bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification and Analysis of The Microbiome in Patients Undergoing Removal of Hardware
Authors: LaRochelle Luke M. , Morningstar Joshua L. , Hoch Caroline , Rodriguez-Materon Solangel , Scott Daniel , Gross Christopher E.
Published: December 2023

Category:

Basic Sciences/Biologics; Ankle

Introduction/Purpose:

Next-generation DNA sequencing (NGS) technologies have increased the sensitivity of bacterial cultures and helped to better understand the normal flora of different joints. Researchers have utilized NGS to identify organisms associated with reoperations in shoulder surgery, but there is very little data on the field of foot and ankle. This study uses NGS to determine whether there is a unique microbiome that exists on orthopaedic hardware in the foot and ankle.

Methods:

A prospective study recruited 34 patients undergoing hardware removal surgery from the foot or ankle during 2020- 2023 with one of two fellowship-trained foot and ankle surgeons at an academic medical center. Patients were excluded based on the diagnosis or suspicion of infection prior to surgery. Explanted hardware was sent for analysis at a CLIA-licensed molecular diagnostic laboratory. Demographics, medical comorbidities, surgical indication, postoperative complications, readmission, and reoperation rates were collected from patient records. The majority of patients underwent surgery for diagnosis with painful orthopaedic hardware (70.6%). The cohort was majority female (67.6%) and average age was 53.15 (range 18-78) years.

Results:

Of the 34 samples sent for NGS, 5 (14.7%) indicated 9 bacteria were present (positive), while the remaining 29 (85.3%) had no bacteria present (negative). The most common organisms were of the genus Staphylococcus, representing 4 bacteria (44.4%), and Corynebacterium, representing 2 bacteria (22.2%). C. acnes was only present in one sample. There was no relationship between bacterial presence and patients undergoing hardware removal for diagnosis of painful orthopaedic hardware. No demographics nor postoperative outcomes were statistically associated with the presence of bacteria on removed hardware samples. The overall rate of complication, reoperation, and readmission were 8.8%, 2.9%, and 2.9%, respectively.

Conclusion:

This study found that there is no common microbial community present in patients undergoing hardware removal surgery. The most commonly present bacteria were of the genus Staphylococcus, bacteria overall were isolated in 14.7% of specimens. C acnes appeared to be uncommon. Further research should be done with a larger sample to support these findings.
Increased Calcaneal Pitch and Subtalar Instability are Predictors Associated with Surgical Reconstruction for Patients who Develop Chronic Lateral Ankle Instability
Authors: Porter David A. , Poirier Jon-Luc R. , Kulwin Robert , Hartman Margaret , Xu Guang
Published: December 2023

Category:

Ankle; Sports

Introduction/Purpose:

Most acute lateral ankle sprains are treated non-operatively, however, up to 20% of acute sprains (LAS) develop Chronic Lateral Ankle Instability (CLAI) requiring surgical reconstruction. CLAI risk factors have not been analyzed in the context of a multifactorial system. This study aims to identify a model to identify patients who are at increased risk for CLAI after acute lateral ankle sprains utilizing clinical and radiographic findings, in order to identify patients who may benefit from early surgical intervention (LAR).

Methods:

This retrospective study identified 78 patients who presented with acute lateral ankle sprains and 50 patients with CLAI who underwent lateral ankle reconstruction (LAR), diagnosed 2010-2020. Patients’ clinical exam findings and radiographic data were collected from direct clinical notes evaluation from a single Orthopedic Foot and Ankle surgeon's records. Descriptive statistics were utilized to determine difference, with a regression model used to determine risk factor significance.

Results:

A clinical diagnosis of subtalar instability (SI) was made in 32% of CLAI patients as compared to 2.5% (p=0.0001) of acute sprains. Assessment of calcaneal pitch (CP) yielded a significant difference between CLAI [µ:30.7, Median: 30.9] and acute sprains [µ=25.8, p< 0.0001, Median=25.8]. Correlation analysis yielded a predictive model for CLAI; -10.618 + 0.328CP + 3.33SI, indicating both increased calcaneal pitch [OR: 1.388 (95% CI: 1.185-1.625)] and subtalar instability [OR: 27.931 (95% CI: 4.235 – 184.210)] are significant predictors of CLAI. The sensitivity of this model is 62.5% and specificity is 83.3%, with both variables demonstrating a significance (P < 0.001 for both variables).

