bluuebunny/crossref_metadata_2025 huggingface dataset:
Crop Insurance in India: A Review of Pradhan Mantri Fasal Bima Yojana (PMFBY)
Authors: Tiwari Rajesh , Chand Khem , Anjum Bimal
Published: November 2020

Farmers in India have been the victim of systemic neglect and live a marginalized life. Crop failure due to natural calamities and unfavourable climatic conditions puts farmers in a challenging situation leading to extreme hopelessness and suicides. This article provides an overview of the crop insurance scheme, Pradhan Mantri Fasal Bima Yojana (PMFBY) launched in India by Mr. Narendra Modi in 2016. PMFBY has poor state support, unviable subsidy model, delayed claim settlement and skewed benefit pattern. A technology-enabled demand-driven approach is recommended. Crop insurance should be delinked from political affiliation. Velocity, variety and verifiability in PMFBY will make crop insurance scheme work better for farmers than insurers, administrators and politicians.
Changing Nature of Work and the Gig Economy: Theory and Debate
Authors: Mehta Balwant Singh
Published: November 2020

This article explores the changing nature of work across the globe, specifically in India, with the emergence of the gig economy. It discusses the theoretical background debates on work with technological change and highlights how India’s recent job market trends are rather disappointing, with rising unemployment and a decline in new jobs. In this scenario, the gig economy is fast emerging as a respite, offering employment opportunities for millions of Indians. This article also explores the prospects and challenges of gig work in India and the ways in which it can prove to be a provider of decent work opportunities for people. Finally, the article provides some important future-policy suggestions for the growth and improvement of work in the gig economy.
Comparing Pharyngeal Airway Dimensions and Hyoid Bone Position in the Subgroups of Skeletal Class III Malocclusions: A Cephalometric Study
Authors: Buyukcavus MH , Kocakara G
Published: November 2020

Aim:

To examine pharyngeal airway dimensions and hyoid bone position according to the subgroups of Class III malocclusion.

Materials and Methods:

This retrospective study consisted of patients divided into three subgroups with skeletal Class III malocclusion. The study included a total of 151 individuals (61 females and 90 males). The authors divided individuals with skeletal Class III malocclusion into three subgroups: maxillary retrognathia, mandibular prognathia, and combined. The study’s cephalometric analysis used eight nasopharyngeal, seven oropharyngeal, two hypopharyngeal, nine hyoid, and four area measurements. One-way analysis of variance was used to evaluate patients. Tukey’s post-hoc tests were used for bilateral comparisons of significant parameters. The results were considered statistically significant at a P < .05 significance level.

Results:

The study found no significant differences between the groups’ pharyngeal airway and area measurements ( P > .05). When the authors evaluated hyoid bone position, a statistically significant difference was found between the three groups’ Hy-A (mm), Hy-S (mm), Hy-SN (mm), and Hy-FH (mm) measurements ( P < .05).

Conclusion:

Linear and areal pharyngeal airway dimensions are similar in subgroups of Class III malocclusions, while the hyoid bone is vertically higher in individuals with maxillary retrognathia.
A Review on Cancer Stem Cells in Vasculogenic Mimicry Formation: A New Dimension for Targeted Therapy
Authors: Murugesan Ambika , Sekar B. , Saranyan R. , Manivannan E. , Rajmohan M.
Published: November 2020

Aim:

Cancer stem cells (CSCs) or tumor-initiating cells have self-renewal and uncontrolled tumor growth capacity that promotes metastasis and recurrence. Challenges in anticancer have found a lateral dimension of treatment against a new pattern of tumor microcirculation, known as vasculogenic mimicry (VM), involved in cancer progression. Increasing evidence suggest that CSCs are involved in the formation of VM. In this review the correlation between CSCs and VM formation is been enlightened.

Materials and Methods:

The literature search was done in Medline, PubMed, Wiley, Science Direct, and Scopus. The keywords used for database search were cancer stem cells, vasculogenic mimicry, and anticancer therapy.

Results:

A total of 112 articles appeared from various sources, of which 102 were subjected for screening and 20 were related to the research objective.

Conclusion:

Based on the literature a positive correlation exists between CSC and VM, which plays a key role in tumor progression, and hence, can serve as a potential target in anticancer therapy.
Association Between MRI-Based Tibial Slope Measurements and Mucoid Degeneration of the Anterior Cruciate Ligament: A Propensity Score–Matched Case-Control Study
Authors: Zikria Bashir , Johnson Alex , Hafezi-Nejad Nima , Siddiqui Yalda , Kwee Robert M. , Ahlawat Shivani , Morelli John N. , Fayad Laura M. , Kompel Andrew J. , Haj-Mirzaian Arya , Pishgar Farhad , Demehri Shadpour
Published: November 2020

Background:

The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established.

Purpose:

To investigate whether MTS and LTS measurements are associated with the presence of ACL MD.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models.

Results:

Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD.

