bluuebunny/crossref_metadata_2025 huggingface dataset:
Cadaveric Evaluation of First Metatarsophalangeal Joint Preparation Using a 2.0 mm MIS Burr
Authors: Cooperman Steven R. , Christie Lauren , Smith Chad , Perkins Jacob , Brandao Roberto
Published: December 2024

Category:

Other; Bunion

Introduction/Purpose:

Minimally invasive techniques for foot and ankle procedures have gained popularity as an alternative to traditional open techniques, with proposed benefits including earlier weight-bearing, improved cosmesis, and decreased postoperative pain. The current study aimed to evaluate the efficacy of first metatarsophalangeal joint preparation using a minimally invasive burr while concurrently evaluating the risk of extensor hallucis longus tendon damage with this technique.

Methods:

Nine fresh, thawed cadaveric lower limbs were utilized for this investigation. A single, reproducible dorsomedial minimally invasive portal was created at the level of the first metatarsophalangeal joint, and a 2.0 mm burr was used to denude the cartilage for two minutes under fluoroscopic guidance. Digital calipers were used to measure the distance between the portal and the extensor hallucis longus tendon. The joints were then carefully disarticulated to evaluate the extent of cartilage debridement and surface area ratios were calculated.

Results:

Results identified an average distance of 7.13 mm between the portal and the extensor tendon, with minor partial damage occurring to the tendon in 1/9 specimens. The proximal phalanx and metatarsal head ratios averaged 0.76 and 0.75, respectively, indicating approximately 76% and 75% of the respective joints surfaces were denuded.

Conclusion:

This study demonstrates comparable cartilage debridement to traditional open techniques based on historical data. Results of this study suggest that first metatarsophalangeal joint preparation can be effectively achieved with the use of a minimally invasive burr technique with fluoroscopic assistance, with additional time and experience, with a low risk of injury to the extensor hallucis longus tendon.
Cohort Study on 5-Year Reoperation Rates: Total Ankle Arthroplasty and Ankle Arthrodesis in Patients with Prior Bariatric Surgery
Authors: Kubsad Sanjay , Kishan Arman , Bergstein Victoria E. , Fox Henry M. , Ficke James R. , Aiyer Amiethab A.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Obesity is an ongoing public health epidemic with wide-ranging implications for orthopaedic surgery. Bariatric surgery has been shown to be an effective method for weight reduction. This retrospective cohort study aimed to compare rates of reoperation between patients who underwent primary ankle arthrodesis (AA) and those who underwent total ankle arthroplasty (TAA) after undergoing bariatric surgery.

Methods:

Utilizing data from PearlDiver, patients who received primary AA or TAA with prior history of bariatric surgery to a cohort without prior bariatric surgery were retrospectively analyzed for reoperations. Both cohorts were propensity-matched based on age, sex and Charlson Comorbidity Index in a 1:4 ratio. Indications for reoperation included revision, prosthetic joint infection (PJI), hardware removal, adjacent joint fusion, and local open reduction internal fixation (ORIF). Kaplan-Meier survival analysis and hazard ratios were calculated for five years after the procedure.

Results:

Of the 801 patients with prior history of bariatric surgery, 519 (65%) underwent AA, while 282 (35%) underwent TAA. At 5 years post-operatively, patients who had undergone AA showed a higher incidence of adjacent joint fusion if they had prior history of bariatric surgery (Hazard ratio: 1.79, 95% Confidence Interval: 1.23 - 2.61, P-value < 0.001). No differences in reoperation rates were observed for PJI, hardware removal and ORIF. At 5 years, patients who had undergone TAA with history of bariatric surgery showed no difference in the incidence of revision, PJI, hardware removal, ORIF and adjacent joint fusion as compared to patients who underwent TAA with no history of bariatric surgery.

Conclusion:

Our findings suggest that patients undergoing primary TAA displayed comparable reoperation rates regardless of prior bariatric surgery history over a five-year post-procedure period. In contrast, patients undergoing primary AA exhibited an increased risk of adjacent joint fusions if they had history of bariatric surgery, although the rates of reoperation due to PJI, ORIF, and hardware removal remained comparable. Notably, our results do not position a prior history of bariatric surgery as a significant determinant in reoperation rates. These insights offer valuable guidance for orthopedic surgeons navigating the complexities of surgical interventions in the context of bariatric surgery.
Comparing the Use of Nitinol Compression Screws to Traditional Compression Screws in Foot and Ankle Surgery
Authors: Gauthier Chase , Guttman Anne , Anastasio Albert T. , Bakaes Yianni , Jackson J. Benjamin , Kaplan Jonathan , Schipper Oliver , Adams Samuel B. , Gonzalez Tyler
Published: December 2024

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Nitinol is a metal alloy with high elastic flexibility and shape memory characteristics, making it effective in orthopedic surgery. Although nitinol staples have shown similar efficacy to traditional implants for foot and ankle surgery, the literature is limited regarding nitinol screws. The purpose of this study is to determine whether there is a difference in outcomes and complications between nitinol screws and traditional screws used for foot and ankle surgery.