Conclusion:

These data indicate subtalar instability and increased calcaneal pitch angle are predictors of CLAI development and a higher risk of requiring LAR after LAS. These predictors can aid clinicians in determining ideal candidates for more aggressive non- operative treatment and those who may necessitate earlier surgical lateral ankle reconstruction. Identification of these patients will assist the clinician in management, counseling, treatment, and evaluation after LAS and after developing more chronic symptoms. Future prospective studies are needed to further characterize these risk factors as indicators for failure of and optimal non- operative management as well as patients who may qualify for early LAR.
Influence of Retrograde Intramedullary Beam Position Within Talar Body on Radiographic Failure of Medial Column Fusion
Authors: Wetzig Alexa , Gable Morgan , Cornelius Canon C. , Greaser Michael
Published: December 2023

Category:

Midfoot/Forefoot; Diabetes

Introduction/Purpose:

Intramedullary fixation in the form of retrograde beam or bolt has developed as an intriguing treatment option for unstable midfoot collapse. This is particularly true when it is desired to minimize the length of incision or to avoid surface implants in a compromised soft tissue envelope. However, prior studies have demonstrated high rates of complications associated with intramedullary midfoot fusion constructs (Ford et al., Butt et al). The goal of this study was to create a reproducible convention of classifying position of the terminal implant within the talar body and to uncover an association of relative position of the implant at the time of surgery with an increased risk of failure.

Methods:

Consecutive patients treated surgically from January 2017 to September 2022 with retrograde intramedullary fusion beam were identified; 44 were included in the final analysis. Average age was 62.7 years and mean radiographic follow up measured 12.86 months. Figure 1 demonstrates our classification of relative talar position. First, a line was drawn along the axis of the talar neck and carried posteriorly dividing the talar body into dorsal and plantar hemispheres. Then, a line was drawn from the anterior articular margin of the talar body to the lateral talar process. Parallel lines were then created in an equidistant fashion to divide the talar body into equal relative quartiles. At the time of surgery, the tip of the intramedullary beam was classified into relative axial and coronal position by a single observer. Our primary outcomes were hardware failure defined by implant fracture or cutout from the bone or additional surgery.

Results:

Successful midfoot fusion with intramedullary beam was achieved in 77% of our cases. 10 cases demonstrated hardware failure or the need for additional surgery. Relative implant position was classified as dorsal in 43% of cases and plantar in 57% of cases. Talar quartile depth was classified as 1st in 6% cases, 2nd in 32% of cases, 3rd in 30% of cases, and 4th in 32% of cases. There was no clinical or statistically significant difference between rates of failure based on relative implant position.

Conclusion:

Retrograde intramedullary fusion for medial column collapse remains a viable treatment option and our data supports successful fusion in most patients but a risk of failure remains significant. In this study, the relative position of the terminal implant within the talar body did not correlate with an increased risk of failure. There are likely other patient specific, or biomechanical factors leading to hardware fracture, cut out, or return of deformity. Continued analysis as sample size increases remains paramount to forming additional conclusions.
InternalBrace for Anatomic AITFL Augmentation and Syndesmotic Stabilization: Results at Long-term Follow Up
Authors: Zingas Nicolas , Schuch Matthew , Zingas Christopher
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

In the light of recent randomized control trials, both suture-button and syndesmotic screw fixation are considered standard-of-care for syndesmotic fixation, but no gold standard currently exists. An alternative technique that has been described to stabilize the syndesmosis is with use of suture-tape (InternalBrace, Arthrex) to augment a torn AITFL. This method has been the subject of several biomechanical studies that show it better restores anatomic relationships and can provide a preinjury level of syndesmotic stability. Additionally, it is thought to allow for protected healing of native ligaments, which may be of benefit to patients in the long-term. With this study we sought to explore the long-term outcomes of anatomic augmentation of the AITFL with the InternalBrace for the treatment of syndesmotic injury.

