bluuebunny/crossref_metadata_2025 huggingface dataset:
Transformation of a war journalist profession: The case of the full-scale Russo–Ukrainian conflict
Authors: Węglińska Agnieszka , Seklecka Aleksandra , Peszyński Wojciech , Węgliński Bogusław
Published: December 2024

The Russo–Ukrainian (RU) conflict serves to illustrate the vital role of modern technological tools which are employed on a wide scale by journalists, military personnel and civilians. The internet and social media have had an impact on the work of war journalists, as evidenced by the example of the ongoing war in Ukraine. Journalists reporting on this war have had to adapt to these changes. Therefore, this research investigated the development of the work of war correspondents. The authors conducted 18 in-depth interviews with reporters and journalists covering the RU war with previous experience in work in a war zone. This methodological approach aimed to achieve three research objectives: (1) to demonstrate the changes that have occurred in war coverage; (2) to compare the work of journalists from various editorial offices; and (3) to present the characteristics of contemporary journalists covering the war. The research conclusions indicate a clear evolution of the profession of a war journalist. Recent changes have resulted in improvements in certain areas compared to previous circumstances. Nonetheless, they have also led to a deterioration of working conditions in other fields.
Building a Diabetes Educator Program for Remote Patient Monitoring Billing
Authors: Bishop Franziska K. , Chmielewski Annette , Leverenz Jeannine , Lin Shannon , Conrad Barry , Martinez-Singh Anjoli , Pike Laura , Scheinker David , Prahalad Priya , Maahs David M.
Published: December 2024

Objective:

Develop workflows and billing processes for a Certified Diabetes Care and Education Specialist (CDCES)-led remote patient monitoring (RPM) program to transition the Teamwork, Targets, Technology, and Tight Control (4T) Study to our clinic’s standard of care.

Methods:

We identified stakeholders within a pediatric endocrinology clinic (hospital compliance, billing specialists, and clinical informatics) to identify, discuss, and approve billing codes and workflow. The group evaluated billing code stipulations, such as the timing of continuous glucose monitor (CGM) interpretation, scope of work, providers’ licensing, and electronic health record (EHR) documentation to meet billing compliance standards. We developed a CDCES workflow for asynchronous CGM interpretation and intervention and initiated an RPM billing pilot.

Results:

We built a workflow for CGM interpretation (billing code: 95251) with the CDCES as the service provider. The workflow includes data review, patient communications, and documentation. Over the first month of the pilot, RPM billing codes were submitted for 52 patients. The average reimbursement rate was $110.33 for commercial insurance (60% of patients) and $46.95 for public insurance (40% of patients) per code occurrence.

Conclusions:

Continuous involvement of CDCES and hospital stakeholders was essential to operationalize all relevant aspects of clinical care, workflows, compliance, documentation, and billing. CGM interpretation with RPM billing allows CDCES to work at the top of their licensing credential, increase clinical care touch points, and provide a business case for expansion. As evidence of the clinical benefits of RPM increases, the processes developed here may facilitate broader adoption of revenue-generating CDCES-led care to fund RPM.
Surgical Management of Moderate to Severe Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Meta-Analysis
Authors: Benaim Ezer H. , Kallenberger Ethan M. , Mirmozaffari Yasine , Klatt-Cromwell Cristine , Ebert Charles S. , Kimple Adam J. , Senior Brent A. , Kasthuri Raj S. , Thorp Brian D.
Published: December 2024

Background

Epistaxis is one of the most common and debilitating symptoms of hereditary hemorrhagic telangiectasia (HHT), significantly impacting patients’ quality of life. While various medical and surgical interventions exist for managing epistaxis in patients with HHT, patients with moderate to severe epistaxis are high health-care utilizers who frequently need surgical treatment.

Objective

To compare the efficacy, complications, and patient-reported outcomes for common surgical interventions utilized in treating epistaxis in patients with HHT

Methods

Studies were identified in PubMed, Embase, Scopus, Redalyc, and LILACS databases and uploaded to Covidence. A systematic review following PRISMA guidelines was conducted on studies evaluating outcomes in adults with HHT with moderate to severe epistaxis who had undergone surgical interventions. We compared the respective outcomes for pre-operative and post-operative epistaxis severity/intensity, need for further interventions or transfusions, estimated blood loss, length of surgery, complications, and patient satisfaction.

Results

Twenty studies with a total of 546 patients were included. The most common surgeries studied were nasal closure and laser photocoagulation. Seven studies recorded the change in epistaxis severity score and observed a significant reduction postoperatively (3.91, [95% CI 2.73-5.09]). Eleven studies found a decrease in the number of transfusions and a rise in hemoglobin levels post-operatively. Common complications reported were partial dehiscence of a nasal closure, septal perforation, and continued bleeding requiring re-operation. Most patients report improved quality of life and satisfaction with surgical intervention.

