplueral fistula
Authors: Yapa YMKA , Prashanthan B , Mahanama R , Subasinghe D
Published: December 2023

The incidence of bile leaks following blunt liver trauma ranges from 0.5% to 21%. Bile leaks could give rise to biliopleural fistula, which can end up causing cholethorax, where a bilious effusion is seen in the pleural cavity. Early recognition of this condition is essential for favorable outcome. We report an unusual case of delayed biliopleural fistula causing cholethorax in a 30-year-old male, presented following blunt abdominal trauma following a motor vehicle collision. Abdominal examination revealed tender right upper quadrant. He was haemodynamically stable following initial resuscitation. Computed tomography of the abdomen revealed American Association for the Surgery of Trauma grade IV liver laceration without active extravasation of contrast, causing a moderate haemoperitoneum. Decision was made to manage the liver injury conservatively. Repeat imaging performed on day 11 due to progressive abdominal distension revealed bilateral pleural effusions and increased amount of abdominal free fluid. Bilateral intercostal tubes and an ultrasound-guided pigtail catheter was inserted to the abdomen. The right-sided intercostal(IC) tube drainage found to be bilious, along with a bilious drainage through the pigtail catheter placed on the peritoneal cavity. Due to persistently high drain output, an endoscopic retrograde cholangiopancreatography performed revealed a contrast leakage at cystic duct. Sphincterotomy was performed and a biliary stent was placed. Patient completely recovered following decompression of biliary system. The unusual presentation of biliopleural fistula requires a good clinical acumen for early diagnosis. Timely endoscopic and interventional radiological management for biliary decompression and drainage are required for a successful outcome.
Case report of an infant with congenital mesoblastic nephroma leading to pulmonary metastasis
Authors: Athapathu Arjuna Salinda , Wijayawardhana Sameera M , Meegoda Jithmal , Gunaratne Sandini A , Somathilaka Mahendra , Chang Kenneth Tou En , Wickramasinghe Pujitha
Published: December 2023

Congenital mesoblastic nephroma is considered a tumour with favourable clinical behaviour with only few reported cases of metastases. We report an infant who underwent complete resection and later developed pulmonary metastasis. Ten-month-old baby girl initially presented at 3 weeks of age with macroscopic haematuria, hypertension and a lumbar mass. Contrast-enhanced computed tomography revealed a tumour arising from the left kidney without local invasion or metastasis. She underwent left nephrectomy. Immunohistochemistry confirmed a cellular type of congenital mesoblastic nephroma. At 10 months, she presented with difficulty in breathing. Contrast-enhanced computed tomography revealed an opacity in the right hemi-thorax. Histology of lung mass was suggestive of deposits from the previously excised mesoblastic nephroma. She developed a right-sided haemothorax and succumbed. This case report highlights the fact that even though congenital mesoblastic nephromas are considered tumours with favourable clinical behaviour, they can present later with distant metastasis. Therefore, clinicians need to be aware of this rare malignant potential and adhere to meticulous follow-up protocols.
Smart Mixes for Sustainable Value Chain Management: An Evaluation of the Conflict Minerals, Palm Oil, and Green Bonds Sectors.
Authors: Weiner Mareike , Home Robert , Schader Christian
Published: December 2023

Fragmented governance of international value chains, operating in multiple jurisdictions, is insufficient to prevent social and environmental mismanagement. Smart Mixes, which are combinations of compulsory and voluntary measures, have been proposed as a possible means of securing environmental and social standards, but the concept has not been operationalized in the academic literature. We aim to identify the factors that have contributed to, or hindered, the performance of existing Smart Mixes in three international value chains (conflict minerals, palm oil, and bonds) using data from interviews with 32 experts, supplemented by a literature review. The results suggest that Smart Mixes are effective when they cover a specific issue under conditions in which enforcement mechanisms create a level playing field: thereby aligning public and private sector interests. The keys to success in a Smart Mix include positive interactions, harmonization, and complementary and supportive measures, which combine to motivate engagement by the private sector. We conclude that Smart Mixes can contribute to sustainability in value chains but their effectiveness is dependent on the strength of the relationships between the measures that compose them.
Effect of Nostalgic Memory Retrieval on Anthropomorphism
Authors: Nakamura Hiroko , Kawaguchi Jun
Published: December 2023