Conclusion:

Excessive LTS was associated with the presence of ACL MD, independent of participants’ age, sex, BMI, and cartilage damage severity.
Gendered Paths to Enlightenment: The Intersection of Gender and Religion in Buddhist Temples in Mainland China and the United States
Authors: Di Di
Published: November 2020

This study explores how religious adherents construct their ideas regarding gender in Buddhist faith communities. Two temples, one in China and the other in the United States, both affiliated with the same international Buddhist headquarters, are situated in national contexts that endorse different macro-level gender norms. While leaders of both temples teach similar religious gender norms—specifically, that gender is unimportant for spiritual advancement—adherents do articulate gender differences in other respects. Buddhists at the temple in China believe that men and women differ but should be treated equally, with neither holding dominance over the other; meanwhile, U.S. practitioners also believe that everyone should be treated equally irrespective of gender, but they view men and women as essentially the same. A close analysis reveals that Buddhists at both temples recognize the distinctions between their religious and societal macro-level gender norms and navigate between these norms when constructing their own understandings of gender. This study highlights the influence of national context on the relationship between gender and religion, thereby contributing to and deepening our understanding of the subject.
Racial States and Re-making Race: Exploring Coloured Racial Re- and De-formation in State Laws and Forms in Post-Apartheid South Africa
Authors: Pirtle Whitney N. Laster
Published: November 2020

The nation-state is one powerful entity that makes race. For instance, the mid-twentieth-century South African apartheid racial state cultivated a triracial hierarchy through officially naming three groups into law: White, Black (native African), and Coloured, with Coloured being defined and situated in the “racial middle” as neither White nor Black African. Yet because race is a social construction that is adaptive and dynamic, the state’s role in making race is also malleable and changing. This study offers a case study of how modern racial states re-make racial categories by focusing on the potential for re- or de-formation of the Coloured racial category since the end of apartheid in 1994 and 25 years into democracy. In conducting a critical race discourse analysis of official state forms and laws, the author finds that the post-apartheid nation-state challenges Coloureds’ racial categorization and position in the racial middle. It does this by simultaneously supporting nonracialist (i.e., color-blind racist) strategies and rewriting Coloured as Black as a means for racial redress. Moreover, the author argues that contemporary South Africa practices coloured blindness through both de-formation and then re-making of the Coloured racial category, thus contributing to the potential shift to a dichotomous racial hierarchy. This project demonstrates how the racial middle can be re-made to uphold state racial projects transformed by changes in the sociopolitical context.
Why North Korea Could Not Implement the Chinese Style Reform and Opening? The Internal Contradiction Between Economic Reform and Political Stability
Authors: Cho Sungmin
Published: November 2020

Can North Korea implement Chinese-style reform and opening-up policies? This is an important question, directly relevant to the policy debate on North Korea’s nuclear challenges. Through comparative historical analysis, I argue that Pyongyang has failed to adopt the Chinese-style reform and opening-up for the internal and structural restraints. The Chinese experience shows that the economic reform and opening, to be successful, requires a certain degree of political reform and openness to be executed together. North Korea could not implement the economic reform and opening policies as effectively as China did, not because of the external conditions like international sanctions or security threat to the country, but more for the internal contradiction that North Korea’s own economic development is likely to endanger the stability of the political system more rapidly and widely than China has experienced. For this analysis, I rely on North Korea’s published laws and economic policies, previous survey works and scholarly works published in Korean and Chinese.
The Russian Stand on the Responsibility to Protect: Does Strategic Culture Matter?
Authors: Dagi Dogachan
Published: November 2020

Though Russia has approved the doctrine of responsibility to protect (R2P) in the UN platforms it has often been placed rightly in the ‘sceptics group’ of states that are not at ease with the premises and practices of R2P. What is the basis of the Russian discontent? This article suggests the relevance of strategic culture in explaining the Russian position on R2P. It is based on the assertion that, in addition to humanitarian and moral aspects, responding to mass atrocities within the doctrine of R2P takes place in a context of security considerations since, in severe cases, it involves, among others, a military component under a UN Security Council mandate. As such the use of force, approving or disapproving, it is all related to the realm of security even if the motive and objective may be humanitarian. In the security domain, this article argues that Russian strategic culture, in interaction with its national identity, historical experiences and prevailing narratives, forms a loose code of conduct and a context within which strategic decisions concerning the use of force in responding to a humanitarian crisis are made. It is, thus, concluded that Russian strategic culture by constraining decision-makers, defining appropriate behaviour and reflecting insecurities and aspirations explains Russia’s approach to R2P’s normative propositions, legal standing and implementation in practice.
Next-Generation Sequencing for Pathogen Identification in Infected Foot Ulcers
Authors: Choi Yoonjung , Oh Irvin
Published: November 2020

Category:

Other

Introduction/Purpose:

Foot infections are often polymicrobial with diverse microbiomes. Accurate identification of the main pathogen in diabetic foot ulcer (DFU) remain challenging due to contamination or negative cultures often leading to ineffective post-surgical antibiotic treatment. Application of molecular diagnostics, such as next generation sequencing (NGS) has been explored as an alternative to standard culture in orthopaedic infections. NGS is highly sensitive and detects an entire bacterial genome along with pharmacologic resistant genes in a given sample. We sought to investigate the potential use of NGS for accurate diagnosis and quantification of various species in infected DFU. We hypothesize that NGS will provide a more accurate means of diagnosing and profiling microorganisms in infected DFU compared to the standard culture method.