Methods:

A multicenter retrospective cohort study was conducted for patients who underwent a foot and ankle procedure utilizing traditional compression screws or nitinol compression screws, between February 1st, 2021, and July 1st, 2023. Demographic factors, type of implant, and outcomes were recorded. Student’s t-test and Wilcoxon rank sum test were used to compare continuous variables, while the chi-squared test was used to compare categorical variables.

Results:

A total of 163 patients were included in the study, with 106 patients treated with traditional screws and 58 treated with nitinol screws. There was no significant difference between those treated with nitinol screws and those treated with traditional screws in complication rate (8.6% vs 11.3%, P=0.78), non-union rate (5.2% vs 8.5%, P=0.54), revision surgeries (1.7% vs 2.8%, P=1), hardware removal (3.4% vs 11.3%, P=0.14), or 90-day hospital readmissions (0% vs 2.8%, P=0.55) for foot and ankle surgery.

Conclusion:

Our study found no difference in terms of complications or postoperative outcomes between those treated with nitinol screws and those treated with traditional screws for elective foot and ankle procedures. Our findings suggest that nitinol screws appear to be safe and effective for foot and ankle surgery with positive postoperative outcomes and a trend in lower complication and non-union rates. However further investigation is warranted to assess if faster time to union and quicker weight bearing may be possible with this type of fixation.
Comparison of Prevalence of Arthroscopically Detected Intra-Articular Pathologies Between Supination and Pronation Type Ankle Fractures
Authors: Suksintharanon Methasit , Kittinopphadol Chavapol , Sripanich Yantarat , Rungprai Chamnanni
Published: December 2024

Category:

Arthroscopy; Ankle

Introduction/Purpose:

Ankle fractures are among the most common fractures of the lower extremity. Most unstable ankle fractures have good outcomes following operative fixation; however, residual pain and swelling are not uncommon despite anatomical bone reduction. Untreated associated injuries, including syndesmotic injury, deltoid ligament injury, and osteochondral injury, are potential causes for suboptimal outcomes. These pathologies are often underappreciated. The Lauge-Hansen classification is used to categorize fractures based on the mechanism of injury and thus has the potential to predict intra-articular pathology. To date, there is limited literature reporting the comprehensive prevalence of arthroscopically diagnosed intra-articular pathologies in acute ankle fractures based on the mechanism of injury. This study aims to report the prevalence of each intra-articular pathology between different fracture patterns.

Methods:

A retrospective database review was conducted on 203 patients with rotational ankle fractures who underwent arthroscopic-assisted open reduction and internal fixation for unstable acute ankle fractures between 2016 and 2023. Patients with open fractures, pilon fractures, delayed treatment, and children with open physes were excluded from the study. The patients were categorized into groups according to the Lauge-Hansen classification: Supination-Adduction (SA), Supination-External Rotation (SER), Pronation-External Rotation (PER), and Pronation-Abduction (PA). Syndesmotic injuries were determined by the arthroscopic drive-through sign with a 3mm shaver, while deltoid ligament injuries and osteochondral injuries were identified using arthroscopic visualization.

Results:

There were 3 patients (1.48%) with SA fractures, 143 patients (70.44%) with SER fractures, 6 patients (2.96%) with PA fractures, and 51 patients (25.12%) with PER fractures. The prevalence of arthroscopically diagnosed syndesmotic instability following malleoli fixation was extremely high in most fracture patterns except the SA mechanism (PER: 98.04%, PA: 100%, SER: 89.51%, SA: 33.33%). The prevalence of osteochondral injury was higher in pronation-type injuries than supination-type injuries (73.78% vs 53.9%, p=0.03). Deltoid ligament injury was found in 56.74% of SER fractures and 68.42% of PA/PER fractures.

Conclusion:

The prevalence of intra-articular pathologies in ankle fracture was higher in pronation-type injuries. However, the prevalence of these pathologies, especially syndesmotic instability, in SER fracture patterns was also alarming. The authors advocate for routine ankle arthroscopy simultaneously with ankle fixation to provide adequate treatment and predict prognosis.
Correction of Talar Sagittal Alignment Using a Novel Biased Polyethylene Insert for a Fixed Bearing Total Ankle Arthroplasty
Authors: Khan Ryan , Halai Mansur , Daniels Timothy R. , Pinsker Ellie , Kooner Sahil , Kayum Shahin , Singh Maninder Shah
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The Cadence Total Ankle System is unique in that it has modular polyethylene components with both an anterior and posterior biased option that may improve reduction of the talus in the sagittal plane. As such, the purpose of this study is to evaluate the effectiveness of anterior and posterior biased polyethylene liners in improving sagittal component alignment and functional outcomes after TAA.

Methods:

This was a retrospective cohort study of consecutive patients that underwent TAA with the Cadence Total Ankle system using biased polyethylene liners with at least 12 months follow-up.