Nostalgic memory often involves one’s close relationships and fosters a sense of closeness to the target person in the memory. The motivation for social connections is a critical factor behind anthropomorphism (humanizing non-human targets). When people feel lonely, they anthropomorphize non-human targets to fulfill their need for social connection. In contrast, people reverse-anthropomorphize (dehumanize) targets when their sociality motivation is fulfilled. This study clarifies the relationship between nostalgia and anthropomorphism and tests two hypotheses. First, nostalgic memory causes a reverse-anthropomorphism of the target that is unrelated to nostalgic memory because nostalgia fulfills the sociality motivation. Second, a nostalgic memory about a target fosters its humanization because people feel close to the target in their nostalgic memory. We conducted two online experiments and analyzed data from 252 participants. They were assigned several tasks, including memory retrieval, loneliness checks, assessing nostalgia proneness, and ascertaining their closeness to the target. The results indicated that nostalgic memories reverse-anthropomorphized unfamiliar targets, while nostalgic memories about a target fostered targeted anthropomorphism.
Clinical Outcomes and Complications of the Zadek Calcaneal Osteotomy in Insertional Achilles Tendinopathy: A Systematic Review and Meta-analysis
Authors: Poutoglidou Freideriki , Drummond Isabella , Patel Amit , Malagelada Francesc , Jeyaseelan Lucky , Parker Lee
Published: December 2023

Category:

Hindfoot; Ankle

Introduction/Purpose:

Insertional Achilles Tendinopathy (IAT) is a degenerative process at the insertion of Achilles tendon onto the calcaneal tuberosity that often coexists with retrocalcaneal bursitis and Haglund’s deformity. The Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with IAT that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT.

Methods:

PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95% confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4).

Results:

Ten studies with 232 patients were included. The AOFAS (American Orthopaedic Foot and Ankle Society) Ankle- Hindfoot Score and the VISA-A score (Victorian Institute of Sports of Australia-Achilles score) were significantly improved after the Zadek osteotomy (p < 0.00001). Pain levels were also significantly reduced (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia.

Conclusion:

The Zadek osteotomy is a safe and effective procedure for patients with IAT. The osteotomy improves pain levels and functions and is associated only with minor complications and a low complication rate. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this.
Deformities Influencing Different Classes in Progressive Collapsing Foot
Authors: Fayed Aly M. , Mallavarapu Vineel , Schmidt Eli , Kim Ki Chun , Lalevee Matthieu , Ehret Amanda , Lintz François , Carvalho Kepler A.M. , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar
Published: December 2023

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high.

Methods:

We retrospectively assessed weight-bearing computed tomography (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary’s angle, class D (peritalar subluxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value < 0.05 was considered significant.

Results:

Class A showed a substantial positive correlation with class C (ρ=0.71; R2=0.576; p 0.001). Class B was substantially correlated with class D (ρ=0.74; R2=0.613; p 0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R2=0.576; p 0.001) and class D (ρ=0.75; R2=0.559; p 0.001). Class D showed a substantial positive correlation with class B and class C (ρ=0.74; R2=0.613; p 0.001), (ρ=0.75; R2=0.559; p 0.001) respectively. Class E did not show correlation with class B, C, or D (ρ=0.24; R2=0.074; p=0.059), (ρ=0.17; R2=0.071; p=0.179), and (ρ=0.22; R2=0.022; p=0.082) respectively. The average values of each class radiographic markers are listed in Figure 1.

Conclusion:

This study was able to find relations between components of PCFD deformity with exception of ankle valgus deformity (Class E). Measurements associated with each class were influenced by others, and in some instances, with pronounced strength such as between class A and C as well as between Class B and D. Surgical procedures to address certain class deformities could indirectly address other classes as well, which ultimately decreases surgical procedures numbers or complexity. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features.
Patient Reported Outcomes using PROMIS after Tarsal Tunnel Release Surgery
Authors: El-Zein Zein S. , Botros Mina , Florentino Samuel A. , Baumhauer Judy
Published: December 2023

Category:

Other

Introduction/Purpose:

Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve and its branches in the tarsal tunnel. The literature on surgical release of the tarsal tunnel shows variable outcomes with no studies reporting validated patient reported outcomes. We aim to determine clinical response after tarsal tunnel release using the Patient-Reported Outcomes Measurement Information System (PROMIS).

Methods:

Under an IRB-approved protocol, CPT code 28035 was used to identify patients who underwent isolated tarsal tunnel release (TTR) between 1/1/2015 and 12/15/2022 at a single institution. Patient demographic data and PROMIS CAT physical function (PF), pain interference (PI), and depression scores were prospectively collected at the initial pre-operative clinic visit and in follow-up throughout the episode of care after TTR. The validated distribution-based method (1/2 sd) was used to assess minimal clinically important difference (MCID). Bivariate analysis was used to determine the postoperative recovery after TTR. Statistical significance was set at p< 0.05.

