bluuebunny/crossref_metadata_2025 huggingface dataset:
Tobacco 21’s Impact Amid the E-Cigarette Surge
Authors: Roberts Megan E. , Keller-Hamilton Brittney , Teferra Andreas A.
Published: January 2022

Objectives:

Nationwide implementation of Tobacco 21 (raising the legal sales age for all tobacco products to 21) is occurring against the backdrop of an electronic cigarette (e-cigarette) epidemic among young people, which makes Tobacco 21 evaluation difficult. To address this issue, we examined young adult use of e-cigarettes separately from use of other tobacco products. Our objective was to determine whether use changed after Tobacco 21 implementation and whether those changes differed by product.

Methods:

In Columbus, Ohio, which began enforcing Tobacco 21 in 2017, we surveyed incoming first-year undergraduates at a large, public university in 2016 (Cohort 1; n = 529) and re-contacted them in 2018. We surveyed a new sample of incoming first-year students in 2018 (Cohort 2; n = 611). Survey items assessed tobacco use, sources for obtaining tobacco, and attitudes surrounding Tobacco 21.

Results:

Both cross-sectional (Cohort 1 vs Cohort 2) and prospective (pre–post Tobacco 21 in Cohort 1) analyses indicated a slight decline in most tobacco use from 2016 to 2018, but e-cigarette use more than doubled during the same period. Students enrolled throughout the transition to Tobacco 21 (Cohort 1) perceived little effect of Tobacco 21 on peer use. The largest proportions (35.3%-43.5%) of combustible tobacco were obtained outside Columbus; 61.8% of e-cigarette users reported obtaining e-cigarettes through borrowing.

Conclusions:

Tobacco 21 was associated with reductions in combustible and smokeless tobacco use, but its impact was not sufficient to curb the surge in e-cigarette use. Tobacco 21 should be contextualized as part of a broader network of tobacco control efforts, including additional youth-access regulations, that may be needed to address e-cigarette use among young people.
Prevalence and Correlates of Physical-mental Multimorbidity in Outpatient Children From a Pediatric Hospital in Canada
Authors: Ferro Mark A. , Qureshi Saad , Van Lieshout Ryan J. , Lipman Ellen L. , Georgiades Kathy , Gorter Jan Willem , Timmons Brian W. , Shanahan Lilly
Published: January 2022

Objective

The aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity.

Method

The sample included 263 children aged 2–16 years with a physician-diagnosed chronic physical illness recruited from the outpatient clinics at a pediatric hospital. Children were categorized by physical illness according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10. Parent and child-reported six-month mental illness was based on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).

Results

Overall, 101 (38%) of children had a parent-reported mental illness; 29 (25%) children self-reported mental illness. There were no differences in prevalence across ICD-10 classifications. Parent-child agreement on the MINI-KID was low (κ = 0.18), ranging from κ = 0.24 for specific phobia to κ = 0.03 for attention-deficit hyperactivity. From logistic regression modeling (odds ratio [OR] and 95% confidence interval), factors associated with multimorbidity were: child age (OR = 1.16 [1.04, 1.31]), male (OR = 3.76 [1.54, 9.22]), ≥$90,000 household income (OR = 2.57 [1.08, 6.22]), parental symptoms of depression (OR = 1.09 [1.03, 1.14]), and child disability (OR = 1.21 [1.13, 1.30]). Similar results were obtained when modeling number of mental illnesses.

Conclusions

Findings suggest that six-month multimorbidity is common and similar across different physical illnesses. Level of disability is a robust, potentially modifiable correlate of multimorbidity that can be assessed routinely by health professionals in the pediatric setting to initiate early mental health intervention to reduce the incidence of multimorbidity in children.
High-precision numerical calculation method of solar radiation pressure force for wrinkled solar sails
Authors: Zou Jie , Li Dongxu , Wang Jie
Published: January 2022

Due to small magnitude of solar radiation pressure (SRP), the area-mass ratio of the solar sail should be large enough to obtain adequate thrust acceleration. Therefore, the membrane structure is usually adopted for solar sails. However, the membrane barely has out-of-plane stiffness; thus, it is necessary to apply in-plane tension on the membrane for maintaining the plane, which may result in wrinkles. The wrinkle will influence SRP force of solar sails. On the one hand, wrinkled regions of the sail are no longer flat, so the angle between the normal vector of the surface in wrinkled regions and the direction of sunlight differ from a flat sail. On the other hand, wrinkles may cause shadow when the solar sail is almost parallel to sunlight and the shadow region cannot generate SRP force. In this paper, the nonlinear buckling theory is used to propose a numerical calculation method to solve the problem of wrinkling analysis of solar sails with complex boundary. Then, a high-precision method for calculating SRP force of wrinkled solar sails is proposed, consisting of two parts: the infinitesimal element SRP force model and the wrinkle shading model. Numerical simulation result verifies the effectiveness of the wrinkling analysis method and the SRP force calculation method. Furthermore, according to calculation result, wrinkles have a certain influence on the SRP force of the solar sail, which will become significant when the solar sail gets parallel to sunlight.
Outcomes in Neonates Following the Surgical Removal of a Teratoma: A NSW and ACT Experience
Authors: Singh Moni Pankhuri , Popat Himanshu , Holland Andrew J. A. , Walker Karen
Published: January 2022

Aim

To describe the characteristics and outcomes of neonates admitted to tertiary hospitals in New South Wales and Australian Capital Territory who have undergone surgical removal of a teratoma, as there is paucity of Australian data.