Methods:

We investigated 30 infected DFU patients who underwent surgical treatment by a single academic orthopaedic surgeon from October 2018 to September 2019. The average age of the patient was 60.4 (range 33-82) years-old. Surgical procedures performed were irrigation and debridement (12), toe or ray amputation (13), calcanectomies (4), and below-knee amputation (1). Infected bone specimens were obtained intraoperatively and processed for standard culture and NGS. Quantitative PCR was performed to determine the bacterial burden present in the sample. DNA was amplified by PCR from a highly conserved region of the rRNA gene in the bacteria (16S rRNA). Once a high level of DNA was generated and determined, it was compared against NIH GenBank database. Concordance between the standard culture and NGS was assessed.

Results:

In 28 of 29 patients, pathogens were identified by both NGS and culture, with complete consistency of organisms in 13 cases (concordance rate: 43.3%). NGS provided relative quantitative measures and the presence of antibiotic resistant genes for each pathogen. In NGS, Anaerococcus species (79.3%) was the most common organism, followed by Streptococcus species (44.8%), Prevotella species (44.8%), Finegoldia magna (44.8%). In culture, S. aureus (58.6%) was the most common, followed by Streptococcus species (34.5%), coagulase-negative Staphylococci (24.1%), Corynebacterium species (20.7%). On average, NGS revealed 5.1 (1-11) number of pathogens, whereas standard culture revealed 2.6 (1-6) pathogens in a given sample. NGS identified 2 cases with false positive standard culture and detected antibiotic resistant organisms in 15 specimens.

Conclusion:

NGS is an emerging method of microbial identification in orthopedic infection. It is particularly helpful in profiling diverse microbes in polymicrobial infected DFU. It can identify major pathogens and may correct false positive or false negative culture. NGS may allow a faster invitation of postoperative targeted antibiotic therapy. [Table: see text]
Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction: A Prospective Cohort Study
Authors: Ferraz Gabriel F. , Santos Tatiana F. , Oksman Daniel , Filho Miguel V. Pereira
Published: November 2020

Category:

Lesser Toes; Midfoot/Forefoot

Introduction/Purpose:

Bunionette is a very common foot disorder, and several kinds of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region became a suitable area for this kind of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for the percutaneous approach.

Methods:

We prospectively evaluated 31 consecutive tailor’s bunion patients who underwent surgical correction after failure of conservative treatment between 2016 and 2019, totaling 42 feet. Clinical outcomes such as pain (VAS), function (AOFAS), criteria of personal satisfaction, and complications were evaluated. Radiographic aspects were also included. The Shapiro and Mann- Whitney statistical tests were run in the Stats package within the R environment.

Results:

The average age of the patients was 69.54 years, and the average follow-up was 13.14 months. There was a decrease of 6.67 points in the VAS for pain (p<0.001) and an increase of 34.94 in AOFAS (p<0.001) after the surgical procedure. Radiographic correction was achieved at both the fifth metatarsophalangeal angle (p<0.001) and intermetatarsal angle (p<0.001), which showed decreased values. There was one case of superficial infection and two cases of nonconsolidation (asymptomatic). A large majority of patients considered the procedure outcome satisfactory.

Conclusion:

The percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity showed improvement in pain and function and a high rate of personal satisfaction with a low incidence of complications and high capacity to correct the deformity.
Comparison of Change in Hindfoot Alignment with Coleman Block Testing Using Clinical Exam, X-ray, and Weight-bearing CT
Authors: Foran Ian , Mehraban Nasima , Jacobsen Stephen K. , Bohl Daniel D. , Hamid Kamran S. , Lin Johnny L. , Lee Simon
Published: November 2020

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

The Coleman block test has traditionally been used to distinguish between forefoot- and hindfoot-driven deformity as well as flexibility of cavovarus deformity. However, there has been no validation of the Coleman block test using x- rays or weightbearing CT scan. The purpose of this study was to compare hindfoot alignment in cavovarus feet with and without the Coleman block using clinical exam, x-ray, and weightbearing CT scan.

Methods:

We retrospectively evaluated 7 feet in 7 patients. The average age was 57, there were 5 males, and the average BMI was 34.7. Average calcaneal pitch was 30 degrees. Clinical measurements were made using standing talocalcaneal angle (STCA) and resting calcaneal stance position (RCSP) with and without a Coleman block using a camera positioned at 0 degrees to the heels. Hindfoot angle (HFA) was measured off of Saltzman-view x-rays and off of weightbearing CT coronal reconstructions with and without the Coleman block. Finally, foot ankle offset (FAO) was measured with and without the Coleman block from weightbearing CT using Cubeview TALAS software. Differences before and after Coleman block were measured using paired t- testing and correlations between different hindfoot alignment measurements were made using Pearson correlation coefficients.