Results:

Study included 66 TAAs that required the use of a biased polyethylene liner. The primary outcome was radiographic sagittal talar alignment, the cohort was broken down into three groups depending on preoperative sagittal alignment: anterior alignment (A, n=38), neutral alignment (N, n=17), and posterior alignment (P, n=11). Patients with anterior or posterior preoperative sagittal alignment demonstrated significant improvement in sagittal alignment using both the TT ratio and talar station. Overall, the proportion of patients that achieved neutral sagittal balance significantly improved from 25.76% to 50.00% postoperatively (χ2 [df=1, n=66] = 18.24, p < 0 .01). Anterior bias liners were associated with anterior preoperative alignment, while posterior bias liners were associated with neutral and posterior preoperative alignment (χ2 [df=2, n=66] = 17.55, p < 0 .01, V = 0.52).

Conclusion:

The Cadence TAA system has novel anterior and posterior biased polyethylene liners that may augment correction of sagittal talar deformities. This study demonstrates that biased liners are effective in correction of pathological sagittal talar deformities to near anatomic alignment clinical with significant improvement in functional outcomes.
Differences in Cortical Activation During Dorsiflexion and Plantarflexion in Chronic Ankle Instability: A Task-fMRI Study
Authors: Wang Xu , Geng Xiang , Wang Zhifeng
Published: December 2024

Category:

Sports

Introduction/Purpose:

Chronic ankle instability is a common sports injury that often presents with increased plantarflexion and restricted dorsiflexion. The cumulative effect of peripheral injuries may induce neuroplasticity in the central nervous system. However, the relationship between dorsiflexion or plantarflexion and the central nervous system in patients with chronic ankle instability remains unknown.

Methods:

December 2020 and May 2022, we treated 400 patients who had chronic ankle instability. Ten percent (40 patients; mean ± standard deviation age 29 ± 7 years; 17 male patients) were randomly selected to participate in this study.The control group underwent MRI with good image quality. Ankle function and disease severity were assessed using three clinical scales: the Cumberland Ankle Instability Tool, Karlsson-Peterson Ankle Function Score, and the American Orthopaedic Foot & Ankle Society Score. A uniplanar and nonweightbearing ankle dorsiflexion-plantarflexion paradigm (a recognized model or pattern) was performed using a short-block design during the functional MRI scan.The cerebral excitability patterns between patients with chronic ankle instability and controls were analyzed using t-tests.Spearman analysis was performed to explore the correlation between activation regions and the three clinical assessment scales.

Results:

Patients with chronic ankle instability showed a large effect size compared with controls (Cohen d > 0.8). During plantarflexion, the number of activated voxels in the supplementary motor area had a modest, positive correlation with the Karlsson-Peterson Ankle Function Score (r = 0.52; p = 0.01), and the number of activated voxels in the primary motor cortex (M1) and primary sensory cortex (S1) had a weak, positive correlation with the American Orthopaedic Foot & Ankle Society Score in patients with chronic ankle instability (M1: r = 0.45; p = 0.02, S1: r = 0.49; p = 0.01).

Conclusion:

Compared with volunteers with normal ankle function, patients with chronic ankle instability had increased cortical activation during plantarflexion and decreased cortical activation during dorsiflexion. We analyzed the central neural mechanisms of chronic ankle instability in patients with sports injuries and provided a theoretical basis for the development of new central and peripheral interventions in the future.
Differences in Intraoperative Fluoroscopic Radiation Exposure during Ankle Fracture ORIF between Orthopaedic Surgery and Podiatry
Authors: DiFiori Monica , Luginbuhl Joshua , Bires Kristofer , Rallis Gaivn , Gokcen Eric
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Operative ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used, however, excessive radiation can be harmful to both the patient and surgical team. The primary aim of this study is to determine if there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists.

Methods:

This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018 and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients greater than 18 years of age with an ankle fracture managed operatively were included. Subjects were then stratified by procedure. Mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists.

Results:

Of the 333 included procedures, 186 were performed by orthopaedic surgeons and 147 were performed by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared those performed by podiatry (68.4s versus 104.8.s; p = 0.0280). Additionally, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared to those performed by podiatry (244.6 mRad v 565.6 mRad; p = 0.0090).

Conclusion:

Patients and surgical teams are exposed to significantly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared to those performed by a podiatrist.
Discrepancies in Pedobarography between Affected and Unaffected Sides in Patients with Plantar Fasciitis
Authors: Kim Jahyung , Kyung Min Gyu , Kim Joonhee , Lee Hye Ran , Kim Ji Hye , Yoon A Ro , Kim Min Ju , Lee Dong Yeon
Published: December 2024

Category:

Other; Basic Sciences/Biologics

Introduction/Purpose:

Plantar fasciitis is one of the most common causes of chronic heel pain. Typically, conservative treatment involves stretching exercises and the use of orthosis such as heel cups. To prescribe the appropriate orthosis, a fundamental understanding of plantar pressure distribution is essential. We evaluated the plantar pressure distribution of patients with unilateral plantar fasciitis by comparing it with contralateral unaffected sides.