Methods

All neonates admitted to the neonatal intensive care unit with teratoma between 2007 and 2017 inclusive (as per neonatal intensive care units data collection) were included in this retrospective study.

Results

Forty-three neonates with a diagnosis of teratoma were included in the study. The most common tumors were sacrococcygeal teratomas, accounting for 79% (34) of all the cases. Twenty-four (56%) neonates were diagnosed with teratoma antenatally. Ninety-one percent (39) of the deliveries took place in the tertiary center. Median gestational age of the neonates was 37 weeks and the median weight was 3.39 kg. One or more additional anomalies apart from teratoma were detected in 16 neonates (37%), most common being congenital hydrocephalus and hydronephrosis. Overall survival was 93% at hospital discharge: the 3 neonates who died soon after birth did not undergo surgery and they all were premature with poor Apgar scores.

Conclusions

Sacrococcygeal teratoma was the most common type of teratoma with more than half of the cases determined antenatally. Overall survival of neonates after surgery for teratoma is high.
Establishment and Validation of a Nomogram Based on Negative Lymph Nodes to Predict Survival in Postoperative Patients with non-Small Cell Lung Cancer
Authors: Huang Xinyi , Hu Pingping , Yan Fei , Zhang Jiandong
Published: January 2022

Background: The importance of the negative lymph node (NLN) count has recently attracted attention. This study aimed to determine the prognostic value of NLN count in patients with non-small cell lung cancer (NSCLC) after radical surgery by constructing NLN-based prognostic models. Methods: This study included 33 756 patients pooled from the case listing session of the US Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 and 545 patients collected from The First Affiliated Hospital of Shandong First Medical University between 2012 and 2016. X-tile software was used to calculate the optimal cutoff value for the NLN count. The associated clinical factors were determined using univariate and multivariate Cox analyses. Nomograms were developed using the SEER database and validated using hospital data. Results: The training cohort was divided into high and low NLN count subgroups based on the cancer-specific survival (CSS) and overall survival (OS), respectively. Multivariate analysis showed that NLN count was an independent prognostic factor, and the high NLN count subgroup had better CSS and OS than those of the low NLN count subgroup (HR = 0.632, 95% CI 0.551-0.724, P < .001 for CSS and HR = 0.641, 95% CI 0.571-0.720, P < .001 for OS). Nomograms were established, exhibiting good discrimination ability with a C-index of 0.789 (95% CI 0.778 −0.798) for CSS and 0.704 (95% CI, 0.694 −0.714) for OS. The calibration plots of the validation cohorts showed optimal agreement with the training cohort, with a C-index of 0.681 (95% CI 0.646 −0.716) for CSS and 0.645 (95% CI 0.614 −0.676) for OS. Conclusions: NLN count is a strong prognostic factor for OS and CSS in NSCLC patients and the prognostic model provides a useful risk stratification for NSCLC patients when applied to clinical practice.
COVID-19 and Clinical Pastoral Education: How ACPE Educators Pivoted Amid the Pandemic
Authors: Szilagyi Csaba , Tartaglia Alexander , Palmer Patricia K. , Fleenor David W. , Jackson-Jordan Elizabeth , Knoll Sweeney Sarah , Slaven James E.
Published: January 2022

Clinical Pastoral Education (CPE) programs faced extraordinary challenges during the COVID-19 pandemic. We examined how ACPE-certified educators responded to maintain program delivery. Survey results ( n = 210) suggested a substantial and abrupt increase in remote delivery for CPE instruction and supervised clinical practice, primarily driven by those previously fully in-person. Respondents reported abrupt changes impacted 1152 students. Participants rated their utilization and helpfulness of professional, organizational, and technology resources during the pivot and beyond.
Diagnosis and management of multiple myeloma during pregnancy: case report, review of the literature, and an update on current treatments
Authors: Magen Hila , Simchen Michal J. , Erman Shira , Avigdor Abraham
Published: January 2022

The simultaneous occurrence of pregnancy and multiple myeloma (MM) is rare. The challenge of diagnosing MM during pregnancy is demonstrated in the case presented here. Despite the rarity of concurrent MM and pregnancy, this possibility should be considered in patients with signs and symptoms that may be attributed to MM so as not to delay the diagnosis and decision about pregnancy continuation and initiation of an appropriate and safe therapy to the mother and fetus. Treating physicians should be aware of the potential effects of MM therapies on the fetus and pregnancy outcomes.
What strategies are used by clinician champions to reduce low-value care?
Authors: Parchman Michael L , Palazzo Lorella G , Mogk Jessica M , Webbon Janna C , Demosthenes Lauren , Vossenkemper Elizabeth , Hoke George , Moskovitz Joshua , Dunlap Leslie , Diaz del Carpio Roberto
Published: January 2022

Background:

Clinician champions are front-line clinicians who advocate for and influence practice change in their local context. The strategies they use when leading efforts to reduce the use of low-value care have not been well described. The purpose of this study is to identify and describe strategies used by six clinician champions who led a low-value care initiative in their clinical setting.