Results::

The average change in STCA before and after Coleman block placement was 2.9 degrees (7.14 varus without block, 4.28 degrees of varus with block; p<0.05). The average change in hindfoot angle before and after Coleman block using X-ray was 7.4 degrees (14 degrees varus without block, 6 degrees varus with block; p=0.08), and using CT was 3.9 degrees (14 degrees varus without block, 10 degrees varus with block; p= 0.06). There was no significant change in FAO before and after Coleman block testing. STCA was best-correlated with FAO (R= 0.7, p<0.05). CT HFA was also well-correlated with FAO (R=0.68, p<0.05). There was lesser correlation between X-ray HFA and FAO (R=0.608, p<0.05) and X-ray HFA and SCTA (p=0.63, p<0.05).

Conclusion::

Although Coleman block testing resulted in a decrease in varus, no patient had full re-constitution of physiologic hindfoot valgus with any measurement method. This suggests that either the forefoot was a partial (but never a complete) ‘driver’ of hindfoot varus deformity, or that there was some degree of rigidity in all patients tested. FAO did not demonstrate a statistically significant difference with and without Coleman block on this small sample size. FAO was best correlated with both clinical exam and CT HFA measurements. Clinical exam and weightbearing CT may be more reliable than radiographs in measuring cavovarus hindfoot alignment. [Figure: see text]
Talar Osteonecrosis after Subchondroplasty for Acute Lateral Ligament Injuries: A Small Case Series
Authors: Foran Ian , Bohl Daniel D. , Vora Anand M. , Mehraban Nasima , Hamid Kamran S. , Lee Simon
Published: November 2020

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

Non-operative treatment is regarded as the standard of care for the management of acute, uncomplicated lateral ankle sprains. As diagnostic and treatment options evolve, there is intermittently renewed interest in early surgical treatment of these acute injuries. Wider availability of magnetic resonance imaging (MRI) has made advanced imaging of acute ankle sprains more commonplace. One entity commonly seen on MRI is the ‘bone marrow lesion’ (BML). Recently, a procedure termed ‘Subchondroplasty’ (Zimmer, Warsaw, Indiana) has been developed to address chronic bone marrow lesions that have failed conservative management. We present a series of five cases referred from outside institutions in which patients developed rapid osteonecrosis of their tali after undergoing acute lateral ligament reconstruction with talar Subchondroplasty.

Methods:

We retrospectively evaluated the charts and available imaging of five patients who had developed osteonecrosis after undergoing a Subchondroplasty procedure in the setting of acute lateral ligament injury at outside institutions. Outside radiology reports, x-rays and magnetic resonance images, clinic notes, and operative reports were collected and analyzed. Patient demographics, comorbidities, and secondary interventions (after the index procedure) were recorded.

Results:

Average patient age was 23 (range 16-31). All patients were healthy. The patients were taken care of by different outside providers. All patients had pre-operative MRI demonstrating ATFL signal changes and bony edema within the talus in a distribution expected after ankle sprain. All patients were taken to the OR within 4 weeks of injury. Three underwent isolated talar Subchondroplasty; two underwent Subchondroplasty and an open Broström procedure. Within 6 months, radiographs and MRI in all patients demonstrated diffuse sclerosis of the tali, and diffuse talar hyperintensity on MRI scans, consistent with osteonecrosis. Two patients additionally had talar fragmentation and collapse. Currently, one patient has subsequently undergone total ankle replacement, two have had arthroscopy with bone marrow stimulation, and two are considering arthrodesis.

Conclusion:

We present 5 cases from outside institutions in which patients with acute ankle sprains and associated acute talar bone marrow lesions developed osteonecrosis after Subchondroplasty with or without lateral ligament repair. Although Subchondroplasty was likely not well-indicated in these acute cases, it raises a question of whether Subchondroplasty may be harmful to the talar blood supply. There is currently a lack of evidence to support Subchondroplasty for use in the foot and ankle. Practitioners should exercise caution when performing Subchondroplasy for the talus.
The Effect of Lateral Column Lengthening on Subtalar Motion: Are We Trading Deformity for Stiffness?
Authors: Hedrick Brittany , Riccio Anthony , Thomas Danielle M. , Shivers Claire , Siebert Matthew , Pierce William A. , Harris Mitchell , Zide Jacob R.
Published: November 2020

Category:

Hindfoot; Other

Introduction/Purpose:

While lengthening of the lateral column through a calcaneal neck osteotomy is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, concern exists as to the effect of this intra- articular osteotomy on subtalar motion. The purpose of this study is to quantify the alterations in subtalar motion following lateral column lengthening (LCL).