Conclusion

Surgery can significantly reduce the severity of epistaxis in patients with HHT and improve quality of life. Further studies should focus on head-to-head comparisons of procedures and standardization of outcome measures.
Effect of Dairy Farm Supervisor Leadership Training on Workplace Safety Climate
Authors: Douphrate David I. , Rodriguez Anabel , Kines Pete , Hossein Javid Amir
Published: December 2024

Background: Assessment of workplace safety climate is a recognized approach to assess safe culture in an organization. We developed, implemented, and evaluated a 12-module safety leadership and management e-learning training program tailored for front-line dairy farm supervisors and hypothesized that such a training program would have a positive effect on occupational safety climate. Methods: We enrolled 103 dairy farm supervisors from 35 U.S. farms to participate in a 12-module dairy leadership training program. We assessed safety climate change among supervisors and their workers using a pre-post training intervention methodology. A 24-item, 8-factor safety climate survey was developed and completed pre- and post-training by 65 supervisors and 313 (pre) and 238 (post) workers under their supervision. Findings: Significant improvements were seen on the 14-item supervisor safety climate scale, the 10-item group safety climate scale, and subscales regarding safety priority, empowerment, and dealing with conflicts. No significant improvements were seen for the factor regarding leaders encouraging workers to report safety incidents, as these were already rated highly. Conclusions: Findings suggest safety leadership e-learning training among dairy farm supervisors can result in positive safety climate change among supervisors and subordinate workers. Application to Practice: This study provides a framework for researchers, safety professionals, and training developers for the successful implementation of a safety leadership training program, and its effect on safety climate. Additional research is needed on the effectiveness and sustainability of safety leadership training in high-risk industrial sectors such as agriculture.
Patient Insights on Integrating Sleep Apnea Testing into Routine Stroke and TIA Care
Authors: Rattray Nicholas A. , Story K. Maya , Burrone Laura , Sexson Ali E. , Koo Brian B. , Bravata Dawn M. , Perkins Anthony J. , Myers Laura , Daggy Joanne K. , Taylor Stanley E. , Fields Barry G. , Kunisaki Ken M. , Daley Joseph , Palacio Santiago , Hermann Lisa D. , Sico Jason J.
Published: December 2024

AHA/ASA guidelines recommend patients with ischemic stroke or transient ischemic attack (TIA) be considered for obstructive sleep apnea (OSA) evaluation, given the high prevalence of OSA and improved outcomes for cerebrovascular disease when OSA is treated. However, OSA testing has not been incorporated into routine cerebrovascular management. We interviewed 30 patients hospitalized for acute stroke/TIA at six Veterans Affairs facilities participating in a stepped-wedge implementation trial to improve timely OSA testing after stroke/TIA. Thematic analysis of semi-structured interviews explored the experiences of care received, sleep testing, and education about the association between OSA and cerebrovascular disease. Patients perceived OSA testing as an integrated component of stroke/TIA care and reported few barriers to OSA testing. Patients had limited recall of details concerning sleep testing during hospitalization and education about OSA but expressed preferences about the timing, setting, and importance of caregiver participation. Patients expressed high levels of acceptance of sleep testing as a routine part of cerebrovascular care. Facilities could use these results to implement guideline-concordant screening for OSA, post-stroke/TIA.
Hypertension, intracranial arteriosclerosis, and structural brain changes in patients with TIA or ischemic stroke
Authors: Li Xi , Berghout Bernhard P , van Rooijen Gijs , Ikram Mohammad Kamran , Roozenbeek Bob , Bos Daniel
Published: December 2024

Introduction:

Hypertension is a major risk factor of structural brain changes, including atrophy and cerebral small vessel disease. Intracranial arteriosclerosis could be an underlying mechanism between hypertension and structural brain changes. This study investigated whether intracranial carotid artery calcification (ICAC), as a proxy for intracranial arteriosclerosis, explains the association between hypertension and structural brain changes in patients with TIA or ischemic stroke.

Patients and methods:

About 968 patients (mean age 62.7 years) with TIA or ischemic stroke from a registry who underwent non-contrast CT (NCCT) and CT-angiography (CTA) were included in this study. Presence and volume (mm3) of ICAC were assessed on CTA. Subtypes of ICAC were assessed on NCCT, where ICAC was categorized into intimal and internal elastic lamina (IEL) type calcification. Structural brain changes, indicated by atrophy, periventricular and deep white matter lesions (WML), and lacunes were assessed on NCCT. Mediation analysis was performed using ICAC, ICAC volume, and ICAC subtypes as mediators.

Results:

ICAC was prevalent in 67.8% of patients, with 52.6% of them exhibiting intimal calcification, and 26.5% exhibiting IEL calcification. Atrophy, periventricular WML, deep WML, and lacunes were present in 48.1%, 56.4%, 43.0% and 17.1% of patients respectively. The presence of ICAC explained 7.1% of the association of hypertension with periventricular WML, 3.6% with deep WML, and 17.6% with lacunes. Hypertension was associated with increased atrophy through ICAC (OR: 1.02, 95% CI: 1.00–1.05). In subgroup analyses, IEL calcification partly explained the association between hypertension and periventricular WML (16.8%), and atrophy (OR: 1.12, 95% CI: 1.02–1.27). Intimal calcification did not explain any association.