Methods:

We prospectively recruited 20 participants who were diagnosed with unilateral plantar fasciitis and had been complaining of heel pain for at least 6 months. The emed® system was used to measure the plantar pressure of both feet during gait. We measured the pedobarographic parameters, such as contact area, maximum force, peak pressure, force time integrals, and pressure time integrals. The analysis was performed using a 4-mask configuration (hindfoot, midfoot, forefoot, and toes). In addition, we measured radiographic parameters that could potentially affect plantar pressure in simple foot and ankle radiographs.

Results:

Both sides showed no significant difference in radiographic parameters. The affected side showed significantly higher contact area (28.9±10.3 vs. 26.3±8.2, p=0.007), maximum force (27.3±12.9 vs. 24.4±11.9, p=0.048), and force time integrals (0.6±0.3 vs. 0.5±0.2, p=0.044) in the midfoot. However, the unaffected side demonstrated significantly higher maximum force (67.5±11.4 vs. 60.1±8.4, p=0.030) and force time integrals (1.4±0.2 vs. 1.2±0.2, p=0.038) in the hindfoot.

Conclusion:

The increase in the contact area and maximum force in the midfoot on the side with plantar fasciitis can be interpreted as a result of weight transfer from the hindfoot to the midfoot due to heel pain. It can be suggested that Achilles tendon and plantar fascia stretching exercise is necessary to prevent weight transfer from the original hindfoot to the midfoot or forefoot. Moreover, the findings of this study could be helpful in prescribing appropriate orthosis for patients effectively.
Effect of Malnutrition in Operatively Treated Ankle Fractures for Insulin- and Non-Insulin-Dependent Diabetic Patients
Authors: Ng Terence Y. , Geoffrey Phillips
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

It has been widely demonstrated that patients with insulin-dependent diabetes mellitus (IDDM) have higher complication rates compared to non-insulin dependent diabetic patients (NIDDM) after operative treatment of ankle fractures. However, there is a paucity of research comparing the preoperative nutritional status of IDDM versus NDDM patients, as a modifiable preoperative risk factor. Therefore, this investigation examined whether diagnosis of IDDM, and preoperative serum albumin predicted various complications following operative fixation of ankle fractures.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried, and patients undergoing operative treatment of ankle fractures from 2007-2020 were identified for inclusion. Patients were stratified based on diabetic and insulin-dependent status. Outcomes measured were complications within the 30-day postoperative period, analyzed univariate and multivariate regressions.

Results:

IDDM patients had rates of malnutrition of 41.9% nearly twice the rates of NDDM patients (24.8%) or non-diabetic patients (17.3%). Patients who were malnourished were two times more likely to develop a complication (OR:2.01 [1.38, 2.91], p < 0.001). Malnourished patients had significantly increased incidence of bleeding requiring transfusions (0.5% versus 2.8%, p < 0.001), requiring postoperative ventilation (0.5% versus 0.1% p = 0.048), sepsis (0.4% versus 1.3% p=0.0046), UTI (0.9% versus 2.0% p=0.046). However, there was no increased incidence of deep vein thrombosis (0.7% versus 1.0% p=0.46), pneumonia (0.7% versus 1.0%, p=0.56), surgical site infections (0.1% versus 0.3%, p=0.30), wound dehiscence (0.4% versus 0.5%. p=0.76), pulmonary embolism (0.4% versus 0%, p=0.15) or myocardial infarction (0.1% versus 0.5%, p=0.15) in malnourished patients.

Conclusion:

Retrospective study of 884 patients who underwent ankle open reduction and internal fixation demonstrated that decreased preoperative albumin was associated with increased complications within the 30-day postoperative period.
Enhancing Fracture Detection in Remote Settings: Evaluating the Efficacy of FIXUS AI Deep Learning Algorithms in Identifying Fifth Metatarsal Fractures Using Mixed-Quality X-rays
Authors: Taseh Atta , Gholipour Alireza , Eftekhari Mani , Ebrahimi Alireza , Flaherty Alexandra F. , Flaherty Alexandra F. , Jones Sumner , Nukala Varun , Waryasz Gregory R. , Guss Daniel , Kwon John Y. , DiGiovanni Christopher W. , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil
Published: December 2024

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

The diagnosis of fractures can be challenging in specific medical settings due to limited expertise or time. While deep learning has shown promising results, its use is confined to the quality of images and the hassle of importing images to the models. This study aims to develop a model to detect fifth metatarsal fractures based on cell phone photos of radiographs directly taken from a regular screen.

Methods:

retrospective case-control study was conducted including patients aged > 18 years with fifth metatarsal fractures (n=1240) (Fx), and healthy controls (n=1224) (NoF). Three view radiographs (anterior, posterior, and lateral) were obtained from the Electronic Health Record (EHR) in PNG format. To generate a mixed-quality dataset, Android and iOS smartphones (SP) were used to create two separate datasets for each Fx and NoF group. Two separate deep learning models on each EHR, SP, and combined datasets were developed using Inception V3 architecture (Figure 1.). The models were also tested on a separate SP dataset (SP-test) that was not included in the development process. Area Under the Receiver Operating Characteristics Curve (AUC) along with other performance metrics were calculated and reported. Continuous data were presented as median (interquartile range), and a p-value of < 0.05 was considered to be significant.