Results:

A total of 39 patients who underwent tarsal tunnel release were included. The mean age was 49.1 years (19.44-70.75 years) and mean follow-up was 280.9 days (23-1,459 days). The mean PROMIS PF score improved from 38.97 preoperatively to 46.17 postoperatively (p-value= 0.0024). The mean PROMIS PI score improved from 63.75 preoperatively to 57.65 postoperatively (p-value < 0.001). The mean PROMIS depression score improved from 49.78 preoperatively to 43.85 postoperatively (p-value < 0.001). The mean t-score change (pre to post-operation) was 7.2 for PF, -6.1 for PI, and -5.93 for depression. MCID thresholds were calculated as PF increase of 4.7; PI decrease of 3.9; and Depression decrease of 5.1. Fourteen (35%), 24 (62%), and 27 (69%) patients reached MCID for PF, PI, and depression, respectively.

Conclusion:

This study provides validated outcomes after TTR. Though there is improvement after surgery, the patients still experience some pain and physical limitations. Interestingly, the greatest gains were seen in depression symptoms supporting the idea that mental health is impacted in these chronic compressive neuropathy conditions.
The Burden of Revision Total Ankle Replacement Has Markedly Increased from 2010 to 2020
Authors: Ratnasamy Philip P. , Maloy Gwyneth , Oghenesume Oghenewoma , Peden Sean C. , Grauer Jonathan N. , Oh Irvin
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle replacement (TAR) surgery has steadily increased in recent decades. The aim of the current study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or implant removal. We hypothesized that there has been an increase in revision TAR and explant surgeries in the past decade and that younger age and higher comorbidity burden are risk factors for revision and explant.

Methods:

Using the 2010-2020 PearlDiver M151Ortho dataset, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients. This is a large national database containing billing claims information on over 151 million patients in the United States across all payer types and sites of care. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI, a longitudinal measure of patient comorbidity burden generated using ICD-9 and ICD-10 diagnosis codes). Annual incidence for primary and revision TAR, and explant were recorded. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant relative to primary TAR. For explants, the eventual intervention by two years was analyzed. Ten-year timing and survival to revision or explant surgery following patient-matched unilateral TAR were characterized.

Results:

Over the study period, there were 10,531 primary, 1,218 revision, and 1,735 explant TARs (increasing by 310%, 398%, and 9.6%, respectively). Independent predictors of revision TAR included: younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase) (p < 0.0001 for both). Independent predictors of explant surgery included: younger age (OR 1.80 per decade decrease, p< 0.0001), female sex (OR 1.17, p=0.0011), and higher ECI (OR 1.35 per 2-point increase, p< 0.0001). Explanted patients went on to arthrodesis (37.7%), amputation (26.1%), revision TAR (14.7%), or no identified procedure/other procedures (21.5%) within the subsequent two years. The 10-year implant survival rate following primary TAR was 91.8%. 73% and 83% of revisions and explants occurred in the first three years following index TAR, respectively.

Conclusion:

The burden of TAR revision has grown substantially over the past decade. Younger age, female sex, and higher patient comorbidity burden were associated with increased risk of revision or explant surgery. If explant is pursued, most went on to arthrodesis or amputation. These results suggest that care should be taken in patient selection for TAR to minimize the occurrence of revision and explant surgery. Treatment algorithms should be modified to optimize outcomes among patients who undergo explant or revision surgery.
The Workers Compensation Burden: Does Compensation Status Lead to Increased Utilization of Healthcare Resources Following Foot and Ankle Surgery?
Authors: Goodwin Tyler , Wilson Andrew , Doty Jesse F.
Published: December 2023

Category:

Other

Introduction/Purpose:

The association between workers’ compensation (WC) patients and the increased risk of complications and poor outcomes following orthopaedic procedures has been well documented. Recent studies have shown that WC patients have a higher rate of subsequent pain or injury than non-WC patients following common foot and ankle procedures. Due to the increased risks of complications, poor outcomes, and chronic pain amongst WC patients following orthopaedic procedures, it is possible that these patients consume more healthcare resources than non-WC patients during the post-surgical period. This study aimed to investigate the amount of healthcare resources utilized by WC patients following a foot or ankle procedure compared with a procedure-matched control group.

Methods:

A retrospective review was conducted of all WC and non-WC patients who had undergone foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures by a single surgeon from October 2017 through January 2020. Patients were excluded based on age ( < 18 or >70), bilateral procedures, presence of neuropathy, disability, and insufficient follow-up. Data collection included demographic, social, surgical, perioperative follow-up, and complications. Measures of healthcare burden included patient communications, physical encounters, processed documents, overall total prescriptions, the total number of office visits, days to return to work, and days to discharge from the clinic. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi-square test, or Fisher’s exact test. Power analysis determined the sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size.