Conclusion:

ICAC partially explained the association between hypertension and atrophy, periventricular and deep WML, and lacunes. Although intimal calcification was more prevalent in ischemic stroke patients, IEL calcification takes the leading role in explaining the association between hypertension and structural brain changes.
Risk Factors for Early Major Amputation in the First Diabetic Forefoot Amputation
Authors: Seo JaeHyeon , Lee HoSeong , Choi YoungRak , Shin MyoungYeol
Published: December 2024

Category:

Diabetes; Other

Introduction/Purpose:

Subsequent major amputations within 1 year after initial forefoot amputations are sometimes necessary when other options for saving the foot are unavailable. Risk factors for early major amputation should be analyzed for a successful limb salvage strategy. This study aimed to analyze the risk factors for early major amputation after initial diabetic forefoot amputation.

Methods:

In this retrospective cohort study, clinically important variables of 808 first diabetic forefoot amputations were analyzed. Major amputations were performed in 104 patients (12.9%) throughout follow-up, and 77 (74%) of 104 patients had their major amputation within l year. Cox proportional hazards were examined to assess the risk factors for major amputation performed within 1 year.

Results:

In univariate analysis, 19 possible risk factors significantly differed between patients with and without early major amputation. In stepwise multivariable analysis, age, body weight, chronic renal failure (CRF), intermediate column amputation level, and C-reactive protein (CRP; mg/dl) level significantly differed. CRF showed the largest hazard ratio (HR) for early major amputation: 4.538 (95% confidence interval: 2.667-7.723, p-value < 0.0001). Age, weight, intermediate column amputation level, and CRP level had relatively low HRs: 1.032, 0.968, 1.367, and 1.078, respectively.

Conclusion:

CRF was a strong independent risk factor for early major amputation in the first diabetic forefoot amputation. Furthermore, patients with CRF underwent earlier and more major amputations throughout their follow-up. Before the surgical treatment, patients with CRF should be educated in terms of the high probability (>20%) of early major amputation.
Safety and Efficacy of One vs Two Incision Broström Gould with Calcaneal Osteotomy and Peroneal Tendon Debridement Surgery
Authors: Bernstein Marc , Shah Ashish , Scheinberg Mila
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

Ankle sprains are a common musculoskeletal injury, and a substantial proportion of patients develop chronic ankle instability (CAI). Surgical intervention, such as the Broström-Gould (BG) procedure, is typically indicated for treatment. We are comparing the safety and efficacy between the BG with peroneal tendon debridement repair, a sliding lateralizing calcaneal osteotomy and additional adjuvant procedures performed with a single- versus double-incision approach. In this study, we aim to identify if a less invasive, single-incision procedure may result in decreased risk of wound complication and improved patient reported outcomes.

Methods:

Our retrospective analysis included patients who underwent the procedure of interest between 2011 and 2020. Patients were divided into two groups: undergoing either a one-incision (n=53) or a two-incision approach (n=47), both with a lateralizing calcaneal osteotomy. Demographics, complications, and PROMIS scores were collected. Statistical analysis was performed.

Results:

Initially, 264 patients were identified, and following application of our inclusion and exclusion criteria, 100 patients remained for the study. Most notably, a significant difference in skin bridge breakdown was observed between the two-incision (n = 6 (13%)) and one-incision groups (n = 0 (0%)). There were no significant differences in infection, deep wound dehiscence, nerve palsy, or neuroma between patients in the two groups. Furthermore, no statistically significant differences in mean PROMIS scores existed between the cohorts.

Conclusion:

The described modified technique BG procedure shows promise for treating CAI. While patients in both single- and double-incision groups had similar rates of postoperative complications, the decreased incidence of skin bridge breakdown in the one-incision group highlights the approach’s safety and potential benefits in reducing wound-related complications. Our research contributes valuable insights into foot and ankle surgery, offering an innovative option for patients with chronic ankle instability and potentially enhancing patient care in the management of this condition.
Safety and Exposure Area in Three Different Posteromedial Surgical Approaches for the Treatment of Ankle Fractures. A Cadaveric Study
Authors: Filippi Jorge , Palma Joaquin , Morales Sergio , Urrutia Tomas
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Posterior malleolar fractures, are common in ankle injuries. Open reduction and internal fixation show better outcomes, particularly with direct reduction. While posterolateral fractures can be managed through a posterolateral approach, the optimal approach for large posterior and posteromedial fractures is uncertain. Different posteromedial approaches exist, but concerns persist about soft tissue dissection and posteromedial neurovascular bundle (NVB) safety. This study compares three posteromedial approaches — posteromedial (PM), Modified posteromedial (MoPM), and medial posteromedial (MePM) — measuring posterior malleolar visualization, distance to the neurovascular bundle, and tension. Results aim to compare them regarding bone exposure and safety to the posteromedial NVB.

Methods:

We used 12 cadaveric pieces and evaluated the following approaches: PM: longitudinal incision immediately parallel to the medial border of the Achilles tendon. The FHL fascia was opened and the FHL retracted laterally. MoPM longitudinal incision halfway between the posteromedial tibia's edge and the Achilles tendon's medial edge. The PTT was mobilized medially and the FDL laterally. MePM longitudinal incision along the posteromedial edge of the tibia. The i PTT tendon was retracted posteriorly and elevated Measurements included minimal tension on the posteromedial (NVB) flap, distance from the incision to the NVB, and percentage of malleolar exposure. Tension was gauged using a digital strain gauge on a Langenbeck retractor, while exposure was determined by marking bone edges and measuring medial-to-lateral length. Distribution of the data was assessed by the t-test. A one-way repeated measures ANOVA was conducted, when a significant difference was detected, the post hoc Tukey test was applied.