Results:

Baseline analysis revealed differences between the groups with a median age of 56 years (36-68) for the Fx group, and 62 years (51-72) for the NoF group (p < 0.001). Similarly, the racial composition of the groups was also different (Fx: 84.8% white; NoF: 92.2% white; p < 0.001). Initially, the SP model showed the best performance (Youden Index (YI): 0.92, AUC: 0.99) followed by the EHR (YI: 0.74, AUC: 0.96), and combined (YI: 0.52, AUC: 0.97) models. When tested on the SP-test dataset the EHR model’s performance dropped markedly showing a YI of 0.33, an AUC of 0.78, and a sensitivity of 0.49 (Table 1.). However, the SP and combined models continued to perform optimally (YI: 0.94, AUC: 0.99; YI: 0.78, AUC: 0.98, respectively).

Conclusion:

This study highlights the crucial role of image quality in developing deep learning models for detecting fifth metatarsal fractures. Our findings demonstrate a markedly reduced performance of the EHR model in identifying fractures within lower-quality images. This emphasizes the need for training algorithms on images of varying quality to create more generalizable models capable of operating effectively across diverse settings.
Enhancing Precision in OLT Measurements and Improving Agreement in Surgical Decision-Making: A Comprehensive Evaluation Using WBCT and Distance Mapping for Preoperative Planning
Authors: Barbero Agustin , Efrima Ben , Dahmen Jari , Benady Amit , Maccario Camilla , Indino Cristian , M.M.J. Kerkhoffs Gino M , Giuseppe Usuelli Federico
Published: December 2024

Category:

Ankle; Other

Introduction/Purpose:

WBCT enables the creation of a three-dimensional model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating OLT, allowing for the quantification of its surface area, volume, and depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depth, and volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention

Methods:

This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surface, and volume. The raters were asked to choose between bone marrow stimulation, autologous matrix-induced chondrogenesis, and osteochondral transposition based on the measurement. Inter-rater and intra-rater agreement was measured.

Results:

Interclass correlation of the lesion's depth surface produced an excellent interrater and intrareader agreement of 0.90 -0.94 p-value < 0.001. Cohen's Kappa agreement analysis of the preferable preoperative plan produced a Kappa = 0.834 P-value< 0.001, indicating a near-perfect agreement

Conclusion:

WBCT-based 3D modules and DM can be used to measure the OLT surface and depth and to calculate the lesion volume with excellent interrater and interrater reliability; using the OLT measurement and a predetermined treatment algorithm, a near-perfect interrater agreement for the preoperative planning was reached. WBCT in conjunction could help determine the type of surgery needed preoperatively and assess if additional surgeries are needed.
Epidemiology of Infections, Readmissions, and Reoperations after 1434 Foot and Ankle Surgeries at an Academic Medical Center
Authors: May Jared M. , Bergman Rachel , Kadakia Anish R.
Published: December 2024

Category:

Other

Introduction/Purpose:

Foot and ankle orthopaedic procedures account for approximately 10% of all orthopaedic procedures annually, however, limited data exists on the rates of infection, readmissions and reoperations after surgery. Current literature in other fields of orthopaedic surgery suggests that patient characteristics, including body mass index (BMI), age, gender, race/ethnicity, smoking status, and comorbidities, may impact these rates. The variety of foot and ankle procedures performed presents a challenge when counseling patients on post-operative complications and mitigating risk.

Methods:

In this retrospective study of 1434 foot and ankle surgeries performed at a large, urban medical center by a single surgeon, patient demographics, pre-operative comorbidities, and post-operative complications within 90 days, including superficial wound infection, readmission, and reoperation, were analyzed using Chi-square test of independence. Preoperative demographics analyzed included age, diabetes mellitus (DM) status, smoking status, race/ethnicity, body mass index (BMI), and perioperative opioid use.

Results:

The overall rate of superficial wound infection was 2.3% (n=33); readmission and reoperation rates were 3.3% (n=47) and 3.6% (n=51), respectively. Patients who had DM, were 70 years or older, smoke tobacco products, had no perioperative opioid use, and had BMI >25 were all independently associated with higher rates of readmissions by 90 days (p < 0.05). Smoking tobacco products and perioperative opioid use were associated with higher rates of reoperation within 90 days (p < 0.001). Patients with perioperative opioid use also had higher rates of infection (p=0.0002). Age, DM, smoking status, race/ethnicity, BMI, and procedure type were not associated with differences in rate of infections.