Results:

142 patients met the inclusion criteria including 71 WC patients and 71 non-WC patients. Measures of healthcare burden were greater in WC patients. WC patients had more communication encounters (median 6 vs 3; P<.001), processed documents (median 6 vs 1; P<.001), total prescriptions (median 5 vs 3; P<.001), the total number of office visits (median 8 vs 6; P<.001), days to return to work (median 119 vs 74; P<.001), and days to discharge (median 267 vs 194; P<.001). WC patients were also more likely to have postoperative complications (OR 2.1; P=.045), secondary surgeries (OR 8.2; P<.001), and new complaints during follow-up (OR 1.9; P=.070). WC was less likely to cancel appointments (OR 0.4; P=.028).

Conclusion:

WC patients demonstrate increased healthcare resource utilization compared to the non-WC population. WC was associated with a higher burden on office staff requiring more time commitment to a single patient. Double the effort was evident on some measured parameters. WC patients also receive more medication prescriptions overall and are more likely to have complications, subsequent surgery, and new complaints remote to the inciting injury.
Transient Exposure of Tissue-Engineered Cartilage Analogs to Synovial Fluid Hematoma After Ankle Fracture Promotes Chondrocyte Death and Alters Gene Expression Toward an Osteoarthritic Phenotype
Authors: Allen Nicholas , Aitchison Alexandra Hunter , Bagheri Kian , Guardino Nicholas , Abar Bijan , Anastasio Albert T. , Adams Samuel
Published: December 2023

Category:

Basic Sciences/Biologics; Ankle Arthritis

Introduction/Purpose:

The first stage of fracture healing consists of hematoma formation with recruitment of proinflammatory cytokines and matrix metalloproteinases. Unfortunately, when there is an intra-articular fracture, these inflammatory mediators are not retained at the fracture site, but instead, bathe the healthy cartilage of the entire joint via the synovial fluid fracture hematoma (SFFH). These inflammatory cytokines and matrix metalloproteinases are known factors in the progression of osteoarthritis and rheumatoid arthritis. Despite the known inflammatory contents of the SFFH, little research has been done on the effects of the SFFH on healthy cartilage with regard to cell death and alteration in gene expression that could lead to post- traumatic osteoarthritis (PTOA).

Methods:

SFFH was collected from 12 patients with intraarticular ankle fracture at the time of surgery. Separately, human chondrocytes were three-dimensionally cultured to create scaffold -free cartilage tissue analogues (CTAs) to simulate articular cartilage. Experimental CTAs (n=12) were exposed to 100% SFFH for 3 days, washed, and transferred to complete media for 3 days. Control CTAs (n=12) were simultaneously cultured in complete medium. Subsequently, CTAs were harvested and underwent biochemical, histological, and gene expression analysis.

Results:

Exposure of CTAs to ankle SFFH 3 days significantly decreased chondrocyte viability by 34% (p = .027). Gene expression of both COL2A1 and SOX9 were significantly decreased after exposure to SFFH (p= .012 and p=.0013 respectively). COL1A1 expression trended upward in the SFFH exposure group while there was no difference in RUNX2 and MMP13 gene expression. Quantitative analysis of Picrosirius red staining demonstrated increased collagen I deposition with poor ultrastructural organization in SFFH exposed CTAs.

Conclusion:

Exposure of an organoid model of healthy cartilage tissue to SFFH after intraarticular ankle fracture resulted in decreased chondrocyte viability, decreased expression of genes regulating normal chondrocyte phenotype, and altered matrix ultrastructure indicating differentiation toward an osteoarthritis phenotype.
A Bibliometric Analysis of the 50 Most-cited Publications in Plantar Fascia Release
Authors: Arrington Derek , Markel Jacob F. , Anciano Victor
Published: December 2023

Category:

Hindfoot; Sports

Introduction/Purpose:

As scientific publications continue to increase across all medical specialties, comprehensive bibliometric analyses have been utilized to evaluate the significance and impact of certain articles. Plantar fasciitis is a complex condition with often debilitating symptoms for patients. There is controversy regarding optimal treatment for it. Furthermore, to add complexity to the topic is looking through the vast literature available. The objective of this study was to analyze publications on plantar fascia release to understand the relevancy of publications in the field and provide a framework to review the literature.

Methods:

Using Web of Science database and the search strategy plantar fascia release OR plantar fasciitis OR plantar fasciitis surgery OR plantar fasciotomy, we identified 965 total articles. The search results were then refined to include 931 publications filtered for “English.” Results were further refined to 657 publications filtered for “articles.” Papers were then exported from Web of Science in Microsoft Excel and analyzed for total citations, average number of citations, authorship, journal, institution, country of publication, and year of publication. We determined the 50 most-cited articles about plantar fascia release and analyzed the parameters of these studies.