Methods:

We identified 31 patients who had suffered an acute or subacute syndesmotic injury and were treated with the InternalBrace technique (with or without adjunctive syndesmotic fixation) over a 12-month period from 2019-2020 by a single surgeon. The primary outcome variable was the Olerud-Molander Ankle Score (OMAS) at long-term follow up (12-36 months). Other outcomes collected were FAOS scores, range of motion data, and complications. Additionally, radiographs at five timepoints were reviewed to determine maintenance of syndesmotic reduction.

Results:

At final follow-up, 15 patients completed the primary outcome with a mean OMAS of 78 (SD, 18). All 31 patients were determined to have a successful syndesmotic reduction at the time of the index procedure. No patients were noted to have a radiographic loss of reduction with a tibiofibular clear space > 6mm at time of final radiographic follow up (mean follow-up 439 days). For those patients with ROM data collected at final follow up, 12/15 patients were limited in dorsiflexion (average deficit 6 degrees), and 7/15 in plantarflexion (average deficit 14 degrees). In total, 10/31 patients developed symptoms of anterolateral impingement, for which six underwent secondary arthroscopic debridement.

Conclusion:

We report the first mid-to-long term clinical results of a newer alternative method of syndesmotic stabilization. Functional results are comparable to current standards-of-care. AITFL augmentation provides consistent anatomic reduction of the syndesmosis with enough biomechanical strength to resist rotation and diastasis. However, in some patients the development of irregular thickening/scarring of the AITFL contributed to symptoms of anterolateral impingement and stiffness. To avoid this complication, alterations in technique, such as a more proximal application of the suture-tape or avoidance of overtightening, are possible and emphasize the importance of future research.
Lateral Column Overload in Modified Double vs Triple Arthrodesis: A Biomechanical Study
Authors: Gallagher Brian P. , Guyton Gregory P. , Bifano Shawn , Abbasi Pooyan , Wisbeck Jacob
Published: December 2023

Category:

Hindfoot; Basic Sciences/Biologics

Introduction/Purpose:

There are few comparative studies investigating differences between the modified double and triple arthrodesis of the hindfoot. Previous studies have suggested that stiffening the lateral column of the hindfoot can increase lateral plantar pressures, potentially precipitating lateral column pain. We sought to characterize the difference in forefoot plantar pressures between the native state, after talonavicular (TN)/subtalar (ST) arthrodesis and triple arthrodesis.

Methods:

Ten fresh-frozen cadaver legs were tested in 4 positions: neutral, dorsiflexion, inversion and eversion. Testing was done in a native state, after TN/ST arthrodesis then after triple arthrodesis for all 4 positions. Forefoot plantar pressures were recorded.

Results:

Peak pressures increased from the native state laterally underneath the 5th metatarsal (MT) head after TN/ST arthrodesis and triple arthrodesis respectively by 247% and 164% and fell medially underneath the 1st MT head to 38% and 41% in axially loaded legs at neutral (p < 0.025) without a difference between arthrodesis groups. Similarly, 5th MT head pressures were significantly increased from the native state after TN/ST and triple arthrodesis in the legs mounted in eversion by 129% and 109% respectively (p < 0.025), without differences between the two arthrodesis groups.

Conclusion:

In our cadaveric model of native, non-deformed legs, both a modified double (TN/ST) and triple arthrodesis led to increased lateral forefoot plantar pressures compared to the native state without a difference between the arthrodesis groups.
Ligamentous Injuries in Stable Ankle Fractures
Authors: Ho-Huynh Albert , Karanja Alex , Platt Simon , Walsh Tom
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

When considering ankle fractures requiring fixation, it has been shown that stability is the key determinant. Lauge-Hansen supination external rotation (SER) 2 injuries are by definition stable and has been shown to be successfully managed non-operatively. SER 3 and SER 4 ankle fractures are unstable with complete syndesmosis disruption and the majority are managed operatively. We hypothesise that a percentage of radiologically stable injuries involve more structures than previously thought. The primary aim is to determine the prevalence of SER3 and SER4 ankle injuries amongst radiographically SER 2 injuries.