Conclusion:

In elective and non-elective foot and ankle orthopaedic surgery, older age, DM, smoking and BMI>25 were associated with increased postoperative complications. The association of opioid use perioperatively and lower complication rates represents an area of future investigation. The conclusions of this study should be used to counsel patients on their anticipated risks of surgery and help identify areas risk mitigation to prevent and avoid complications.
Exploring causal relationship of traumatic brain injury and comorbidities: A Mendelian randomization study
Authors: Zhang Xiaohang , Wu Wenze , Mao Yaqing , Cheng Jiaxin , Zhou Zixuan , Tang Yaqi , Zhao Qiulong , Yan Hui
Published: December 2024

Background

Previous observational studies demonstrated a link existed between traumatic brain injury (TBI) and cerebral disease and multisystem complications, such as dementia, pneumonia, and gastrointestinal disease, but they could be confused by confounding and reverse causality

Objective

We aimed to figure out the causal correlation between TBI and the following complications.

Methods

Database concerning TBI and complications from genome-wide association study (GWAS) and two-sample Mendelian randomization (MR) analysis was employed to examine whether TBI was causally associated with the risk of some complications. All the analysis was carried out through R, version 4.3.3.

Results

MR analyses indicated that any dementia has a promotional effect on TBI (OR = 1.067, 95% CI, 1.011–1.123, p = 0.017). However, there was no causal genetically association between TBI and Alzheimer's disease (AD), Parkinson's disease (PD), pneumonia, or gastrointestinal disease.

Conclusions

Contrary to observational studies, our results uncovered little causal association between TBI and PD, AD, depression, pneumonia, and gastrointestinal diseases. Interestingly, we found any dementia might be the risk of TBI, which was a new discovery.
The “Forklift” Flap: A Conjoined Perforator Flap for Bilateral Cervicofacial Reconstruction
Authors: St. Pierre Dakota L. , Prince Joel M. , Ali Abdel-Moneim M. , Nanda Arjun V. , Gonce Collin E. , Barreiro Guilherme C.
Published: December 2024

Background: Cervicofacial defects have a profound functional, aesthetic, and psychological impact. If optimal bedside wound care fails, surgical management is warranted. We propose our innovative forklift flap technique in the reconstruction of medically-refractory Hurley Stage III hidradenitis suppurativa (HS) affecting the lower face, submentum, and neck: providing both improved functionality and aesthetic appearance. Methods: Full-thickness excision of the area was performed with immediate reconstruction utilizing our novel forklift flap—a local, doublysupercharged, independent branch-based, conjoined perforator flap. The flap encompasses the vascular territories of the supraclavicular, parascapular and lateral arm flaps. The flap remained pedicled on the supraclavicular artery and supercharged with both the circumflex scapular and the posterior radial collateral arteries. The supraclavicular, parascapular, and extended lateral arm measured 33 cm × 8 cm, 30 cm × 10 cm, and 53 cm × 14 cm, respectively, and resulted in 1306 cm2 of coverage. The supraclavicular and parascapular sites were closed primarily with interspersed penrose drains. The lateral arm healed by secondary intention following application of a dermal regeneration template. Five months postoperatively, 2000 mL debulking was performed with liposuction. Results: Results were stable at subsequent postoperative visits. At 2 years follow up, minor recurrence of submental HS occurred adjacent to our flap. Conclusion: Surgical management is an optimal choice for patients with refractory HS lesions. Our forklift flap technique provides satisfactory aesthetic and functional outcomes for large cervicofacial defects.
A social media professor, mediated: Being subject, object, and spectator in #BamaRush TikTok
Authors: Maddox Jessica
Published: December 2024

#BamaRushTok is a yearly viral event in which young women at the University of Alabama audition for spots in gender-specific social clubs (sororities). As a researcher working at the University of Alabama, I was uniquely situated in this viral phenomenon. I quickly became the expert called upon to explain this trend. However, being on the periphery of a viral event from my standpoint—social media researcher, lifelong resident of the U.S. South, tenure-track academic education—problematized everything I knew about the self and the research as I became subject, object, and spectator. Through this highly personal and reflexive digital autoethnography, I explore how I experienced context collisions—something normally thought of as collapsed audiences but invoked by me to explore what happens when researchers become physically entangled in the digital worlds they study. I experienced being subject, object, and spectator of these context collisions in three ways: At times I was in control; at times I was used; and at times I could only stand back and watch. My experience mirrored the visibility and precarity experienced by the girls of #BamaRushTok and the creators I have made a career out of studying. This speaks to the broader neoliberal conditions that structure platforms and American higher education. This work also underscores the importance of autoethnography as a valuable but underutilized method in Internet Studies research, as it is a way for those studying digital spaces to reach inside of themselves and understand vulnerable and liminal social media experiences.
Risk of Tendon Injury in Patients Treated With Fluoroquinolone (FQ) Vs Non-Fluoroquinolone Antibiotics for Urinary Tract Infection (UTI)
Authors: Fleming Virginia H. , Xu Jianing , Chen Xianyan , Hall Daniel , Southwood Robin L
Published: December 2024

Background:

Fluoroquinolones (FQs) are associated with potential tendon injury but comparative risk versus other antibiotic (non-FQ) options for the same indication has rarely been evaluated.

Objective

Describe the incidence (relative risk) of any tendon injury in patients receiving FQs compared with other (non-FQ) antibiotics for treatment of urinary tract infections (UTIs).