Results:

The 657 analyzed articles were published between 1974 and 2023 with a plurality 57 published in each of 2020 and 2022. Elsevier was the most successful publisher with 136 of the publications. Of the authors, Langford authored 7 of the 657 publications. The top 50 most cited articles were cited on average 131.2 times, ranging from being cited 76 to 403 times. The United States was found to have the most publications with 30 of the top 50 regarding Plantar fascia release, followed by Australia with 5 publications. The top 50 articles in this analysis were published between 1983 and 2013, with the most cited being Riddle (2003).

Conclusion:

A vast array of publications regarding plantar fascia release exists within the field of Orthopaedics. With so much information available, it is difficult to navigate the intricacies of pertinent research. As research began in 1974 and has flourished over the last decade, both publications and the number of times articles are cited have been increasing. This growth indicates a growing relevance of researching plantar fascia release. The purpose of this article was to review the 50 most cited articles discussing plantar fascia release to help guide the reader and further research of this topic.
A Novel Treatment Protocol to Improve Outcomes with Transtibial Amputations
Authors: Duda Marcus V.
Published: December 2023

Category:

Diabetes; Other

Introduction/Purpose:

A retrospective case series study was performed to evaluate the outcomes and risk factors of transtibial amputations (TTA) using a novel post operative treatment protocol. The study hypothesis is that a novel post operative treatment protocol could improve outcomes for TTAs. All patients who underwent a TTA from July 2019 through December 2022 were treated with this protocol. Outcomes identified included time to prosthetic fitting after surgery and complications including wound dehiscence and mortality at 30 days. Risk factors were also identified for the patients in this case series study.

Methods:

The novel post operative protocol includes a circumferential incisional negative pressure wound therapy (CiNPWT) dressing that covered with a novel residual limb shrinker (nRLS) and a limb protector (LP) applied after incision closure. The CiNPWT and nRLS were removed at the first follow up visit. Then the nRLS was applied as the primary dressing directly against the incision covering the residual limb. The nRLS was changed for wound cleansing and was sequentially decreased in size to facilitate consolidation of the residual limb.

Results:

There were 433 surgeries performed on 304 patients. This included 222 (73%) men and 81 (27%) women with an average age of 67 years (41-90 years). There were 129 revision surgeries including 25 above-the-knee amputations (AKA). The average time to prosthetic fitting for TTA was 8 weeks. The average study group BMI was 32 kg/m2, A1c 8.7%, albumin 2.6 g/dL and neutrophil to lymphocyte ratio (NLR) 4.9. Traumatic wound dehiscence from falls represented 26% of revision surgeries. Mortality at 30 days was 3.2% for all study participants. The early death average age was 70 years (41-90 years), 73% with end stage renal disease (ESRD) and 82% with diabetes mellitus (DM).

Conclusion:

The novel protocol for transtibial amputations decreased the 30 day mortality to 3.2% from a national average of 13.5%. The average time to prosthetic fitting was 8 weeks for the study group compared to 16 weeks for US Department of Veterans Affairs amputations. The early death group’s average albumin of 2.15 g/dL with a NLR of 8.9. The study demonstrated that a novel postoperative protocol may improve outcomes in transtibial amputations and that a few simple blood values may provide an indication of the diminished overall physiologic health of this patient population.
Biomechanical Evaluation of Different Fixation Methods for a First Metatarsal Transverse Neck Osteotomy in a Hallux Valgus Sawbone Model
Authors: Wagner Pablo , Wagner Emilio , Pinochet Miguel I. , Lam Peter
Published: December 2023

Category:

Bunion

Introduction/Purpose:

There are no studies available that provide information about fixation methods for minimally invasive Hallux Valgus osteotomies. Our objective was to evaluate different fixation methods' strength for a first metatarsal transverse neck osteotomy in a sawbone model.

Methods:

30 sawbone foot models were used. Transverse neck first metatasal osteotomies were performed and fixed in a standardized fashion in 6 different configurations. Group 1 used one 4.0 screw; Group 2 used two (one 4.0 and one 3.0) parallel screws; Group 3 used two (one 4.0 and one 3.0) divergent screws; Group 4 used two divergent screws, one 4.0 with lateral metatarsal head cortex purchase, and one 3.0 screw; Group 5 was like Group 4, but with two 4.0 screws. Group 6 was like Group 4 and 5, but with two 3.5 screws. Cyclic and load to failure testing were performed, measuring stiffness and force needed to create deformity, using a Zwick Roell Universal Testing Machine.