Methods:

Qualitative data collected during an overuse reduction initiative led by clinician champions were used to identify strategies, guided by the Expert Recommendations for Implementing Change compilation of strategies. Clinician champions were asked to rank the importance of these activities and indicate which one of the six most important activities they would be willing to discuss in an interview. A 30-min semi-structured interview was conducted with each clinician about the activity they selected and thematically analyzed.

Results:

Twelve Expert Recommendations for Implementing Change strategies were identified. The top six strategies discussed during interviews were: build a coalition, conduct a local needs assessment, develop a formal implementation blueprint, conduct educational meetings, use facilitation, and develop clinical reminders. Common themes that emerged across all interviews were the use of data to engage clinicians in conversations, including the patient’s perspective in designing the interventions, and investing the time upfront to plan and launch the initiative because of the inherent challenges of relinquishing a service.

Conclusions:

Clinician champions identified multiple strategies as important when de-implementing a low-value service. Many were used to engage in conversations with stakeholders, including leadership, providers, and patients, to increase buy-in and support, challenge beliefs, promote behavior change, and gather insights about next steps in their effort. Future work is needed to better understand how prepare clinicians for this role and to understand the mechanisms through which these strategies might be effective.
Lateral Instability in Total Ankle Arthroplasty: A Comparison Between the Brostrom-Gould and Anatomic Lateral Ankle Stabilization (ATLAS)
Authors: Rushing Calvin J. , McKenna Bryon J. , Berlet Gregory C. , Malloy McCoy Antonio M.
Published: January 2022

Category:

Ankle; Sports; Other

Introduction/Purpose:

Lateral ankle instability is not uncommon after osseous cuts and soft tissue releases are performed during Total Ankle Arthroplasty (TAA), particularly with varus malalignment. The purpose of the present study was to compare the outcomes of ankles that underwent TAA with concurrent Brostrom-Gould (BG) or Anatomic Lateral Ankle Stabilization (ATLAS) at a minimum of 1-year follow-up.

Methods:

Thirty-eight TAA's underwent BG (21 INFINITY, 4 CADENCE) or ATLAS (13 INBONE-2) between August 2015 and February 2019 at a single institution and were at least 1 year postoperative (mean 18.3 months, range 12-40). Baseline patient demographics, characteristics, and operative factors were assessed via medical record and chart reviews. Radiographs parameters were measured preoperatively, at 6 weeks postoperative, and during the latest follow-up. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook et el., respectively. Univariate and multivariate analyses were performed.

Results:

Survivorship for TAA with concurrent BG/ATLAS was 97%. Overall, TAA with concurrent BG had higher incidences of early TAA revision (4%), recurrent instability (4%), reoperation (16%), and complications (29%) compared to ATLAS. Postoperative coronal and sagittal tibiotalar alignment changes were significant for both groups (p< 0.001, p=0.014); however, the differences were greater for ATLAS (p= 0.045, p<0.001).

Conclusion:

The present study is the first to compare outcomes between techniques for addressing ankle instability in the TAA population. At short-term follow-up, anatomic reconstruction produced better outcomes than the traditional BG procedure. Additional comparative studies between techniques to address instability in the TAA population are warranted.
Impact of Resilience on Patient Reported Outcomes of First Metatarsophalangeal Arthrodesis
Authors: Andrews Nicholas A. , Tran Sterling , Halstrom Jared R. , Ray Jessyca , Harrelson Whitt , Dib Aseel G. , Agarwal Abhinav , Shah Ashish
Published: January 2022

Category:

Other; Ankle; Midfoot/Forefoot

Introduction/Purpose:

Resilience is an interactive dynamic construct most simply defined as the ability to recover from stress. To date, there is no literature examining the impact of resilience on the outcomes following foot and ankle surgery.

Methods:

We retrospectively reviewed patients who underwent first MTP arthrodesis from September 2011 to May 2020, 98 met inclusion criteria. Medical records were reviewed for patient characteristics and union status. PROMIS Physical Function (PF), Pain Interference (PI), Depression (D), and the Foot Function Index (FFI) were collected. Resilience was measured using the Brief Resilience Scale. A multivariable linear regression analysis examining the impact of resilience on patient reported outcomes while adjusting for potential confounding covariates was conducted.

Results:

At an average of 3.4+-2.6 (SD) years postoperatively, resilience was found to have an independent effect on patient reported outcomes across all instruments, except the FFI pain subscale. Resilience's effect on the instruments was as follows: PROMIS physical function (Unstandardized β 5.0, 95% CI 2.6 to 7.4), PROMIS pain interference (Unstandardized β -4.8, 95% CI - 7.8 to -1.8), PROMIS Depression (Unstandardized β -9.4, (95% CI -12.8 to -6.1), FFI disability subscale (Unstandardized beta -13.3, 95% CI -20.3 to -6.3 ), FFI activity limitation subscale (Unstandardized beta -15.7, 95% CI -23.0 to -8.5), FFI total (Unstandardized beta -11.7, 95% CI -18.1 to -5.4), and FFI pain subscale (Unstandardized beta -6.5, 95% CI -13.1 to.01).