Methods

A retrospective propensity score-weighted cohort study was performed to evaluate the association between FQ antibiotics and tendon injury at two time points (within one month and within six months of use) compared with non-FQ regimens for treatment of UTI. The evaluation was performed using the Merative™ MarketScan® Research Databases from 2014 to 2020. Adult patients with International Classification of Diseases (ICD)-9/10 coding for UTI were included. Patients with a history of tendon injury or those who received both FQ and non-FQ regimens during the study period were excluded. Propensity score weighting was used to adjust for selection bias due to contributing risk factors, including demographics (age, sex), comorbidities (diabetes mellitus, chronic kidney disease), and concurrent medications (corticosteroids).

Results

Both the 1-month and 6-month cohorts were predominately female and less than 50 years of age. At one month, the incidence of tendon injury was 0.2% in the FQ group and 0.1% in the non-FQ group, and the odds of tendon injury were not estimated to be significantly different between groups (odds ratio [OR] = 1.03, 95% confidence interval [CI] 0.93, 1.32). Odds of tendon injury were also not estimated to be significantly different in the 6-month cohort (OR = 0.98, 95% CI 0.84, 1.05).

Conclusion and Relevance

In this population of predominantly young female patients without high incidence of potentially contributing comorbidities, increased risk of tendon injury was not associated with FQ use. Future research is needed to determine whether demographic differences between this and other previously studied populations account for this discordant result
ADAM Metallopeptidase domain 19 promotes skin fibrosis in systemic sclerosis via neuregulin-1
Authors: Meng Qiming , Bao Ding , Liu Sijia , Huang Jing , Guo Muyao , Dai Bingying , Ding Liqing , Xie Shasha , Meng Meng , Lv Chunliu , He Weijia , Luo Hui , Zhu Honglin
Published: December 2024

Background

ADAM19 (ADAM Metallopeptidase Domain 19) is known to be involved in extracellular matrix (ECM) remodeling, yet its specific function in systemic sclerosis (SSc) fibrosis remains unclear.

Objectives

This study sought to clarify the role and underlying mechanism of ADAM19 in SSc skin fibrosis.

Methods

The expression of ADAM19 was assessed in skin tissues of SSc and wound healing using publicly available transcriptome datasets. This analysis was further validated through real-time PCR, western blot, and immunostaining in our SSc cohort, as well as in a mouse model of hypochlorite (HOCl)-induced fibrosis. To downregulate the expression of ADAM19, ADAM19 siRNA was employed. The influence of ADAM19 on fibroblast transcriptomics was examined using bulk RNA-seq. Data analysis and visualization were conducted using R packages, including edgeR, limma, clusterProfiler, ggplot2, gseaplot2, and complexheatmap.

Results

ADAM19 exhibited a significant upregulation in skin tissues of SSc patients, as well as in wound healing and a HOCl-induced fibrosis mouse model. Additionally, there was a notable positive correlation between ADAM19 and fibrosis-related genes, local skin score, Modified Rodnan skin score, skin thickness progression rate, and the presence of ARA antibodies in SSc patients. Furthermore, ADAM19 levels were markedly elevated in SSc primary dermal fibroblasts and TGF-β-stimulated healthy controls primary dermal fibroblasts. The downregulation of ADAM19 resulted in the repression of TGF-β-induced ECM deposition and fibroblast activation. ADAM19 was identified as a mediator for the shedding of neuregulin-1 (NRG1) in fibroblasts, a pro-fibrotic cytokine that must be cleaved to exert its function.

Conclusion

ADAM19 plays a role in TGF-β-induced ECM deposition and fibroblast activation by mediating the shedding of NRG1, ultimately contributing to the development of skin fibrosis in SSc.
Collaborative logistics: optimizing fixed-scheduled container trains
Authors: Ritzinger Ulrike , Brandstätter Georg , Krasel Lukas F. , Prandtstetter Matthias
Published: December 2024

We propose a new logistics concept for rail-based container transportation where, instead of booking individual slots on specific trains (which is the current state of the art), customers only specify from where to where they want their containers to be delivered, as well as appropriate time windows for pickup and delivery. A containers actual transportation route is then chosen by a freight forwarder based on the availability and compatibility of freight trains. We provide an optimization algorithm based on an integer linear programming formulation that can be used to find globally optimal transportation schedules for a given set of containers. Our computational experiments show that this new paradigm can significantly reduce the number of trains required for serving a given container transportation demand, improving the logistic systems’ overall environmental and economic efficiency.
Drivers of car driving: lessons on infrastructure, peer-group, habits and socio-demographics from a survey on car ownership and usage in Germany
Authors: Thema Johannes , Reul Julian , Arnz Marlin , Wiese Frauke
Published: December 2024