Methods:

The subtalar motion of 14 fresh frozen cadaveric feet was assessed using a three-dimensional motion capture system and materials testing system (MTS). Following potting of the tibia and calcaneus, optic markers were placed into the tibia, calcaneus and talus. The MTS was used to apply a rotational force across the subtalar joint to a torque of 5Nm. Abduction/adduction, supination/pronation, and plantarflexion/dorsiflexion about the talus was recorded. Specimens then underwent LCL via a calcaneal neck osteotomy which was maintained with a 12mm porous titanium wedge. Repeat subtalar motion analysis was performed and compared to pre-LCL motion using a paired t-test.

Results::

No statistically significant differences in subtalar abduction/adduction (10.9O vs. 11.8O degrees, p=.48), supination/pronation (3.5O vs. 2.7O, p=.31), or plantarflexion/dorsiflexion (1.6O vs 1.0O, p=.10) were identified following LCL.

Conclusion::

No significant changes in subtalar motion were observed following lateral column lengthening in this biomechanical cadaveric study. While these findings do not obviate concerns of clinical subtalar stiffness following planovalgus deformity correction, they suggest that diminished postoperative subtalar motion may be due to soft tissue scarring rather than alterations of joint anatomy.
Preliminary Results of a Multicenter Prospective Randomized Trial: Traditional Modified Brostrom versus InternalBrace™ Augmentation
Authors: Kulwin Robert , Suhling Mallory , Rigby Ryan , Vora Anand M. , Watson Troy S.
Published: November 2020

Category:

Sports; Ankle; Arthroscopy

Introduction/Purpose:

The modified Brostrom (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI) despite concerns about the strength of the repair. Recently, the InternalBraceTM (IB) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be established. The purpose of this study is to determine whether or not IB augmentation provides an advantage over the traditional MB. The preliminary results of this study are presented.

Methods:

Patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI, age over 18, and able to provide informed consent. Exclusion criteria included pregnancy, cognitive disability, concomitant bony correction, inadequate soft tissue for MB, or prior ankle surgery affecting the lateral ligament complex. Preliminary outcome measures included complication rates, ability to participate in an accelerated rehabilitation protocol, and time to return to pre- injury level of activity. Complications were identified during post-operative clinical evaluations. Conversion from accelerated to traditional rehabilitation protocol was determined by patient’s self-reported ability to participate or VAS >= 5 per the physical therapist. Patients were contacted every 2 weeks from 6 to 26 weeks post-operatively to determine return to pre-injury level of activity.

Results:

119 patients with CLAI who met criteria were enrolled in the study and randomized to the MB (59 patients) or IB (60 patients) treatment arm. At six months 11 patients (18.6%) of the MB arm and 4 patients (6.7%) of the IB arm were lost to follow up. 6/48 patients in the MB group and 2/56 patients in the IB group had not returned to preinjury activity level (p =.115). The complication rate was 8.5% in the MB group versus 1.7% in the IB Group. 4 patients in the MB group failed to complete the accelerated rehabilitation protocol versus 1 in the IB group. Average time to return to pre-injury level of activity was 17.6 weeks after MB and 13.2 weeks after IB (p<0.001).

Conclusion:

Preliminary results from this multicenter, prospective, randomized trial suggest that IB augmentation allows for faster return to pre-injury level of activity than MB alone. IB augmentation may support successful accelerated rehabilitation. IB augmentation did not add any additional risk of post-operative complication. Further areas of investigation include longer-term follow up and patient reported outcome scores.
The Effect of Supramalleolar Osteotomy without Marrow Stimulation on Cartilage Regeneration for Medial Compartment Ankle Osteoarthritis: Second-Look Arthroscopic Evaluation of Cartilage Regeneration
Authors: Lim Jung-Won , Jung Hong-Geun
Published: November 2020

Category:

Ankle Arthritis; Ankle; Arthroscopy

Introduction/Purpose:

The effect of supramalleolar osteotomy (SMO) without an additional bone marrow-stimulating procedure (BMSP) on articular cartilage regeneration in ankle joint still remains unknown. This study aimed to investigate whether SMO yielded favorable clinical and radiologic outcomes, and to evaluate whether the regeneration of articular cartilage could be observed after SMO without BMSP by second-look arthroscopy.

Methods:

43 ankles after SMO (mean follow-up: 35.5 months) were retrospectively reviewed. Visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, patient satisfaction were used for functional evaluations. The tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were measured on radiographs, and ankle osteoarthritis was classified by Takakura stage. Among the 43 patients, 31 underwent ankle arthroscopy prior to SMO, and second-look arthroscopy was performed at 1-year postoperatively. Tibiotalar cartilage regeneration was evaluated according to the modified Outerbridge classification for the 29 patients who had undergone SMO without BMSP.

Results:

The mean VAS score and AOFAS score significantly improved from 6.4 preoperatively to 1.4 postoperatively and from 61.1 preoperatively to 88.4 postoperatively, respectively (P < 0.05). Regarding overall postoperative patient satisfaction, 18 (41.8%) patients reported their satisfaction as excellent, 23 (53.5%) as satisfied. The mean TAS and TLS significantly improved from 83.8° and 94.8° preoperatively to 78.4° and 82.2° postoperatively, respectively (P < 0.05). 23 out of 28 preoperative Takakura stage IIIa cases and 3 out of 7 IIIb cases improved to postoperative stage II. On second-look arthroscopy, cartilage regeneration of the medial compartment of the tibiotalar joint was observed in 26 of 29 patients (89.7%), whereas cartilage deterioration was not observed in any patient.