Methods:

This cross-sectional study uses baseline data from a longitudinal study at Gold Coast University Hospital and Health Service (GCHHS). Patients attending the GCHHS fracture clinic were invited to participate provided they had a radiographically stable SER 2 fracture. Those meeting the eligibility criteria were referred for ankle magnetic resonance imaging (MRI) to assess the integrity of the syndesmotic and ankle ligaments.

Results:

To date, this study has recruited 33 participants. Following MRI, 23 were determined to have true SER 2 injuries. Nine participants were however reclassified as SER 3 and one participant was reclassified as having an SER 4 injury. Of the SER 3 injuries six included a non-displaced posterior malleolus fracture, while the remaining three were purely ligamentous.

Conclusion:

This study demonstrates that a portion of radiographically stable ankle injuries involve more structures than previously thought. When radiographic SER 2 injuries were further evaluated with MRI, nearly half were reclassified as SER 3 and 4 injuries. This may suggest that some SER 3 and 4 injuries are functionally stable and can be managed successfully non-operatively.
Medial Column Soft Tissue Imbrication with Internal brace Augmentation Following Lateral Column Lengthening in the Ambulatory Pediatric CP with Pes Planovalgus Foot Deformities: A Novel Indication
Authors: Mathew Smitha E. , McKeon Kelly A. , Tabaie Sean A.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Pes planovalgus foot deformity is common in children with cerebral palsy (CP), and with failed bracing or painful progression, surgery is often needed. This study examines the effect of flatfoot reconstruction utilizing a novel approach to address the redundant medial soft tissue on these measures when compared to matched cohort undergoing the traditionally described soft tissue plication (STP) (Figure 1).

Methods:

An IRB approved, retrospective review of ambulatory pediatric CP, GMFCS I-III, patients with pes planovalgus foot deformities was conducted. Patients underwent a lateral column lengthening (LCL) along with medial column STP, with/without internal brace (IB) augmentation at a single tertiary institution by the same surgeon from 2017 to 2020. Patients were divided into two groups: without IB, and with IB augmentation. Radiographic indices on orthogonal weightbearing (WB) x-rays were measured at multiple timepoints: Preoperative, immediate postoperative and at the 3/6/12/24 months postoperative follow-up periods. Variables measured included AP and lateral talus-first metatarsal angles (TFMA), talonavicular coverage angle (TCA) and calcaneal pitch (CP). Means and standard deviation for continuous radiographic variables were calculated, followed by one-sided t-tests to compare the values between the two groups at all intervals.

Results:

58 patients were identified, 31 without IB and 27 with IB augmentation. Both groups were well matched with respect to age, CP type, GMFCS level and gender. Preoperative WB radiographs showed no statistical difference between the two groups: Mean AP TFMA (26° vs. 28°, p=0.073), lateral TFMA (27° vs. 30°, p=0.067), TCA (34° vs. 30°, p=0.059) and CP (4° vs. 2°, p=0.069)(Table 1). Both cohorts maintained improved radiographic indices at the final 2-year timepoint. However, radiographs showed that the IB group had less midfoot collapse, maintaining a statistically significant difference in all radiographic parameters at final 2-year follow-up: Mean AP TFMA (13° vs. 5°, p< 0.001), lateral TFMA (11° vs. 2°,p < 0.001), TCA (15° vs. 6°,p < 0.001) and CP (10° vs. 19°,p < 0.001) Table 2).

Conclusion:

Internal brace augmentation is an innovative surgical technique that provides additional stability to the medial column soft tissues following LCL. This procedure will help prevent mid-foot collapse and better maintain long-term foot shape when WB. Utilizing this novel technique helps maintain proper biomechanical orientation of foot following reconstruction of pes planovalgus deformities in the ambulatory pediatric CP population.
Midfoot and Hindfoot Charcot Deformity Correction is Well Maintained with Beam Fixation
Authors: Guareschi Alexander S. , Moore Andrew , Goodloe Jonathan , Hoch Caroline , Morningstar Joshua L. , Scott Daniel , Gross Christopher E.
Published: December 2023

Category:

Midfoot/Forefoot; Diabetes

Introduction/Purpose:

Charcot arthropathy is a neurotraumatic foot disorder seen in patients with peripheral neuropathy. Surgical reconstruction via medial column arthrodesis with beams can restore plantigrade foot anatomy with decreased soft tissue dissection and improved bony compression.