Results:

Group 1 failed due to rotational instability. Group 2 showed increased stiffness (p < 0.05) against group 1. Group 3 did not achieve difference to group 2. Group 4 was stronger (p < 0.05) in all variables than groups 1-3. Group 5 did not show differences against Group 4. Group 6 was only stronger than Group 1-2.

Conclusion:

In this study, better biomechanical behavior is seen using divergent screws with lateral head cortex purchase. This is the first study that provides biomechanical information on first metatarsal transverse neck osteotomy fixation methods. Clinical studies are needed to evaluate the clinical impact of these findings.
Bone Mineral Density Distribution in the Foot Bones and Correlation with Hindfoot Alignment
Authors: Mathieu Julie , Dagneaux Louis , Netto Cesar de Cesar , Bernasconi Alessio , Chabrand Patrick R. , Lintz François
Published: December 2023

Category:

Basic Sciences/Biologics; Hindfoot

Introduction/Purpose:

Weight-bearing CT (WBCT) enables accurate 3D hindfoot alignment (HA) measurements such as the Foot Ankle Offset (FAO). However, this uses anatomical landmarks and oversimplifies anatomy. Stress distribution influences bone mineral density (BMD). Hounsfield units (HU) are the tomographic measurement unit for BMD. We aim to analyze the distribution of BMD in the foot bones, relative to the long axis of the second metatarsal (M2), an accepted landmark for foot orientation, and its correlation with HA.

Methods:

In this retrospective study, 81 feet (27 per HA group : normal, valgus or varus) were included from our database after ethics approval. After 3D segmentation, a HU-weighted map (HUM) of the foot was projected on the ground plane with orientation defined by the longitudinal axis of the 2nd metatarsal. A HU Curve (HUC) was drawn, corresponding to the center of mass of the HUM in the coronal plane. We studied the HU angle (HUA) formed by HU Line (HUL) (linear regression of the HUC) and M2 longitudinal axis.

Results:

The groups were comparable by age, sex and BMI. A positive correlation between FAO and HU angle was found (r =0.75, p< 0.001). HUA were -0.4° ± 5.5° in varus, 3.5° ± 6.8° in normals, 13.4° ± 5.1° in valgus (F=39.7 and p< 0.001). HUA differences were significant between normals and varus (p < 0.05), and between normals and valgus (p < 0.001). FAO and HUA were significantly correlated in valgus (rho=0.437, p=0.002) and varus (rho=0.540, p=0.004).

Conclusion:

We found altered distributions in misaligned cases, and BMD was correlated with HA. The HUL could be an interesting new tool to analyse the topography of bone distribution in WBCT.
Comparison of Bone Healing and Delayed or Nonunion Rates Between Operatively and Non- operatively Treated Displaced Zone 1 Fifth Metatarsal Fractures
Authors: Kim C. James , Parekh Selene G. , Tsai Justin , O’Neil Joseph T. , Fuchs Daniel , Shakked Rachel , Winters Brian S. , Daniel Joe , Pedowitz David I.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Acute fractures of the proximal fifth metatarsal are one of the most common injuries to the foot, occurring in up to 70% of all metatarsal fractures1. Displaced zone 1 fractures of the fifth metatarsal with greater than 2 mm fracture gap or those comprising greater than 30% of the cubometatarsal joint warrant operative treatment with open reduction internal fixation (ORIF)2,7, as satisfactory bone healing and patient-reported outcomes have been reported previously8–13. More recently, a few studies have demonstrated good functional outcomes after conservative treatment of zone 1 fractures with initial displacement greater than 2 mm7,13. Nevertheless, the lack of comparative studies and conflicting available evidence of outcomes warrant further investigation on this topic.

Methods:

A chart review was conducted to identify patients with displaced zone 1 fractures of the fifth metatarsal. Age at time of injury, gender, smoking and diabetes history, were collected. Degree of fracture displacement were measured (mm) on AP, lateral, and oblique view radiographs obtained at the initial encounter. Non-operatively treated patients were instructed to weightbear as tolerated in a Controlled Ankle Motion (CAM) boot for 6 weeks. Surgically-treated patients were placed in a short-leg splint for 2 weeks, and remained non-weightbearing in a CAM boot until 6 week period. They transitioned to normal shoe wear at the 8 week postoperative period. Chart notes were reviewed to identify the time to complete healing and incidences of delayed or nonunion. Means were compared using a one-way ANOVA or Kruskal Wallis test depending on normality, and categorical variables were compared using Chi-square or Fisher’s exact test.