Conclusion:

Medial tibio-talar articular cartilage regeneration was observed in most cases (89.7%) of medial compartment ankle osteoarthritis after SMO without BMSP, which was confirmed with second-look arthroscopic evaluation. It also showed satisfactory clinical and radiologic outcomes with high patient satisfaction.
Return to Play Following High-Grade Turf Toe Injuries in National Football League Athletes
Authors: Lindsey Benjamin B. , Bakshi Neil K. , Walton David M. , Holmes James R. , Talusan Paul G.
Published: November 2020

Category:

Sports; Midfoot/Forefoot; Trauma

Introduction/Purpose:

Return-to-play (RTP) rates of National Football League (NFL) athletes following surgical intervention for numerous foot and ankle injuries has been reported. To our knowledge, no studies have reported on RTP rates of NFL athletes after non-operative and operative treatment of high-grade turf toe injuries. The purpose of this study was to evaluate the RTP rates in NFL athletes who sustained high-grade turf to injuries. We hypothesized that NFL athletes requiring operative intervention for high-grade turf toe injuries would have lower RTP rates and longer recoveries than athletes treated non- operatively. Additionally, we hypothesized that regardless of treatment, NFL athletes would demonstrate equal productivity following RTP.

Methods:

Publicly available NFL injury data was reviewed to identify athletes who sustained high-grade turf toe injuries, as indicated by surgical intervention or missed playing time of 2 weeks or more. Athletes were excluded if RTP was prevented for reasons unrelated to the injury. Demographic and performance data was obtained including a player’s injury, date of injury, date of surgery, RTP, time to RTP, number and percentage of games played, and performance.

Results:

53 NFL athletes were identified with high-grade turf toe injuries that met inclusion criteria. 28 of these athletes were treated non-operatively and 25 were treated with surgery. The overall RTP rate was 91%. Athletes who were treated non- operatively had a RTP rate of 100% while athletes who underwent surgery had a RTP rate of 80% (P = 0.011). The mean time to RTP for all athletes was 140.9+-111.9 days. The mean time to RTP for non-operatively treated patients was 75.8+-99.0 days, compared with 221.4+-81.6 days for operatively treated athletes (P = 0.002). In skill position athletes who achieved RTP, 78% treated non-operatively were able to return to their prior level of performance compared to only 27% for athletes treated surgically (P = 0.032).

Conclusion:

There is a significant difference in return to play following surgical versus non-operative management of high-grade turf toe injuries, with only 80% of athletes achieving return to play after surgery. No athletes were able to return the same season as surgery and the mean time to RTP following initiation of treatment was significantly shorter for players who underwent non- operative management. Postoperative performance was also significantly worse in players who underwent surgical intervention compared to non-operative management. This study provides important prognostic information to high level athletes in regards to recovery following high-grade turf toe injuries
Correlation Between Three-Dimensional Biometric Weightbearing CT Assessment of Hindfoot Alignment and Conventional Measurements of Adult Acquired Flatfoot
Authors: Mansur Nacime S. , Netto Cesar de Cesar , Bang Katrina E. , Cychosz Chris , Garfinkel Jonathan H. , Lintz Francois , Bernasconi Alessio , Deland Jonathan T. , Ellis Scott J.
Published: November 2020

Category:

Hindfoot; Ankle; Other

Introduction/Purpose:

Semi-automatic three-dimensional (3D) biometric weightbearing CT (WBCT) tools have been shown to accurately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the Foot and Ankle Offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD.

Methods:

In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20 to 86) years. Three-dimensional coordinates (X, Y and Z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were harvested by two blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse plane were manually measured.

Results:

We found overall good to excellent intra (range, 0.84-0.99) and interobserver reliability (range, 0.71-0.96) for manual AAFD measurements. FAO semi-automatic measurements demonstrated excellent intra (0.99) and interobserver reliabilities (0.98). Hindfoot moment arm (p<0.00001), subtalar horizontal angle (p<0.00001), talonavicular uncoverage angle (p=0.00004) and forefoot arch angle (p=0.0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R-squared value of 0.79. A value of hindfoot moment arm of 19.8mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8mm and 14.6 when the HMA was equal or higher than 19.8mm.