Methods:

We identified 12 patients with midfoot (n=7) or hindfoot (n=5) Charcot who underwent medial column beaming arthrodesis between 2015 and 2021 b y one of two fellowship-trained foot and ankle surgeons at an academic medical center. Data collected from patient charts included demographics, medical history, complications, and reoperation rate. Meary’s angle was measured on lateral weightbearing radiographs preoperatively and up to two years postoperatively. Mean follow-up time was 2.50 (range, 1.04-6.98) years. Statistical analysis included correlation, two-tailed Student t-test, and Chi-squared test.

Results:

Meary’s angle was recorded preoperatively for 12 patients (19.3° ± 6.7°) and postoperatively at three months for 12 patients (4.0° ± 6.7°), at six months for 12 patients (7.1° ± 9.7°), at one year for 11 patients (6.1° ± 9.4°), and at two years for five patients (10.2° ± 6.4°). However, two (16.7%) patients showed a loss of deformity correction, which was demonstrated by a Meary’s angle that was greater at final follow-up than preoperatively. Overall complication, infection, reoperation rates were 50.0%, 41.7%, and 58.3%, respectively. Finally, dependent on preoperative ulceration, those with and without an ulcer did not differ in Meary’s angle at any time point, overall complication, infection, nor reoperation rate.

Conclusion:

Although the results showed a relatively high complication rate, the use of beaming arthrodesis was generally able to maintain a plantigrade foot and overall alignment, while decreasing the recurrence of plantar ulceration.
Midterm Outcomes of the Salto Talaris Total Ankle Arthroplasty
Authors: Kim C. James , Winters Brian S. , Tsai Justin , O’Neil Joseph T. , Fuchs Daniel , Sidhu Verinder S. , Campbell Benjamin R. , Shakked Rachel , Daniel Joe
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle arthroplasty (TAA) has become an accepted alternative to ankle arthrodesis for end-stage ankle arthritis and has seen significantly increased utilization in the past decade1. The Salto Talaris total ankle prosthesis has shown excellent short-term and mid-term survivorship results since its FDA approval in the U.S. in 20062,3. At a minimum of five-year follow-up, the currently reported midterm survivorship has ranged from 93.3% to 100% with equally satisfactory clinical outcomes as evidenced in short-term outcome studies4–8. The purpose of this study is to report the outcomes of one of the largest cohort of patients who underwent a Salto Talaris total ankle arthroplasty with a minimum of five-year follow-up.

Methods:

103 Salto Talaris TAA patients with 5-view weight-bearing series of radiographs and minimum follow-up time of 5 years since index surgery were included. Age at time of surgery, gender, body mass index, diagnosis, diabetes status, and tobacco use were collected through chart review. Radiographic imaging was assessed at the most recent follow-up for evidence of radiolucency and osteolysis as previously described9. Range of motion was assessed on plantarflexion and dorsiflexion views on sagittal radiographs as previously described10. The Foot and Ankle Ability Measure (FAAM) and Visual Analog Scale for pain (VAS) scores were obtained at the most recent follow up visit and compared with preoperative scores. Baseline characteristics were compared between groups using Wilcoxon rank-sum test for continuous data or Fisher exact test for discrete data. Survivorship probability was calculated using a Kaplan-Meier analysis for revisions and reoperations. Revisions were defined as exchange or removal of metal component.

Results:

The survivorship for revision surgery was 93.2% (95% CI [89.8,98.8]). 5 out of the 7 patients requiring revision surgery experienced talar subsidence, 1 patient experienced an infection, and 1 patient experienced lateral impingement. The survivorship for reoperation was 90.2% (95% CI [83.4-95.4]). 5 out of the 10 patients requiring reoperation experienced pain from impingement, 2 experienced periprosthetic fractures, 1 experienced infection, and 2 experienced osteolytic cysts. At last follow- up, the FAAM-ADL, FAAM-Sport, and VAS pain scores were improved from preoperatively. The average range of motion at last follow-up was 31.6 degrees. On the AP view, radiolucency and osteolysis were most frequently detected in zones 3 and 4, while on the lateral view they were most frequently seen in zones 2 and 6.