Results:

The average time to complete healing was greater in non-operatively treated patients by 3 weeks (17.1 vs. 14.1, p=0.282). 4/37 (10.8%) non-operatively treated patients experienced delayed or non-union whereas 4/38 (13.2%) operatively-treated patients experienced delayed or non-union. This difference was statistically non-significant. The average fracture displacement (mm) on the oblique view was significantly greater in operatively-treated patients (2.68 vs. 5.40, p< 0.001). For patients with fracture gaps greater than 2 mm on the oblique view, non-operatively treated patients took 20.9 weeks whereas operatively- treated patients took 11.8 weeks to reach complete healing (p < 0.01).

Conclusion:

Patients who were treated non-operatively for displaced zone 1 fractures of the fifth metatarsal took on average 3 weeks longer to reach complete healing than operatively-treated patients. For patients with fracture gap greater than 2 mm on the oblique view, operative treatment was associated with significantly reduced time to complete healing.
Correction of Distal Metatarsal Articular Angle in Hallux Valgus Surgery Utilizing a Minimally Invasive Percutaneous First Metatarsal Distal Transverse Osteotomy
Authors: Encinas Rodrigo , Edelman David , Hall SarahRose , McMillen Tucker , Jackson J. Benjamin , Gonzalez Tyler
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Hallux valgus, a common deformity treated by orthopedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Minimally invasive (MIS) percutaneous hallux valgus surgery is becoming more popular and often used in patients with increased DMAA. Additional recent literature has shown low rates of recurrence, minimal pain and high patient functional outcomes with MIS hallux valgus correction. Thus, we investigated the efficacy of MIS percutaneous distal transverse first metatarsal osteotomy procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery. We hypothesize that give the ability to obtain a triplanar correction with this osteotomy no additional osteotomy will be needed to correct the DMAA.

Methods:

A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a MIS percutaneous distal transverse first metatarsal osteotomy between September 2021 to December 2022. Exclusion criteria included patients with inadequate follow up and all patients not undergoing MIS percutaneous distal transverse first metatarsal osteotomy for hallux valgus correction. Hallux valgus angle (HVA), intermetatarsal angle (IMA) and DMAA were measured on pre- operative and 2-week post-operative radiographs to assess immediate correction of these angles. Univariate analysis was used to describe pre- and post- measurements for DMAA, HVA, and IMA. Differences in pre- and post- measurements were evaluated using paired t-test.

Results:

In total, 43 minimally invasive surgery (MIS) hallux valgus corrections on 39 patients were included. On average, the DMAA decreased from 9.5 degrees pre-operatively to 4.8 degrees two weeks post-operatively (decrease of 4.7 degrees, p-value < 0.001). The average HVA decreased from 29.9 degrees pre-operatively to 4.2 degrees two weeks post-operatively (decrease of 25.7 degrees, p-value of < 0.001). Lastly, the average IMA decreased from 15.1 degrees pre-operatively to 2.9 degrees 2 weeks post-operatively (decrease of 12.2 degrees, p-value < 0.001).

Conclusion:

Our study showed that utilizing a MIS percutaneous distal transverse first metatarsal osteotomy for hallux valgus correction was able to significant reduce the DMAA without the need for supplementary metatarsal osteotomies. Additionally significant correction of the IMA and HVA was also obtained. MIS hallux valgus correction may be considered by orthopedic foot and ankle surgeons for those patients that need surgical correction for hallux valgus deformity that also requires DMAA correction.
Effectiveness of Platelet-rich Plasma Injections for Plantar Fasciitis: A Patient Reported Outcomes Evaluation
Authors: Nicolas Andrea Pujol , Nicholson Alys , Ramaskandhan Jayasree R. , Siddique Malik , Torres Paulo , Alkhreisat Mohammad , Qasim Sultan , Chambers Simon
Published: December 2023

Category:

Other

Introduction/Purpose:

Steroid injection is a common treatment for Plantar fasciitis (PF) but has high recurrence rates. Platelet- rich plasma (PRP) injections have been used as an alternative treatment. Our aim was to review the effectiveness of PRP injection.

Methods:

All patients who underwent PRP injection for PF between 2015 and 2021 were included in this study. Clinical results and patient reported outcomes (MOX-FQ scores, EQ-5D and FAOS scores) were collected pre and post-operatively.

Results:

A total of 34 patients underwent PRP injection between 2015 and 2021 (mean age 34 years). There was a 71% PROMs response rate (80% female with, mean age 53). The mean duration of symptoms was 4 years and the median follow up time was 4.2 years. 77.1% were satisfied with overall outcomes of treatment with PRP injections (p < 0.05). 68.1% of patients reported satisfaction with pain relief. 74.6% were satisfied with return to activities of daily living. 72.6% were satisfied with return to recreational activities. 59% reported improvement in quality-of-life post treatment. 64% were happy to receive the same treatment again; 13.6% would not have the procedure again. 2 patients had severe pain within 2 weeks following the injection but symptoms settled. No other complications.