Conclusion:

In this first study examining the impact of resilience following foot and ankle surgery, we found that resilience has an independent positive effect on overall physical function, disability, pain, and mental health following MTP arthrodesis. Preoperative resilience scores could be used to predict postoperative functional outcomes following MTP arthrodesis and guide postoperative rehabilitation. These findings help establish the role of early positive psychosocial characteristics within orthopaedic foot and ankle population.
Chronic Achilles Tendon Ruptures: A Systematic Review
Authors: Azam Mohammad , Butler James J. , Mercer Nathaniel P. , Hurley Eoghan , Shimozono Yoshiharu , Kennedy John G.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Chronic Achilles tendon ruptures (CATR) are an uncommon injury compared to acute ruptures. Currently, no evidence-based guidelines exist for treating CATR. The purpose of this systematic review was to present the outcomes of the current treatment options for CATR and to analyze the level of evidence (LOE) and quality of evidence (QoE) of the included studies.

Methods:

In July 2020, MEDLINE, EMBASE and Cochrane Library databases were systematically reviewed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The LOE and QOE of the included studies was evaluated using the Modified Coleman Methodology Score. Studies reporting outcomes following repair of CATR were included.

Results:

Thirty-one studies with 653 CATRs were included. Three studies were LOE III and 28 studies were LOE IV. Six studies reported dual technique procedures and 23 studies reported single technique procedures. Semitendinosus graft was the most frequently utilized single technique procedure amongst the included studies. Most studies reported good postoperative subjective outcomes, strength outcomes, and return to sports data at mid-term follow-up. In total, 14.6% of patients experienced postoperative complications. The most common complication was surgical wound complications (10.8%).

Conclusion:

This systematic review found that no evidence-based treatment guidelines exists for CATR. Surgical management of CATR produces good clinical outcomes at mid-term follow up, but a high complication rate (14.6%) was noted. Future studies of higher QOE and LOE with improved data reporting are warranted to determine the optimal treatment strategy for CATR.
Outcomes of Minimally Invasive Proximal Chevron Metatarsal Osteotomy for Moderate to Severe Hallux Valgus Deformity
Authors: Choi Jun Young , Suh Jin Soo
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

The effectiveness of minimally invasive surgery (MIS)-distal chevron metatarsal osteotomy (DCMO) for the correction of moderate to severe hallux valgus deformity is unclear. Traditionally, proximal chevron metatarsal osteotomy (PCMO) has been considered a reliable procedure for correcting severe hallux valgus deformity. This study aimed to clarify the clinicoradiographic outcomes of our novel MIS-PCMO technique and compared its outcomes to those of MIS-DCMO performed during the same timeframe. We addressed the following research questions: (1) can the MIS-PCMO technique be an effective option for correcting moderate to severe hallux valgus deformity?; (2) are there differences in the extent of deformity correction possible with MIS-PCMO and MIS-DCMO?; and (3) what points should be considered before performing the MIS-PCMO technique?

Methods:

We prospectively compared the outcomes of patients who underwent MIS-PCMO (n=20 patients; 22 surgeries) and those of patients who underwent MIS-DCMO (n=23 patients; 26 surgeries) for moderate to severe hallux valgus deformity (hallux valgus angle [HVA] >=30o) between January 2017 and December 2018. The minimum follow-up duration for inclusion in this study was 18 months. The HVA, first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, medial sesamoid position, and Meary angle were measured preoperatively and at the final follow- up.

Results:

Compared to MIS-DCMO, MIS-PCMO resulted in significantly greater correction of the HVA (P<0.001) and IMA (P=0.01), along with Meary angle improvement (P<0.001); however, the DMAA worsened (P=0.01). Furthermore, there was a significantly greater change in the relative second metatarsal length in the MIS-DCMO group (P=0.01). There were no significant between-group differences in the correction of the medial sesamoid position (P=0.445).

Conclusion:

MIS-PCMO can be a better option for correcting moderate to severe hallux valgus deformities than MIS-DCMO. However, this technique should be applied carefully when the preoperative DMAA is already large because the DMAA can become worse postoperatively.
Talar Osteoperiostic Grafting from the Iliac Crest (TOPIC): 2-Year Results of a Novel Press-Fit Surgical Treatment for Large Talar Osteochondral Lesions
Authors: Dahmen Jari , Stufkens Sjoerd A. , Kerkhoffs Gino
Published: January 2022

Category:

Ankle

Introduction/Purpose:

The purpose of this study was to present the surgical technique and to evaluate the clinical and radiological outcomes of a new press-fit OATS technique for large primary and secondary talar osteochondral defects of the talus, Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC).

Methods:

Forty patients underwent a press-fit TOPIC procedure. Mean age was 38 years (SD 4.6). Pre- and postoperative clinical assessment at 12- and 24-months follow-up included the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Short- Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS). Return to work was assessed in time and rate. Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively.