Conclusion:

Patients undergoing Salto Talaris prosthesis showed improvements in patient-reported outcomes with satisfactory survival rates.
Minimally Invasive Transverse Distal Metatarsal Osteotomy for Hallux Valgus Correction: Is there a Difference in Outcome Between Moderate and Severe Deformities?
Authors: Yoon Yeokwon , Shim Dong Woo , Park Kwang Hwan , Han Seung Hwan , Lee Jin Woo
Published: December 2023

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

We compared the radiological and clinical outcomes of moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon.

Methods:

Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) greater than 40° or preoperative first-to-second intermetatarsal angle (1–2 IMA) greater than 16°; the moderate group was defined as having an HVA less than 40° and a 1–2 IMA less than 16°. Pre- and postoperative measurements of the HVA, 1–2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The Visual Analogue Scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey-36 Physical Component Summary were used to assess clinical outcomes.

Results:

Both groups showed significant improvements in all radiologic parameters postoperatively with the degrees of correction greater in the severe group than in the moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups.

Conclusion:

This study showed that short-term radiographic results for patients with either moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. MITO with screw fixation is a satisfactory surgical option for patients with HV deformities.
Multiple Ankle Injuries are Associated with an Increased Risk of Subsequent Concussion in National Football League Players
Authors: Bergstein Victoria E. , Shu Henry , Bodendorfer Blake , DeFroda Steven , Aiyer Amiethab A.
Published: December 2023

Category:

Sports; Ankle

Introduction/Purpose:

Ankle injuries are among the most common musculoskeletal injuries in National Football League (NFL) players. Concussions are also concerningly frequent, especially given increasing post-mortem observations of chronic traumatic encephalopathy (CTE) in former NFL players. There is a gap in the literature regarding musculoskeletal risk factors for concussion, which is an avenue that must be explored to promote player safety. The purpose of this study is to observe if ankle injuries, especially multiple ankle injuries, are associated with an increased risk of subsequent concussion in NFL players.

Methods:

The public online database ProFootballReference.com was utilized to identify ankle injuries and concussions in NFL players, as well as demographic variables such as BMI and age. Multivariable logistic regression for subsequent concussion and ankle injury was performed, adjusting for BMI and player position. For descriptive statistics, unpaired T-tests with unequal variance were performed for continuous variables, including BMI and age. Chi-squared testing was performed for categorical variables, including player position, and whether the position was offensive (quarterback, running back, tight end, wide receiver, offensive line), defensive (defensive back, defensive line, linebacker), or on special teams (kicker, punter, long snapper).

Results:

5,538 NFL players from the 2009-2010 to 2019-2020 seasons were included in the study. The mean BMI and age of the cohort was 31.06 (SD 4.55) and 24.41 (SD 3.63), respectively. Of these players, 941 had an ankle injury, 633 had a concussion, and 240 had both an ankle injury and a subsequent concussion. The adjusted odds ratio (aOR) for concussion following a single ankle injury was 0.90 (95% CI 0.72 – 1.14, p = 0.387), however, the aOR for concussion following multiple ankle injuries was 2.88 (95% CI 1.28 – 6.74, p = 0.015). The kicker position was determined to have the lowest risk for concussion following ankle injury, and the positions with comparatively greater risk are outlined in Table 1.