Car ownership is the primary driver of car use, which in turn is the leading contributor to passenger transport sector emissions. Hence, understanding the key determinants of car ownership is crucial to designing a policy framework that will effectively reduce emissions. Based on a 2022 German mobility survey, this study utilizes multinomial logit models to analyse a range of influences on car ownership including socio-demographic and infrastructural factors, respondents’ stated policy responses, and their motives for car ownership. We find that car ownership increases with an individual’s age, income, the share of social contacts owning cars and with smaller towns of residence. Habits, measured as the number of years already spent as a car owner or non-owner emerges as a dominant factor. Our three main insights include: First, car ownership in rural Germany is particularly high and can be effectively reduced by public transport supply measures. Second, situations of radical change—when individuals overcome the force of routine to reflect on their car ownership status – present unique opportunities for policy intervention. And third, isolated or mild policy interventions may only have a limited impact. To significantly influence car ownership levels, policies will likely have to be very stringent.
Cytomorphological changes of oral mucosal cells among smokeless tobacco users in low and middle-income country settings: new findings from Pakistan
Authors: Hassan Sabreen , Sifat Ayesha , Munib Mohammad , Saeed Saleha , Nisa Waqar U. , Durrani Sofia Haider , Rahim Abid , Ullah Naeem , Afaq Saima , Ali Khattak Farhad , Haq Zia Ul
Published: December 2024

Background

Chronic tobacco use, in any form, induces significant cellular alterations in the oral mucosa. This study investigates four distinct cytomorphological changes in oral mucosal cells among smokeless tobacco users, examining their association across different genders and age groups.

Materials and methods

This cross-sectional study involved collecting mucosal samples from smokeless tobacco (naswar/snuff) users through consecutive sampling. The prepared smears were examined for dysplastic changes. Data analysis was performed using SPSS, with Chi-square tests and logistic regression employed to evaluate proportions and associations.

Results

Among 100 Naswar/snuff users, the labial sulcus mucosa was the most common site affected (47%). The most frequent cytomorphological change was micronuclei (46%), followed by nuclear budding (25%), perinuclear halo (18%), and binucleated cells (14%). In the 51–60 age group, micronuclei (78.9%), nuclear budding (55.3%), binucleation (31.6%), and perinuclear halo (36.8%) were more prevalent (P < 0.005). Gender analysis revealed that micronuclei were more common in females (54.2%) compared to males (43.4%), while nuclear budding was more prevalent in males (27.6%) than females (P < 0.28). Logistic regression indicated that individuals aged 51–60 were more likely to exhibit micronuclei (OR = 1.15, 95% CI: 0.22 to 5.83, P = 0.863) and nuclear budding (OR = 15.34, 95% CI: 9.23 to 30.75, P < 0.05).

Conclusion

The dysplastic changes observed included micronuclei, nuclear budding, binucleated cells, and perinuclear halo, with micronuclei being the most prevalent. These findings could facilitate the early diagnosis of oral lesions and their timely management in habitual smokeless tobacco users.
The pandemic within a pandemic: mental health and wellbeing of racially Minoritised women experiencing domestic abuse during the COVID-19 pandemic in the UK
Authors: Mishra Ankita , Gibson-Miller Jilly , Wood Chantelle
Published: December 2024

Background

The prevalence of domestic abuse is greater in times of humanitarian crisis, and the COVID-19 pandemic has been no different. Considerable evidence indicates that domestic abuse disproportionately impacts the mental health and wellbeing of racially Minoritised women. The present study aimed to explore racially Minoritised women’s experiences of domestic abuse and mental health in the COVID-19 pandemic in the UK.

Method

An online cross-sectional survey was used with racially Minoritised women (n = 1202) in the UK during the third national lockdown.

Results

Results demonstrate complex interplay of psychosocial factors, such as the roles of autonomy, resilience, self-silencing, family functioning, and social support as predictors of mental health and wellbeing during the ‘shadow pandemic’.

Conclusion

Implications such as incorporating culturally competent mental health support, exploring the complex and multiple underpinnings of mental health in racially Minoritised victim-survivors of domestic abuse for future pandemic preparedness and support provision are discussed.
Liver transplantation in a boy with TFAM mutation associated mtDNA depletion syndrome
Authors: Zhao Jing , Chen Lian , Wang Ni , Xie Xin-bao
Published: December 2024

Mitochondrial transcription factor A (TFAM) deficiency may cause mtDNA depletion syndrome, which manifests as neonatal liver failure or primary ovarian insufficiency, hearing loss, seizures, and intellectual disability. Treatment focusing on symptomatic management, and the clinical prognosis remains poor. Here, we describe a novel case of TFAM mutation presenting with progressive neonatal cholestasis, hypoglycemia and abnormal amino acid profiling. The patient progressed to liver failure at 6 months of age but did not exhibit neurological involvement. No morphologic abnormalities were observed in muscle biopsy, while mtDNA copy number was reduced in comparison to age- and tissue-matched controls. After liver transplantation, liver biochemistries and blood amino acid profiling normalized three weeks later. Moreover, the boy was doing well post-transplant without any clinical concerns, and his development and neurological examination remain normal 33 months after liver transplantation. Our report suggests that liver transplantation appears to have a favorable profile in such patients.