Results:

There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV, favoring the PM approach (71,00% ±1.83 and 25.50 mm ±4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ±1.28) compared to the other two approaches.

Conclusion:

The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choice for large fractures of the posteromedial aspect of the PM.
Short Term Adverse Events Following Ankle Arthroplasty and Ankle Arthrodesis: A Matched Analysis of Recent Nationally-Representative Data
Authors: Hopper Haleigh , Nelson Chase , Satalich James , Anastasio Albert T. , O'Neill Conor N. , Patel Tejas , Hanselman Andrew , Schweitzer Karl M. , Adams Samuel B.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Surgical management of ankle osteoarthritis (AOA) includes Ankle Arthrodesis (AA) or Total Ankle Arthroplasty (TAA). Existing literature has been inconclusive regarding a clear standard of treatment for AOA. The purpose of this study was to analyze data from the National Surgical Quality Improvement Project (NSQIP) to elucidate differences in outcomes between TAA and AA.

Methods:

Patients who underwent TAA or AA from January 2010 to December 2020 in the NSQIP database were included in this analysis. All patients were followed for at least 30 days following surgery. The independent variable was procedure type: AA or TAA. The dependent variables were complications. Independent sample t-tests and chi square tests were used to determine if there was a difference between groups. A binary logistic regression was performed to determine the odds ratio (OR) and 95% confidence intervals.

Results:

The matched cohorts included 359 patients in the arthroplasty group (57.2±13.3 years, 56.8% male, 33.0±7.3 kg/m 2 ) and 359 patients in the arthrodesis group (57.4±13.9 years, 58.5% male, 32.7±7.9 kg/m 2 ). There was an increase in transfusions, UTI, and return to the operating room in the arthrodesis group compared to the arthroplasty group (1.95%, 0.28%, p=0.038; 1.11%, 0.00%, p=0.045, 3.90%, 1.11%, p=0.017). The multivariate regression revealed that length of hospital stay (OR = 1.157) and insulin dependent diabetes (OR = 6.043) had an increased risk of any adverse event.

Conclusion:

The overall rate of any adverse event for ankle arthroplasty or arthrodesis was relatively low at 4.18% in the 30-day postoperative period. There was no adverse event that reached statistical significance, that was more likely in the TAA group compared to the AA group. Identification of these complication rates after TAA and AA, along with patient risk factors for adverse events can assist surgeons and patients in their choice of treatment for AOA.
Short Term Outcomes Utilizing Custom Total Talus Replacement with Subtalar Arthrodesis for Revision and Complex Total Ankle Arthroplasty
Authors: Horner Kevin , Schweser Kyle M.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) in the setting of talar avascular necrosis (AVN) is a challenging problem and is often a contraindication for revision or primary TAA. However, 3D custom talar replacements offer a potential solution to this problem and has been shown to re-establish the normal alignment of the foot, preserve motion (with some achieving almost physiologic motion), and allow for almost normal ambulation. We performed this study to assess the short-term outcomes of 3D printed total talus replacements (TTRs) for revision TAA in the setting of talus AVN or collapse of the talar implant, or primary TAA in the setting of pre-existing talar AVN. Our hypothesis is that custom 3D printed talar body replacements lead to good outcome scores and patient satisfaction scores.

Methods:

We performed a retrospective chart review on 8 patients (9 TTRs) who underwent a TTR at our institution between May 2019 and October 2023. Initial data query yielded 14 patients (15 TTRs), TTR for acute trauma were excluded (n=6). All TTRs (9/9; 100%) had an associated subtalar ingrowth stem and were performed in conjunction with a primary TAA (5/9) or implanted in the setting of a previous TAA (4/9). One TTR had a talonavicular ingrowth surface. Patients included in this study had at least 12-week follow-up. Patient reported outcome measures (PROMs) included AAOS Foot and Ankle Questionnaire and visual analog scale (VAS) pain scores. Range of motion and 10-meter walking speed were evaluated.

Results:

Mean length of follow-up was 1.4 years. All patients achieved subtalar arthrodesis. Mean VAS score was 3 (range: 2-4) post-operatively. Average Foot and Ankle Core Standardized Mean was 70.5 (range: 52.2 - 93.6). Mean Shoe Comfort Standardized Mean was 64.5 (range: 40 – 88). Mean time to walk 10 meters post-operatively was 8.75 seconds (range: 6.2 – 10.4). Mean ankle dorsiflexion was 4.4° and plantarflexion was 23°. Three (3/9; 33%) TTRs had unplanned return to the operating room. The TTR with the talonavicular ingrowth stem went onto symptomatic nonunion of the TN joint requiring revision talonavicular fusion. Two TTRs had surgical wound dehiscence, one of which necessitated a radial forearm free fasciocutaneous flap but none had positive synovial fluid cultures, both were smokers.