Conclusion:

Multiple ankle injuries were associated with an increased risk of a subsequent concussion by 188% after adjusting for BMI, player position, and offense/defense/special teams designation. Special teams as a group and by position (kicker, long snapper, punter) had the lowest risk of concussion following ankle injury, likely owing to the lower-impact nature of these positions. These findings can inform injury prevention practices in the National Football League.
Non-operative Success of Treating Midfoot and Transverse Tarsal Joint Osteoarthritis
Authors: Kulkarni Ronit , Hoch Caroline , Morningstar Joshua L. , Caughman Alex , Baxley David , Rodriguez-Materon Solangel , Scott Daniel , Gross Christopher E.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Midfoot osteoarthritis affects over 16% of adults over the age of 50, interfering with activities of daily living and leisure. One form of non-operative management is cortico-steroid injections, which are often done under fluoroscopic guidance to improve accuracy. Operative intervention is sometimes performed, although non-union rates and continued pain after surgery can be challenging. This study aims to quantify how well midfoot and transverse tarsal joint arthritis can be treated non- operatively with fluoroscopic-guided injections.

Methods:

We reviewed the records of 132 patients (155 feet), who were newly diagnosed with midfoot arthritis between 2015 and 2019. Conservative management included periodic fluoroscopic-guided steroid injections at an academic medical center by a single fellowship-trained foot and ankle surgeon. These joints were identified by computed tomography prior. Mean age was 62.7 years and mean BMI was 30.9 kg/m2. Twenty-five feet (16.1%) eventually underwent surgical treatment, and one of those (4.0%) underwent reoperation.

Results:

On average, each foot received 3.1 (range, 1-21) injections, this did not differ between the surgical and conservative cohorts (operative=3.9, non-operative=3.0; p=.147). Of the 95 feet (61.3%) that received more than one injection, mean duration was 21.6 (range, 0.9-67.4) months. Injection duration did not differ between cohorts (operative=21.8 months, non-operative=21.6 months; p=.952). Cases treated surgically did not receive any injections postoperatively. Patients with higher pre-treatment Pain Catastrophizing Scale (PCS) scores in all subsection5-depression=2.9, p=.046) over a greater injection duration (depression=22.2 months, non-depression=11.4 months, p=.046).

Conclusion:

Overall, fluoroscopic-guided injections are sufficient for the non-operative treatment of midfoot and transverse tarsal joint arthritis, as only 16.1% of our cohort failed conservative treatment and required surgery. Therefore, although not always successful, non-operative treatment with fluoroscopic guidance injections is able to provide patients relief for an extended period.
Opioid Consumption Following Foot and Ankle Surgery: A Systematic Review
Authors: DeMaio Christian , Nayfa Rob , Reasnor Ty D. , Fox Jake A. , Thompson Samuel , Amin Amgad Haleem
Published: December 2023

Category:

Other; Hindfoot

Introduction/Purpose:

The opioid epidemic in the United States has gained significant attention over the past few years. Subsequently, there have been several publications characterizing postoperative opioid consumption in patients who underwent foot and ankle surgery. Our goal was to systematically review the literature to identify trends in opioid consumption between procedures of the forefoot, midfoot, hindfoot and ankle and ultimately create finalized prescribing guidelines that treat patients’ pain adequately while limiting leftover pills.

Methods:

A systematic review was performed in concordance with the MOOSE guidelines. We included retrospective and prospective observational cohort studies that reported on mean opioid consumption following foot and ankle surgery, as well as unpublished data from our institution that fit the review’s parameters. We excluded studies that did not report this data or reported patients receiving alternative surgical techniques. The ROBINS-E tool was used to assess bias and the MINORS criteria was used to evaluate study quality.

Results:

Six studies met inclusion criteria from 395 identified articles. Reported data from 2,445 patients were analyzed for overall opioid consumption, region of surgery, and invasiveness of procedure. Five studies standardized opioids prescribed and consumed to a 5-milligram oxycodone "pill." Of the three studies reporting mean pill consumption by region of surgery, 16.1, 27.8, and 26.4 pills were consumed by forefoot, midfoot, and hindfoot patients, respectively. The largest mean and median pill consumption was observed in hindfoot patients (45.7 and 22, respectively). 4 of 5 studies found significantly higher opioid use in hindfoot and ankle patients, and 2 of 5 studies found significantly higher consumption among those undergoing bony versus soft-tissue procedures. Across all studies, patients used 45.7%-75.2% of their opioid prescriptions.