Conclusion:

We found that 3D WBCT semi-automatic measurements of Foot and Ankle Offset (FAO) significantly correlated with traditional markers of pronounced AAFD. HMA, subtalar horizontal angle, talonavicular uncoverage angle and forefoot arch angle were found to explain 79% of the variations in FAO measurements. FAO Measurements were also found to be more reliable than the manual measurements. The FAO offers a more complete biomechanical and multiplanar assessment of the AAFD, that that accounts for relative positioning of the foot tripod and the center of the ankle joint, representing in a single measurement the three-dimensional components of the deformity.
Contamination Profile of the Mini C-Arm Fluoroscopy Unit in Orthopedic Surgery
Authors: Momenzadeh Kaveh , Williams Caroline , Czerwonka Natalia , Alemi Mohammad Mehdi , Kwon John Y. , Nazarian Ara , Miller Christopher P.
Published: November 2020

Category:

Other; Ankle

Introduction/Purpose:

Fluoroscopy is critical for orthopaedic surgery. The mini C-arm is popular among foot and ankle surgeons owing ease of easy, maneuverability, and cost effectiveness. However, there are concerns that the mini C-arm may represent a potential source of contamination and increasing the risk of postoperative infection. Evaluation of large c-arm drapes have shown high rates of contamination. However, the mini C-arm may be even more concerning due to how it is handled. The mini c-arm is continuously manipulated by the surgical team who then return to the surgical field carrying with them any potential cross-contamination.Objective: We hypothesize that there is significant contamination of the drape, and that specific locations of the drape are at higher risk.

Methods:

50 foot and ankle surgery cases which required the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were chosen for sampling. Locations were defined based on commonly touched areas on the drape by the surgical team, and their proximity to the non-sterile field. Negative controls were obtained by separately sampling an additional 20 mini C-arm drapes after draping c-arm and waiting for average surgery time. Positive controls were obtained by sampling non- sterile surfaces within the OR.Culture Q-swabs were used for sampling defined locations, using an established semiquantitative technique. Plates were incubated at 37 °C for 48 hours. Based on the number of quadrants on plate where colony growth was observed, bacterial growth was graded on a scale of 0, 1+, 2+, 3+, or 4+. Contamination threshold was defined as any growth pattern of 1+ or higher.

Results:

Figure 1 shows the contamination rates of the sampled areas of the c-arm drape. Contamination was noted in 70% of the cases for at least one area, and in two or more areas in 38% of cases.Contamination rates were significantly higher on defined locations in comparison with their relative negative control, except for locations 4 and 5. (P<0.05)The most frequently contaminated location was location #2 (30%) followed by Location 1 (26%), and then location 8 (22%). (P<0.05)

Conclusion:

Bacterial contamination of the drape was found to be common (70% of cases) after foot and ankle surgery. Contamination was more common on the superior and inferior aspects of the mini c-arm. This correlates to the area that is most commonly manipulated by the surgical team to position the arms of the c-arm. This information can be utilized by surgeons to identify and avoid high risk areas and, in high risk cases, they may consider changing gloves or re-draping the mini c-arm part way through the case.
Relationship Of Press Ganey® Satisfaction and Promis Function and Pain in Foot and Ankle Patients
Authors: Nixon Devon C. , Zhang Chong , Weinberg Maxwell , Presson Angela , Nickisch Florian
Published: November 2020

Category:

Other

Introduction/Purpose:

Patient satisfaction has garnered interest as a tool to measure healthcare quality. The Press Ganey (PG) instrument was designed to assess outpatient patient satisfaction by probing multiple domains of the patient experience including clinic wait-times and overall assessment of the provider practice. However, orthopaedic studies in total joint arthroplasty, spine, and hand patients have offered conflicting relationships between PG satisfaction metrics and patient-reported outcome (PRO) measures. No prior study has assessed the relationship between PG and PROs in foot and ankle patients. Here, we tested if there was an association between PROMIS outcomes and PG satisfaction scores.

Methods:

Between 2015 and 2017, new patient visits to orthopedic foot and ankle clinics at a single academic center were retrospectively analyzed. Patients that completed PG satisfaction surveys were included for study. All patients who completed PG surveys had completed either one or both of the PROMIS physical function (PF) or pain interference (PI) metrics administered by computerized adaptive testing. Negative binomial regressions were used to compare PRO scores to PG overall satisfaction and PG satisfaction with care provider, adjusting for patient characteristics. Results were reported as dissatisfaction score ratios along with 95% confidence intervals (CIs) and P-values.

Results:

Out of 3,984 new patient visits, only 441 completed the PG survey (11.3% response rate). Ceiling effects were seen with PG data as 64% of our patients reported perfect satisfaction with care provider and 27% had perfect overall satisfaction. Higher function on the PROMIS PF was weakly associated with increased overall satisfaction (Ratio=0.82, 95% CI: 0.68-0.99, P=0.039) and increased satisfaction with care provider (Ratio=0.60, 95% CI: 0.40-0.92, P=0.019). However, pain (PROMIS PI) was not associated with overall satisfaction or with satisfaction with care provider.