Conclusion:

TTR for primary or revision TAA offers good outcomes and should be considered for patients presenting with a failed TAA or talar AVN with associated tibiotalar arthritis. Patient selection is important, as is education. This study adds to the current limited data on the use of 3D custom talar implants for revision and complex TAA and is the only one to the authors knowledge presenting data concerning concurrent subtalar arthrodesis utilizing on growth surfaces.
Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review
Authors: Butler James J. , Calton Megan , Manjunath Amit , Mener Amanda , Rosenbaum Andrew , Mulligan Michael , Samsonov Alan P. , Kennedy John G.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Social determinants of health (SDOH) encompass environmental, institutional, and intrinsic conditions that can influence an individual's access to and utilization of healthcare over their lifespan. While SDOH effects are linked to disparities in patient-reported outcomes post hip and knee arthroplasty, their impact on total ankle arthroplasty (TAA) remains unclear. This study sought to examine how SDOH factors affect access to appropriate orthopedic treatment and their repercussions on patient-reported outcomes following TAA.

Methods:

In January 2024, a systematic review of the PubMed, Embase and the Cochrane Library was conducted to identify studies reporting at least 1 SDOH and its effect on access to health care, clinical outcomes, or patient-reported outcomes following TAA.

Results:

Fifty-eight studies, involving 212,944 patients, were analyzed. The INBONE system emerged as the most utilized Total Ankle Arthroplasty (TAA) system. Factors contributing to healthcare access delays included female gender, advanced age, worker's compensation claims, comorbidities, tobacco use, federally subsidized insurance, lower education, racial/ethnic minority status, low-income residence, low-volume surgery regions, unemployment, and preoperative narcotic use. Black patients experienced significantly worse postoperative clinical and patient-reported outcomes, along with heightened pain following TAA. Lower education level independently predicted poor surgical and patient-reported outcomes, increased pain, and lower patient satisfaction. Moreover, patients with federally subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes.

Conclusion:

The impediments created by SDOH lead to worse clinical and patient-reported outcomes following TAA including increased risk of postoperative complications, TAA failure, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.
Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): Five-Year Prospective Results of a Novel Press-Fit Surgical Technique for Large, Complex Osteochondral Lesions of the Talus
Authors: Hollander Julian , Dahmen Jari , Stufkens Sjoerd , M.M.J. Kerkhoffs Gino M
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Osteochondral lesions of the talus (OLT) are lesions that affect both the articular cartilage and underlying subchondral bone that often arise after trauma. Large OLTs may be treated using osteochondral autografts, for example from the ipsilateral knee. This, however, often results in donor site morbidity. Moreover, the cylindric nature of the osteochondral grafts does not allow for a perfect fit for the defect. The novel technique Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) overcomes these challenges by using an osteoperiosteal autograft of the ipsilateral iliac crest. The aim of the present study is to prospectively evaluate the clinical, radiological and safety outcomes after 5 years of follow-up for patients who underwent the new TOPIC procedure for an OLT.

Methods:

A prospective cohort study of patients who underwent the TOPIC procedure was conducted. The primary outcome was the Numeric Rating Scale (NRS) of pain during walking. Other clinical outcomes included the NRS during rest and stair climbing, the Foot and Ankle Outcome Score (FAOS) and the Mental Component Score (MCS) and Physical Component Score (PCS) of the Short Form-36 (SF-36). In addition, the AOFAS ankle-hindfoot score was measured. All clinical outcomes were measured preoperatively and after 6 months, 1 year, 2 years and 5 years of follow-up. Computed tomography (CT) scans were performed preoperatively and postoperatively at 12 weeks, 1 year, 2 years and 5 years to assess osteotomy union, graft consolidation and graft cyst development. In addition, complications and hardware removal were evaluated.

Results:

36 patients (current data is 29pt; expected to be complete at congress) were assessed, and no patient were lost to follow-up. The NRS of pain during walking improved from 6.5 [5-8] preoperatively to 2 [1-3] at 5-year follow-up (p < 0.001). The NRS during rest and stair climbing improved with 2 (p = 0.002) and 4 points (p < 0.001), respectively. All FAOS subscales improved significantly. The SF-36 PCS improved (32 to 35; p = 0.059) and the MCS improved (39 to 47; p < 0.001). The AOFAS improved from 52 to 90 (p < 0.001). There was 100% union at the osteotomy site after 12 weeks and 100% of the graft showed consolidation at 1, 2 and 5 years postoperatively. No major complications occurred.

Conclusion:

The TOPIC procedure is an effective treatment option for large osteochondral lesions of the talus, with durable results after 5 years of follow-up. A significant improvement in clinical outcomes was observed, with excellent radiological results. No major complications were recorded.
The Association of Social Determinants of Health and Patient-Reported Outcomes In Patients with Surgical Treatment of Osteochondral Lesion of the Talus
Authors: Ullmann Henri , Ashkani-Esfahani Soheil , Ebrahimi Alireza , Ranganathan Noopur , Bejarano-Pineda Lorena , Kwon John Y. , Guss Daniel , M.M.J. Kerkhoffs Gino M , DiGiovanni Christopher W. , Waryasz Gregory
Published: December 2024

Category:

Ankle; Sports

Introduction/Purpose:

Osteochondral lesions of the talus (OLT) commonly arise after chronic ankle sprains and fractures. Conservative treatment is the first step, yet surgical intervention is often warranted in patients with persistent symptoms. The effect of social determinants of health (SDOH) on treatment outcomes of this patient population has rarely been investigated to date.