Results:

All patients were available for the two-year follow-up. The AOFAS improved from 48 to 90 (p<0.05). All NRS scores improved: the NRS during rest from 3 to 0 (p<0.05), the NRS during walking from 5 to 1 p<0.05), and the NRS during stairclimbing from 5 to 1 (p<0.05). Both components of the SF-36 improved. The PCS improved from 34 to 47 (p<0.05) and the MCS from 37 to 66 (p<0.05). All FAOS subscales significantly improved. 70% returned to sport at pre-injury sports level and mean time to return to sports was 9 months (SD 2.4). All patients showed remodeling of the talus and all grafts showed consolidation as well as bone ingrowth on the CT scans. All patients returned to work, at a mean time of 4 months post-operatively (SD 4.4). One patient had a temporary loss of n. saphenous sensibility.

Conclusion:

The TOPIC procedure is a highly promising surgical treatment option for large primary and secondary talar OCDs. Despite these good mid-terms clinical, sports and radiological outcomes, longer follow-up is necessary to assess the clinical outcome and the progression of osteoarthritis at the long term.
An Anatomical Study of the Sural Nerve: A Review of Cadaveric Data and Comparison with 3 Tesla MRI
Authors: Ghetti Claudio B. , Mitchell Brendon , Shah Vrajesh J. , Huang Brady K. , Kent William , Foran Ian M.
Published: January 2022

Category:

Ankle

Introduction/Purpose:

The sural nerve (SN) is a distal cutaneous nerve that provides sensation to the lateral foot and ankle, and is at risk of iatrogenic injury during surgery at the foot and ankle.1 Previous anatomic studies of the SN are limited to cadaveric studies with small sample sizes.2,3,4,5,6,7,8,9 We analyzed a large cohort of high-field 3 Tesla (3T) magnetic resonance images (MRI) of the ankle to obtain a more generalizable, in-vivo sample of the distal course of the SN. A comparison of this in- vivo method of measurement vs. cadaveric studies may provide surgeons with a more accurate representation of SN anatomy and its relation to anatomic landmarks.

Methods:

We performed a retrospective review of 3T MRI studies of the ankle performed at our institution between January 2015 and December 2020. Three blinded reviewers measured the vertical distance of the SN to the distal tip of the lateral malleolus (DTLM), the horizontal distance of the SN to the DTLM, and the lateral border of the Achilles tendon (LBA) at the level of the DTLM. Also measured was the horizontal distance of the SN to the LBA at the level of superior Achilles insertion (SAI) onto the calcaneus as well, as 5 cm above the SAI. Intraclass correlation coefficient was calculated to assess reliability between reviewers. A total of 204 3T MRIs of the ankle were included.

Results:

The mean vertical distance from the SN to the DTLM was 2.2 +- 0.5 cm (ICC, 0.85; range 0.9-3.6 cm). The mean horizontal distance of the SN to the DTLM at the level of DTLM was 1.7 +- 0.3 cm (ICC, 0.98; range 0.8-3.0 cm). The mean horizontal distance of the SN to the LBA at the level of DTLM was 1.9 cm +- 0.3 cm (ICC, 0.91; range 1.0-2.9 cm). The mean horizontal distance from the SN to the LBA at the level of the SAI and 5 cm above the SAI was 2.6 +- 0.4 cm (ICC, 0.85; range 1.4-3.7 cm) and 0.9 +- 0.2 cm (ICC, 0.87; range 0.4-1.8 cm), respectively. Neither height nor BMI were strongly associated with the distance of the SN to any of our anatomic landmarks (R2 < 0.08 for all measurements).

Conclusion:

Several of our measurements summarized in differed from those reported in previous cadaveric studies. Although our mean horizontal distance of SN to LBA at SAI differed notably from cadaveric studies (2.6 cm vs 1.8-2.1 cm), a 2018 ultrasound study of the SN by Popieluszko et al observed a mean distance of 2.4 cm for this measurement. This concordance may indicate reliability between in-vivo methods of measurement vs. cadaveric studies. In-vivo measurements may also provide a more accurate representation of the anatomy, as these methods are not subject to the effects of embalming and dissection required of cadaveric studies.
Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?
Authors: Gianakos Arianna L. , Okedele Olasumnbo , Flynn Sean , Mulcahey Mary K. , Kennedy John G.
Published: January 2022

Category:

Ankle

Introduction/Purpose:

Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence and presentation of talar OCLs and resultant outcomes following AOT. The purpose of this study is to compare these differences between male and female patients.

Methods:

Eighty-seven consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation.

Results:

Fifty-six (64%) males and 31 (36%) females with a mean clinical follow-up was 47.2 months were included in this study. OCL defect size was significantly larger in male patients (112.8mm2) when compared with female patients (88.7mm2) (p<0.0001). Male patients presented with a significantly longer duration of symptoms (p<0.001) and OCLs were more likely to be associated with a recognized trauma (p=0.0006) when compared with female patients who typically presented with associated chronic ankle instability. Mean FAOS improved pre- to postoperatively from 50 to 81(p< 0.001) with a statistically significant increase found in male patients (p<0.0001). The mean MOCART score was 82.1 in male and 86.7 female patients. (p<0.0001).No differences were found in knee donor site morbidity, complication rate, or revision surgery between male and female patients.