Conclusion:

Patient satisfaction was weakly related to patient-reported function but not pain among new foot and ankle clinic patients. It appears from our data that PG and PROMIS measure differing components of patient care. Further, our findings showcase the limitations of the PG tool including low response rates and notable ceiling effects. Until we achieve a broader understanding of the relationship between patient satisfaction and clinical and surgical outcomes, we would caution against the use of PG data in the assessment of quality of care and reimbursement for orthopaedic foot and ankle surgery. [Table: see text]
The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
Authors: Reb Christopher W. , Haupt Edward T. , Berlet Gregory C.
Published: November 2020

Category:

Trauma; Other

Introduction/Purpose:

Knee flexion has been demonstrated to impede popliteal venous return with large effect size among patients lying supine for surgery. Passive popliteal flow impedance has also been suggested to occur with knee scooter usage due to knee flexion. This study compared the effect of knee flexion angles on popliteal venous return between upright, crutch and knee scooter positioning when immobilized. Further, the countervailing effect of standardized hallux musculovenous pump activation was observed.

Methods:

This was an IRB approved study of young, healthy volunteers. Popliteal venous diameter and flow metrics were assessed with venous ultrasonography and compared between straight leg, crutch, and knee scooter positioning while wearing a walking boot and nonweightbearing. Flow was assessed with muscles at rest and with hallux musculovenous pump activation via active oscillation between hallux metatarsophalangeal joint extension and flexion at one motion per second (0.5 Hz) as paced by a metronome. Observer consistency was assessed. Paired-sample Student’s t-test and the Wilcoxon signed rank tests were used to assess within-subject differences for diameter and venous flow parameters, respectively. Knee flexion and musculovenous pump activation effects sizes were calculated. A priori sample size indicated 24 subjects were needed to achieve 80% power to detect a significant ( p < 0.006 ) difference in medial flow for any of 8 comparisons, assuming large effect sizes.

Results:

16 of 24 (67%) subjects were female. Twelve limbs (50%) were right sided. The mean age was 21.9 years (SD 3.0 years) and the mean body mass index was 21.9 (SD 1.9). Observer consistencies were excellent (0.93 to 0.99). No significant differences in mean vessel diameter, time-averaged mean velocity, and total volume flow occurred. Corresponding knee flexion effect sizes were small (range -0.04 to -0.26). A significant decrease (-24%) in active median time-averaged peak velocity (TAPV) occurred between upright and crutch position (20.89 cm/s vs. 15.92 cm/s, p < 0.001) with a medium effect size (-0.51). Hallux musculovenous pump increased all flow parameters (all p< 0.001) and effect sizes were comparatively larger (>0.6) across all knee flexion positions.

Conclusion:

Compared to values reported for supine individuals, upright passive popliteal venous return was observed to be markedly diminished at all knee flexion angles. Knee flexion had minimal effect on diameter, a small effect in further diminishing TAMV and TVF and a medium effect on diminishing TAPV. Hallux musculovenous pump activiation had a large effect on increasing flow at all knee flexion angles. Patients may well be counseled to use toe motion to counter the negative effects of gravity, and to a lesser extent knee flexion, when using crutches and knee scooters while their ankle is immobilized.
Percutaneous Chevron Akin (Peca) Osteotomy for Treatment of Hallux Valgus Deformity: The Long- Term Results
Authors: Robinson Peter W. , Ray Robbie , Goff Thomas A. , Dearden Paul M. , Watt Clare , Smith Margaret , Lam Peter
Published: November 2020

Category:

Bunion

Introduction/Purpose:

Little is known about the long-term results of percutaneous hallux valgus correction, particularly the recurrence rate and factors leading to recurrence.

Methods:

We retrospectively reviewed a single surgeon consecutive series of percutaneous chevron and akin osteotomies (PECA) performed between 2012-14 on 127 feet in 86 patients. Mean age was 52+-13 years at surgery and mean follow up (FU) was 69+-7 months. Patient reported outcome measures (PROMs) were completed by 65 patients (MOXFQ, VAS pain (0-100)) and Likert satisfaction scale by 86 patients. Pre-operative, 6 month and final follow up weight bearing radiographs were available for 68 feet. Radiological parameters measured were the hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA). The data was normally distributed and presented as mean+-SD. Paired t-test was used to compare pre- and post-operative angles. Ordinal logistic regression was used to test for significant dependent variables on PROMs.

Results:

Mean MOXFQ was 10+-16 and mean VAS pain was 6+-13 out of 100 at a mean FU of 69+-7 months. 99% (85/86) patients were highly satisfied or satisfied. Mean HVA improved from 28.3+-8.1º to 8.4+-5.6º at final FU (p<0.001). No clinically relevant difference in HVA was seen between 6 months and final FU. Mean IMA improved from 12.7+-2.9º to 6.2+-2.7º at final FU (p<0.001). 2.9% (2/68) had an HVA >20º at final FU, these both started with a pre-operative HVA >40°. Pre-operative HVA >40º was significantly more likely to have an HVA >20º at final FU than those with pre-operative HVA <40º (22% vs 0%, p<0.001). There were 5 re-operations for removal of screws. 1 foot had hallux varus, but was still satisfied.

Conclusion:

The 5 year results for PECA hallux valgus correction show high levels of patient satisfaction, function and pain relief, with low complication and re-operation rates. Radiological correction is maintained at long term FU.