Methods:

Patients with OLT who were 18 years of age and older and underwent operative treatment, with at least one patient-reported outcome and SDOH data available, were included. Patient-Reported Outcome Measures (PROMs) and Visual Analog Scale (VAS) pain scores were collected, and their trends were analyzed based on the patients’ SDOH, including Area DeprivationIndex(ADI)andSocialVulnerabilityIndex(SVI). Pre-operativePROMsorVAS pain scores had to have been collected within 90 days of surgery, immediate post-operative PROMs or VAS scores were recorded within 90 days of surgery were and post-operative PROMs or VAS scores within 180 days (± 30 days). Exclusion criteria were presence of concomitant pathologies such as fractures, bone lesions, cysts, foot and ankle deformities, presence of hardware, and lack of follow-up visits and lack of any patient reported outcomes in their profile. A P-value < 0.5 was considered statistically significant.

Results:

109 of 551 confirmed patients with OLT met the inclusion criteria. Significant correlations were found between SDOH and PROMs, elucidating disparities in pain scores, physical function, and depression. A multitude of SVI components, but most profoundly overall SVI, and ADI rank, were found to be significantly correlated to VAS pain scores (Table 1.). Furthermore, insurance status showed a significant impact on pain intensity and depression measures. Nuanced influences of race, insurance status, and social vulnerability were observed.

Conclusion:

This study shows that SDOH have a significant effect on postoperative PROMs and VAS scores. Based on our results, these most prominently include overall SVI, insurance status, ethnicity, and race. Systemic interventions guided by neighborhood-level measures of disadvantage are key in advancing health equity.
The Efficacy of Polyhexamethylene Biguanide (PHMB) with Negative Pressure Wound Therapy in Open Diabetic Foot Amputation
Authors: Ahn Jiyong , Ranganathan Noopur , Jung Jaewoong , Waryasz Gregory R. , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil , Bejarano-Pineda Lorena
Published: December 2024

Category:

Diabetes; Midfoot/Forefoot

Introduction/Purpose:

The therapeutic efficacy of negative pressure wound therapy (NPWT) in treating skin defects in diabetic foot ulcers has been demonstrated, although the management of bacterial biofilms remains controversial. Limited clinical data exist on outcomes when utilizing polyhexamethylene biguanide (PHMB) alongside NPWT. This study aims to assess the efficacy of PHMB in diabetic foot ulcers compared to conventional methods during NPWT.

Methods:

After receiving IRB approval from a single center Korean institution, sixty patients with Wagner 3 or 4 diabetic foot ulcers undergoing open amputation of forefoot and midfoot were included from March 2020 to August 2021. NPWT was administered at two-day intervals post-amputation by an expert surgeon affiliated with the institution. Patients were assigned to 3 different adjuvant therapies; 1) Saline; 2) povidone iodine; and 3) hydrochloric PHMB irrigation solutions. Bacterial cultures were performed, assessing time to negative bacterial culture. Wound analysis utilized a three-dimensional infrared camera (inSight®, eKare, Fairfax, VA, United States) to measure volume and area continuously and its correlation of risk factors.

Results:

Patients with hydrochloric PHMB therapy exhibited faster wound recovery rates in terms of volume and area compared to those treated with saline and povidone iodine solutions (p=0.001) (Figure 4 and 5). Hydrochloric PHMB and povidone iodine groups showed significantly shorter times to bacterial negativity compared to the saline group (p=0.001) (Figure 6). HbA1c, body mass index, dialysis status, age, smoking history, and diabetes duration did not significantly impact wound recovery rates.

Conclusion:

Hydrochloric PHMB with NPWT can be useful to treat open diabetic foot ulcers, with a high wound recovery rate and moderate antimicrobial efficacy, as the combination decreases wound toxicity and intermediate bactericidal effects in comparison to normal saline and povidone-iodine solutions.
The Kinematic Effect of Anatomic Deep Deltoid Ligament Stabilization in a Cadaveric Model of Syndesmotic Instability with Deep Deltoid Ligament Instability
Authors: Elghazy Mohamed Abdelaziz , Hajewski Christina , Duchman Kyle , Goetz Jessica , Femino John
Published: December 2024

Category:

Trauma; Sports

Introduction/Purpose:

The objective of this work was to investigate the utility of a suture augmented deep deltoid ligament (DDL) stabilization with different accepted treatments of distal tibiofibular syndesmosis injuries. We hypothesized that adding DDL stabilization would improve the rotational stability of the ankle. Also, that flexible syndesmotic stabilization using suture button fixation, AITFL suture stabilization, with DDL stabilization would restore the kinematics of an intact ankle most closely during external rotation stress (ERS).