Conclusion:

Our study demonstrates that male patients typically present with talar OCLs that are larger in size, associated with a recognized trauma, and with longer symptom duration when compared with female patients. Talar OCLs in female patients typically were smaller in size and associated with chronic ankle instability. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.
Lower Extremity Injury Rates on Artificial Turf and Natural Grass Playing Surfaces: A Systematic Review
Authors: Gould Heath P. , Lostetter Stephen J. , Samuelson Eric R. , Guyton Gregory P.
Published: January 2022

Category:

Sports

Introduction/Purpose:

Artificial turf (AT) playing surfaces have emerged as a common alternative to natural grass (NG) at all levels of athletic competition from youth to professional. While several prior articles have compared the lower extremity injury rates on AT and NG, the heterogeneity of these studies in terms of design and methodology has led to widely variable results. The purpose of this systematic review was to determine whether any definitive conclusions can be drawn with regard to the risk of lower extremity injury on AT and NG playing surfaces.

Methods:

A systematic review of the English-language literature was performed according to the PRISMA guidelines. All included studies presented a direct comparison of injury rates on AT versus NG playing surfaces. No restrictions were made with regard to sport, level of competition, level of evidence, or year of publication. Studies that examined only head injury rates (e.g. concussions) without any comparison of overall injury rates or lower extremity injury rates were excluded. Systematic reviews and meta-analyses were also excluded. The following data elements were extracted from each article: publication year, study design, level of evidence, industry funding, cohort selection process (ad-hoc vs. systematic), sport, level of competition, number of athletic seasons, injury setting, AT type, overall injury rate, knee rate, and foot & ankle injury rate. AT types were classified into Old Generation (1st or 2nd generation) or New Generation (3rd generation or higher).

Results:

53 articles met inclusion criteria. 31 articles compared overall injury rates on AT versus NG. Roughly one-half of these studies (51.6%) found no significant difference between NG and AT, while roughly one-third (35.5%) found a higher overall injury rate on AT and just 4 studies (12.9%) found a higher overall injury rate on NG. Similarly, of the 26 articles comparing knee injury rates, 14 studies (53.8%) reported no difference between AT and NG, 8 studies (30.8%) reported a higher injury rate on AT, and 4 studies (15.4%) reported a higher injury rate on NG. With regard to foot & ankle injuries, however, a majority of articles (14/24, 58.3%) reported a higher injury rate on AT. Comparatively few articles (3/24, 12.5%) reported a higher foot & ankle injury rate on NG, while the remaining articles (7/24, 29.2%) reported no difference in foot & ankle injury rate between AT and NG.

Conclusion:

The present study is a systematic review of 53 articles in the English-language literature that compared injury rates on AT and NG. Our findings suggest that the rates of overall injury and knee injury are similar between these two playing surfaces, though AT may be associated with a higher rate of foot & ankle injuries compared to NG.
Trends in Medicare Physician and Facility Fee Reimbursement in Orthopaedic Foot and Ankle
Authors: Hui Clayton , Kisana Haroon , Martin John R. , Stecher Chad , Hustedt Joshua
Published: January 2022

Category:

Ankle; Ankle Arthritis; Arthroscopy; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma

Introduction/Purpose:

The purpose of the study was to examine the trends in physician and facility reimbursement for the orthopaedic foot and ankle subspecialty utilizing the 23 most common foot and ankle surgeries based on national payment amounts.

Methods:

The Current Procedural Terminology (CPT) codes and corresponding Medicare Severity - Diagnosis Related Group (MS-DRG) codes for the 23 most common orthopaedic foot and ankle surgeries were identified. With the CPT codes, physician reimbursement was obtained through querying the Medicare Physician Fee Schedule (MPFS) for the work, malpractice, and practice expense relative value units (RVU) and then multiplying the total RVUs by the yearly conversion factor. CPT codes were also utilized to gather hospital outpatient reimbursement data from the Hospital Outpatient Prospective Payment System (OPPS) database. Hospital inpatient reimbursement rates were obtained from the Hospital Inpatient Prospective Payment System (IPPS) database utilizing the MS-DRG codes. All amounts were then adjusted for inflation using the Consumer Price Index (CPI).

Results:

From 2008 to 2021, physician reimbursement for the 23 most common orthopaedic foot and ankle surgeries decreased by 20%, with a mean Compound Annual Growth Rate (CAGR) of -1.7%. Hospital inpatient reimbursement increased by 34.7% with a mean CAGR of 2.3%; while outpatient hospital reimbursement increased by 97.2% with a mean CAGR of 5.1%.