Conclusion:

PF is considered to be a self-limiting condition but can be debilitating whilst awaiting resolution of symptoms which can take upwards of 12 months to fully resolve. PRP injection provides effective pain relief for PF at 4 years follow up.
Governing Public–Private Partnerships of Sustainable Construction Projects in An Opportunistic Setting
Authors: Maqbool Rashid , Sridhar Harini
Published: December 2023

Government-sponsored public–private partnership (PPP) projects in the United Kingdom face particular complexity and uncertainty challenges because of the country’s specific socioeconomic context. This research investigates the role of governance and stakeholder management in PPP-based sustainable projects by conducting a mixed methods approach, which includes a quantitative survey and a qualitative case study inference. The results show that project governance and stakeholder management have a significant positive impact toward sustainable development and PPP project success. Whereas the negative impact of opportunism over contractual governance and stakeholder management is insignificant. Similarly, the negative effect of project uncertainty over contractual governance is insignificant toward sustainable development.
How I diagnose and treat antiphospholipid syndrome in pregnancy
Authors: Branch D. Ware , Lim Ming Y.
Published: December 2023

Antiphospholipid syndrome (APS) is a rare autoimmune disease characterized by arterial, venous, or microvascular thrombosis, pregnancy morbidities, or nonthrombotic manifestations in patients with persistently positive antiphospholipid antibodies. These antibodies bind cellular phospholipids and phospholipid–protein complexes resulting in cellular activation and inflammation that lead to the clinical features of APS. Our evolving understanding of APS has resulted in more specific classification criteria. Patients meeting these criteria should be treated during pregnancy according to current guidelines. Yet, despite treatment, those positive for lupus anticoagulant have at least a 30% likelihood of adverse pregnancy outcomes. Patients with recurrent early miscarriage or fetal death in the absence of preeclampsia or placental insufficiency may not meet current classification criteria for APS. Patients with only low titer anticardiolipin or anti–β(2)-glycoprotein I antibodies or immunoglobulin M isotype antibodies will not meet current classification criteria. In such cases, clinicians should implement management plans that balance potential risks and benefits, some of which involve emotional concerns surrounding the patient’s reproductive future. Finally, APS may present in pregnancy or postpartum as a thrombotic microangiopathy, a life-threatening condition that may initially mimic preeclampsia with severe features but requires a very different treatment approach.
Antitumor efficacy and safety of unedited autologous CD5.CAR T cells in relapsed/refractory mature T-cell lymphomas
Authors: Hill LaQuisa C. , Rouce Rayne H. , Wu Mengfen J. , Wang Tao , Ma Royce , Zhang Huimin , Mehta Birju , Lapteva Natalia , Mei Zhuyong , Smith Tyler S. , Yang Lina , Srinivasan Madhuwanti , Burkhardt Phillip M. , Ramos Carlos A. , Lulla Premal , Arredondo Martha , Grilley Bambi , Heslop Helen E. , Brenner Malcolm K. , Mamonkin Maksim
Published: December 2023

Despite newer targeted therapies, patients with primary refractory or relapsed (r/r) T-cell lymphoma have a poor prognosis. The development of chimeric antigen receptor (CAR) T-cell platforms to treat T-cell malignancies often requires additional gene modifications to overcome fratricide because of shared T-cell antigens on normal and malignant T cells. We developed a CD5-directed CAR that produces minimal fratricide by downmodulating CD5 protein levels in transduced T cells while retaining strong cytotoxicity against CD5+ malignant cells. In our first-in-human phase 1 study (NCT0308190), second-generation autologous CD5.CAR T cells were manufactured from patients with r/r T-cell malignancies. Here, we report safety and efficacy data from a cohort of patients with mature T-cell lymphoma (TCL). Among the 17 patients with TCL enrolled, CD5 CAR T cells were successfully manufactured for 13 out of 14 attempted lines (93%) and administered to 9 (69%) patients. The overall response rate (complete remission or partial response) was 44%, with complete responses observed in 2 patients. The most common grade 3 or higher adverse events were cytopenias. No grade 3 or higher cytokine release syndrome or neurologic events occurred. Two patients died during the immediate toxicity evaluation period due to rapidly progressive disease. These results demonstrated that CD5.CAR T cells are safe and can induce clinical responses in patients with r/r CD5-expressing TCLs without eliminating endogenous T cells or increasing infectious complications. More patients and longer follow-up are needed for validation. This trial was registered at www.clinicaltrials.gov as #NCT0308190.