Methods:

Ten matched pairs of through-the-knee cadaveric ankle specimens were mechanically tested in 5 Nm of ERS under 750 N of axial load. Specimens were tested intact, after transection of all the syndesmotic and deep deltoid ligaments and after each iteration of one of two stabilization sequences: 1) AITFL + suture button (SB) stabilization; AITFL+SB + DDL suture stabilization; syndesmotic screw with or without DDL stabilization; or 2) AITFL+SB+DDL; AITFL+SB; syndesmotic screw with or without DDL stabilization. Optical motion tracking was used to capture the kinematics of the tibia, fibula, and talus. CT scans of each specimen with markers were used to transform kinematic data into an anatomic coordinate system. Individual bony kinematics were extracted by decomposing the transformation matrices needed to align the starting test position to the ending test position and tracking points on the anterior medial and anterior lateral talus.

Results:

The average axial rotation of the talus was significantly increased after destabilization from 5.15 to 9.02 as compared to the intact state (P< 0.001). All the four fixation constructs reduced the axial rotation of the talus without significant difference when compared to intact (figure 1). Addition of DDL stabilization reduced the talar axial rotation with both screw and flexible stabilization. The axial plane translation direction changed from 16.22 degrees in intact stage to 53.21 after destabilization (P=0.044). The range of axial plane translation direction after all stabilizations was 35.02 to 44.43, however, they were not significantly different as compared to the intact state.

Conclusion:

DDL stabilization improved rotational stability of the talus. Although there were no significant changes in the axial plane translation direction of the talus after any stabilizations, there was a 19 to 28 degree difference as compared to the intact stage. This could be clinically significant over the course of years since the latency period of posttraumatic ankle arthritis is known to be approximately 20 years. The apparent over-tightening of both flexible and screw stabilization of syndesmosis with DDL stabilization should be thought of as time zero due to creep of flexible fixation that was observed at the conclusion of testing.
The Performance of Bio-Integrative Mineral-Fiber Reinforced Screws in a Load Bearing Osteotomy Model in Sheep
Authors: Netto Cesar de Cesar , Nyska Abraham , Rousselle Serge
Published: December 2024

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Injuries to weight-bearing bones can be detrimental to patient mobility, often requiring surgical intervention, as mechanical failure leads to non-union, joint stiffness, and compromised function. Metal implants are widely used for fracture fixation; however, stress concentration, irritation, and pain often result in hardware removal, driving the development of non-permanent implants, traditionally polymer-based. These, in turn, lack strength and may cause adverse inflammatory reactions. Thus, an unmet need exists for more robust, safely eliminated fixation devices. This study aimed to evaluate the performance of bio-integrative, mineral fiber-reinforced screws, currently utilized for multiple surgical procedures in Orthopedic Foot and Ankle Surgery, in an in vivo fully load-bearing distal femur fracture model in sheep.

Methods:

Five sheep were subjected to femur lateral condyle osteotomy. Fixation was performed using two 3.5mm fiber-reinforced compression screws made of mineral fibers comprised of elements found in native bone, bound by PLDLA [poly (L-lactide-co- D, L-lactide)]. Animals recovered to full load-bearing conditions. Micro CT and histopathology were performed at 26, 78, 104, and 130 weeks (W). Osteotomy healing, new bone formation, tissue ingrowth into the implant wall, and biocompatibility measures were evaluated.

Results:

All animals demonstrated uneventful recovery. Stable reduction was evident by optimal bone healing on imaging and histological evaluation. At 12 weeks, all sites demonstrated anatomical alignment and complete bone bridging across osteotomy sites, with no implant failure. Cellular response was dominated by anti-inflammatory M2 macrophages and multinucleated giant cells associated with the expected phagocytic response. Implant bio-integration was completed by 130W, with no material remaining and no adverse effects.

Conclusion:

Large animal models are considered benchmarks for the long-term effects of orthopedic implants due to their similarity to humans with respect to bone composition, dimensions, physiology, biomechanics, and remodeling. This fully load-bearing femoral osteotomy sheep model demonstrates the safe and effective use of bio-integrative implant technology, suggesting its applicability in various orthopedic foot and ankle indications.
The Presence of An Avulsion Fracture of the 1st Tarso-Metatarsal Joint in Lisfranc Injuries is a Useful Adjunct in Detecting 1st TMTJ Instability
Authors: Singh Prashant , Jones Neil , Malagelada Francesc , Patel Amit , Jeyaseelan Lucky
Published: December 2024

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Lisfranc fracture-dislocations are uncommon injuries that are often missed or diagnosed late. The consequences of this include post-traumatic osteoarthritis and deformity. Injuries with ligamentous involvement injuries often have avulsion fractures at the level of the tarso-metatarsal joint (TMTJ) on either plain radiographs or CT scan. A proportion of these will have a congruent TMTJ joint on initial imaging. However, it has been suggested that many of these patients will have an unstable TMTJ which requires stabilisation. The purpose of this study was to determine the relationship between the presence of an avulsion fracture on initial imaging and instability or incongruence of the first TMTJ.

Methods:

A prospectively maintained database of all Lisfranc fracture-dislocations presenting to our centre was collected. Initial plain radiographs and CT scans were analysed for the presence of 1st TMTJ avulsion fractures independently by two senior authors. Data were collected regarding the initial mechanism of injury, fracture classification (Myerson and Qenu). Injuries which were managed non-operatively were excluded from the study. All included cases were managed with examination under anaesthesia (EUA) and intra-operative screening with stress testing under image intensification prior to fixation or arthrodesis surgery. The rate of instability for each fracture classification type was also determined. The sensitivity and specificity of the presence of an avulsion fracture of the 1st TMTJ in detecting an unstable joint was determined.