Conclusion:

Over the past 13 years, physician reimbursement for common orthopaedic foot and ankle surgeries has declined while hospital reimbursement has increased. The larger increase in outpatient reimbursement compared to inpatient reimbursement highlights how CMS aims to transition surgeries from the inpatient setting to the more efficient and less expensive outpatient setting. This downward pressure on physician reimbursement while incentivizing outpatient services could have many unintended consequences on the landscape of foot and ankle practice in the US.
Elevated Body Mass Index Does Not Adversely Influence the Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus
Authors: Koh Don T. , Xia Zhan , Li Zongxian , Tay Kae Sian , Tan Shi Ming , Yeo Nicholas , Rikhraj Inderjeet S.
Published: January 2022

Category:

Ankle; Arthroscopy; Hindfoot; Trauma

Introduction/Purpose:

Osteochondral lesion of the talus (OLTs) is a common condition found in patients with chronic ankle pain after previous ankle sprains. Conservative measures such as analgesics, activity modification and immobilisation of the affected ankle are usually applied as first line treatments. Surgical management are indicated after conservative management have failed. This study evaluates the influence of body mass index (BMI) on the early clinical outcomes of arthroscopic debridement and microfracture of OLTs.

Methods:

An IRB approved study was conducted between 2007 and 2017. A total of 252 patients with symptomatic OLTs who failed conservative management underwent arthroscopic debridement and microfracture of OLTs over the affected ankle. Postoperatively, all patients underwent a standardised postoperative rehabilitation protocol. Patients who underwent previous fractures, previous infections or associated ligamentous injury of the affected ankle were excluded from this study. Patients from this cohort were divided into two groups based on BMI. The normal BMI group (NB-Group) (BMI 18.5-25.0kg/m2) and raised BMI group (RB-Group) (BMI >=25kg/m2). Visual Analogue Score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score as well as the Physical and Mental Components of the Short-Form 36 Questionnaire (PCS and MCS respectively) were prospectively collected from these cohort during their standard postoperative outpatient follow up.

Results:

A total of 252 patients were reviewed. Patients from either group were otherwise well matched demographically (Table 1). The operative duration was significantly shorter for NB-Group compared to RB-Group. Patients from both groups had significant improvement VAS, AOFAS and PCS scores postoperatively at 6 months and 24 months after surgery (Table 2).Between both groups, patients had comparable VAS, AOFAS as well as PCS scores at preoperative, 6 months postoperative and 24 months postoperatively (p > 0.05). However, MCS in the RB-Group showed a gradual deterioration over 24 months postoperatively and was significantly poorer compared to the NB-Group at 24 months (p = 0.036) (Figure 1).

Conclusion:

Arthroscopic debridement and microfracture is a reliable procedure, providing significant improvement in pain relief and functional improvement in patients. A raised BMI did not adversely affect pain and functional outcomes. However, patients with raised BMI required a longer duration of procedure and had significantly poorer MCS scores at 24 months after surgery.
Are SER-II Ankle Fractures Actually Anatomic? Bilateral CT Demonstrates Subtle Non-Anatomic Mortise & Syndesmotic Alignment in the Setting of Apparent Normal Radiographs
Authors: Kwon John Y. , Chien Bonnie Y. , Ingall Eitan M. , Staffa Steven , Williams Caroline , Miller Christopher P.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Current treatment of ankle fractures is predicated on 1-2 mm of talar shift leading to abnormal contact pressures. Determination of anatomic alignment has conventionally been based on plain radiographs. The ability of x-ray to detect subtle mortise displacement however is unknown. The purpose of this investigation is to determine if CT scan can detect malalignment undetectable utilizing plain radiography when assessing injuries assumed to have anatomic mortise alignment. The findings have implications for utilizing higher resolution diagnostic imaging to assess malalignment and challenging the validity of previous literature in which conclusions of anatomic mortise alignment were determined based on plain radiography.

Methods:

24 patients with stress-negative, stable SER-II type ankle fractures were included. Contralateral ankle mortise radiographs were obtained in addition to static and gravity stress radiographs of the injured side. Bilateral CT scans were performed once patients were deemed to have achieved clinical/radiographic healing. Measurements of the medial clear space (MCS) and syndesmosis were performed by two blinded orthopedic surgeons at two different time points. Intraclass correlation coefficients (ICC) were calculated to evaluate the intra- and inter-rater reliability and consistency of measurements. Statistical analyses were performed to determine any differences between x-ray and CT scan measurements to detect discrepancies between the injured and normal ankle measurements. Statistical significance was defined as a two-sided alpha error of less than 0.05 (p < 0.05).

Results:

Despite plain radiographs demonstrating no statistical side-to-side differences and achieving apparent final anatomic alignment in the majority of the cohort, CT MCS on coronal, axial planes and syndesmosis measurements were significantly different when comparing the injured to the normal contralateral ankle by on average of about 0.5mm. There was also excellent intra and interobserver agreement achieved for the measurements.

Conclusion:

CT is superior to plain radiography in detecting subtle mortise/syndesmotic displacement and side-to-side differences undetectable by x-ray. These findings challenge conventional assumption of anatomic alignment for SER II injuries and reliance on x-rays to assess anatomic alignment. While injured ankles uniformly demonstrated non-anatomic alignment as compared to the uninjured side, the clinical implications of subtle malalignment are unknown. However, broad reaching implications of this preliminary study include challenging the validity of x-ray to detect possibly clinically-relevant mortise malalignment in patients presenting with isolated lateral malleolus fractures.
Functional Outcomes Following Operative Management of Ankle Fractures: Intermediate Length Follow-Up
Authors: LaTulip Scott M. , Rascoe Alexander S. , Audet Megan , Vallier Heather
Published: January 2022

Category:

Ankle; Ankle Arthritis; Trauma

Introduction/Purpose:

Ankle fractures are among the most commonly surgically treated orthopaedic injuries, with debate regarding their long-term outcomes and the clinical benefit of contemporary fixation strategies. The purpose of this study was to retrospectively evaluate the functional outcomes of patients following surgical management of ankle fractures, and to determine what, if any, limitations and effects their injury has on their daily lives. The authors of this study hypothesized that despite patients having some degree of measurable impairments, these did not cause meaningful disruption in their everyday lives.