Results:

153 patients with a Lisfranc injury were included. The mean age was 35.2 years, and 68% of patients were male. 99 injuries (64.7%) were identified as having an avulsion fracture at the level of the 1st TMJ on either plain radiographs or CT scan. Of these, 76.7% were found to have a congruent joint on XR or CT scan. 91.9% of patients with an avulsion fracture of the 1st TMTJ were found to have instability on EUA stress testing. Amongst the 54 patients who had no avulsion fracture, 23 (42.6%) demonstrated instability of the 1st TMTJ on EUA. The presence of an avulsion fracture of the 1st TMTJ had a sensitivity of 79.8% and a specificity of 79.5% in the detection of an unstable joint.

Conclusion:

The presence of an avulsion fracture of the 1st TMJ is highly suggestive of instability of the joint and may be a useful adjunct in assessment and decision making for Lisfranc injuries. This finding on pre-operative radiographs should alert clinicians to have a low threshold to perform further imaging in the form of CT scanning or EUA and dynamic stress testing of the 1st TMTJ. A high proportion of Lisfranc injuries without avulsion fractures have instability at the level of the 1st TMTJ, and therefore the absence of this finding does not provide a reliable indication of joint stability.
The Role of First Tarsometatarsal Joint Morphology and Instability in the Etiology of Hallux Valgus: A Case-Control Study
Authors: Zhang Ming-Zhu
Published: December 2024

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

The morphology of foot joints is believed to significantly impact the development of various foot disorders. The relationship of the first tarsometatarsal joint (TMT1) morphology and hallux valgus (HV) is not well understand, and the influence of TMT1 morphology on TMT1 instability has not been fully explored. This study aimed to investigate the TMT1 morphology and its potential correlation with HV and TMT1 instability.

Methods:

Weightbearing CT (WBCT) scans of 82 consecutive feet with hallux valgus and 79 controls were reviewed in this case-control study. Using Mimics software and WBCT scans, the three-dimensional (3D) models of TMT1 were constructed. The height of the TMT1 facet (FH), superior, middle, and inferior facet width (SFW, MFW, and IFW) were measured on anteroposterior view of the first metatarsal base. On the lateral view, the inferior lateral facet height and angle (ILFH and ILFA) were measured. TMT1 instability was evaluated using the TMT1 angle.

Results:

Compared with the control group, the HV group suggested significantly wider MFW (9.6mm in HV, 8.8mm in control), lower ILFH (1.7mm in HV, 2.5mm in control), smaller ILFA (17.7° in HV, 24.3° in control), and larger TMT1 angle (1.9° in HV, 0.9° in control) (All P < 0.05). No significant differences were found between the two groups in FH, SFW, and IFW (All P > 0.05). Four types of TMT1 (continuous-flat, separated-flat, continuous-protruded, and separated-protruded) were identified according to the TMT1 morphology. The continuous-flat type possessed significantly larger HVA, IMA and TMT1 angles compared with other types (All P < 0.001).

Conclusion:

This study suggests an association between TMT1 morphology and the severity of HV, and identifies four TMT1 types. Notably, the continuous-flat type is found to be associated with more severe HV and TMT1 instability.
The Unspoken Complication Following MIS Bunion Surgery
Authors: Genuth Gil
Published: December 2024

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Hallux valgus (HV) is a common orthopedic foot and ankle condition involving deformity and subsequent pain and dysfunction of the first ray. Surgical interventions, such as open and minimally invasive surgery (MIS), are frequently utilized if nonoperative management is insufficient . In recent years, MIS has been increasingly used and has been regarded as one of the most innovative surgical interventions for HV. As with all new surgical techniques complications can occur. The most common complications after MIS bunion surgery are infections and hardwear removal. Nonunion after MIS bunion correction can be surgically challenging. Recent publications report 1% of non-unions after MIS bunion correction. Despite this prevalence the orthopedic literature is lacking information about how to treat patients who have non-unions after MIS bunion surgeries.

Methods:

We would like to present our experience and treatment protocol for non- union after MIS bunion surgery. Treatment Protocol: 1. Nonunion definition- No signs or minimal signs on consecutive x-rays or CT scan of bony union at the osteotomy site 6 months or more after index MIS bunion surgery. 2. Rull out reversible causes for nonunion. 3. Surgery- An open surgery is performed. Removal of MIS screws, debridement and refreshing of the osteotomy site, adding bone graft (autologous/synthetic), fixing the nonunion site with a dorsal plate and a lag screw if needed. 4. Post op protocol- non-weight bearing for 2 weeks followed by 4 weeks of partial weight bearing in a post-op shoe. All patients receive Vit D supplements for 3 months after surgery. (1000 IU per day). 5. Follow up in clinic with x rays at 6 weeks, 3 months and 6 months after revision surgery.

Results:

We would present a case sereis of 6 cases of nonunions following MIS bunion surgery treated according to the presented treatment protocol and achieved full union 3 months after the revision surgery.

Conclusion:

Nonunion after MIS bunion correction can be surgically challenging. The suggested treatment protocol shows high union rates for revision cases.