Methods:

We retrospectively reviewed a total of 259 patients who underwent surgical management of their ankle fractures between 2004 and 2012. Two separate patient reported outcome measures, the Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) were obtained at a minimum of 5 years following time of surgery. Multivariate linear regression analysis was performed to compare FFI and SMFA against several patient and injury specific variables.

Results:

A total of 259 patients with ankle fractures were included in the study population. 7 of the demographic and injury- related variables were found to have a statistically significant relationship to both the FFI and SMFA scores. The multivariate linear regression analysis using these 7 variables in addition to both sub-group components of the SMFA to predict the total FFI score yielded an output adjusted-r2 = 0.78. The SMFA dysfunction sub-category was found to correlate with FFI (standardized beta 0.85, p<0.001), but the SMFA bothersome sub-category did not (p=0.866). Ankle pain limiting function and Medicaid insurance status were also predictive of higher FFI scores.

Conclusion:

Despite patients, at times, experiencing persistent issues with pain and mild activity limitations following surgical management of ankle fractures, these did not lead to measured burdens in daily activities. At a moderate-length follow-up, patients overall do well from a functional standpoint after sustaining ankle fractures treated surgically.
Cost of Operative Fixation of Ankle Fractures: Comparing Orthopaedics and Podiatry
Authors: Luginbuhl Joshua C. , Deemer Alexa R. , Gokcen Eric C.
Published: January 2022

Category:

Trauma; Other

Introduction/Purpose:

Ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons are licensed to treat them. Despite increasing emphasis on value-based medical care, there are few cost analyses focused on the treatment of ankle fractures. The goal of this study is to determine if there are cost differences between an orthopaedic surgeon and podiatrist to operatively manage an ankle fracture.

Methods:

Retrospective cohort study of patients who underwent ankle fracture fixation over a 22 month period at an academic level 1 trauma center. Patient data was subcategorized by surgeon type and treatment groups. Four treatment groups were included: lateral malleolus open reduction and internal fixation (ORIF), bimalleolar/trimalleolar ORIF (no posterior malleolus fixation), lateral malleolus ORIF with syndesmotic fixation, bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation. Primary outcome was total (OR time cost + Implant cost) cost per case.

Results:

A total of 134 cases met criteria. Eighty-five cases were treated by a total of 4 orthopaedic surgeons while 49 were treated by 8 podiatrists. There was significantly longer OR time (minutes) for lateral malleolus ORIF (111 vs 134.92), lateral malleolus ORIF with syndesmotic fixation (130.53 vs 156.7), and bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation (162.13 vs 208) when podiatry was the treating team. Average total cost per case was significantly more for lateral malleolus ORIF (+$1188.45), lateral malleolus ORIF with syndesmotic fixation (+$2259.16), and bimalleolar/trimalleolar ORIF with syndesmotic fixation (+$2837.29) when podiatry was the treating team.

Conclusion:

Lateral malleolus ORIF, lateral malleolus ORIF with syndesmotic fixation, and bimalleolar/trimalleolar ORIF with syndesmotic fixation costs less per case when performed by an orthopaedic surgeon based on OR time costs and implant costs.
Risk Reduction and Perioperative Complications in Diabetics with Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction
Authors: Lyons Madeline M. , Pinzur Michael S. , McGregor Patrick C. , Adams William , Wilkos-Prostran Lynette
Published: January 2022

Category:

Diabetes; Other

Introduction/Purpose:

Modern Patient Safety Programs focus on medical optimization prior to surgery, regional anesthesia and hospitalist-orthopaedic co-management during the perioperative period.

Methods:

Eighty-five consecutive diabetic patients with multiple medical co-morbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized perioperative medical optimization program, which included medical optimization prior to surgery, regional anesthesia whenever possible and hospitalist-orthopaedic comanagement during hospitalization. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk.

Results:

On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (RR = 1.36; P =.01) and congestive heart failure (RR = 1.42; P =.02). There were 22 (27%) complications, though only 10 (12%) were serious. These included acute kidney injury (n = 6), sepsis (n = 2), one cardiac event, and one pulmonary embolism. Overall, the accuracy of predicting a complication using the NSQIP risk calculator was 74% (95% CI: 63% - 85%) which was comparable to the accuracy of predicting a complication using only patients' congestive heart failure and pin-tract infection statuses (c = 74%, 95% CI: 62% - 86%).

Conclusion:

Medical optimization of diabetic patients with multiple medical co-morbidities prior to elective complex reconstruction orthopaedic surgery leads to improved clinical outcomes. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The American College of Surgeons NSQIP Risk Calculator is a reliable predictor of complications in the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to risk for complication.