Conclusion:

In this systematic review, we identify literature reported mean number of recommended pills to be subscribed for each anatomical region, as prescriptions could be decreased by around half and still adequately control pain. This can be of significant aid in providing final guidelines to orthopedic surgeons to finalize prescription patterns in foot and ankle surgery based on the published literature.
Outcomes following Intra-Articular Hyaluronic Acid Injection for the Management of Hallux Rigidus: A Systematic Review
Authors: Randall Grace W. , Butler James J. , Petropolous Stephen J. , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The purpose of this systematic review was to evaluate outcomes following intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus. Data regarding injection characteristics, subjective clinical outcomes, failure rates and complications were extracted and analysed.

Results:

In total, 5 studies were included in this review. In total, 209 patients underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus at a weighted mean follow-up of 4.4 ± 1.4 months. The weighted mean VAS improved from a pre-injection score of 6.4 ± 0.3 to a post-injection score of 2.8 ± 0.4. A 10.1% complication rate was noted, the most common of which was transient 1st MTPJ swelling. One infection (0.5%) was reported. A symptomatic recurrence rate of 18.6% was observed at a weighted mean time of 7.3 ± 4.2 months

Conclusion:

This systematic review demonstrated that intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus led to a reduction in pain and a moderate complication rate at short-term follow-up. In addition, intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus produced a symptomatic recurrence rate of 18.6% at approximately 7.3 months, suggesting that HA provides short-term relief. The lack of quality comparative studies limits the generation of robust conclusions, reinforcing the need for further research to identify the optimal role of HA in the management of hallux rigidus.
Outcomes following Polyvinyl Alcohol Hydrogel Implant for Hallux Rigidus: A Systematic Review
Authors: Butler James J. , Samsonov Alan P. , Randall Grace W. , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The purpose of this systematic review was to evaluate outcomes following polyvinyl alcohol hydrogel implant for the management of hallux rigidus.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 15 studies were included in this review.

Results:

In total, 1536 patients (1578 feet) underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus at a weighted mean follow-up of 39.4 ± 17.3 months. The weighted mean VAS score improved from a pre-operative score of 6.2 ± 1.3 to a post-operative score of 3.0 ± 1.6. There was limited data regarding improvements in range of motion. The complication rate was 15.7% and the failure rate was 9%.

Conclusion:

This systematic review demonstrated improvement in subjective clinical outcomes following PVA hydrogel implant for the management of hallux rigidus. A moderate complication rate and failure rate was noted at short term follow-up. Further studies with longer follow-up periods are warranted to elucidate the precise outcomes following PVA hydrogel implant for the management of hallux rigidus.
Outcomes following Surgical Intervention for Freiberg's Infraction: A Systematic Review
Authors: Butler James J. , Omar Vian , Konar Kishore , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Lesser Toes; Other

Introduction/Purpose:

The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates following surgical intervention for Freiberg's Infraction.

Methods:

During December 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for the management of Freiberg's Infraction. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed.

Results:

Eighteen studies were included. In total, 299 patients (302 feet) underwent surgical intervention for the management of Freiberg's Infraction at a weighted mean follow-up of 49.9±45.1 months. The distribution of patients by Smillie's (SI-V) classification was recorded in as follows: SI (0 patients), SII (20 patients), SIII (42 patients), SIV (69 patients), SV (54 patients). The most common surgical procedure was dorsal closing wedge metatarsal osteotomy. The weighted mean AOFAS score improved from a pre-operative score of 60.3±9.0 to a post-operative score of 84.3±24. The weighted mean total ROM improved from 46.4±11.7° pre-operatively to 66.2±15.1° post-operatively. The weighted mean time to osseous union was 7.4±3.6. The complication rate was 5.2%, the most common of which was pain. Four failures (1.6%) were observed.

Conclusion:

This systematic review found improvements in subjective and objective clinical outcomes together with a low complication rate following surgical intervention for Freiberg's infraction at mid-term follow-up. However, the level and quality of evidence of the included studies were low and there was marked heterogeneity and under-reporting of data between the included studies. Although surgical intervention appears to is the mainstay treatment option for Freiberg's infraction, further higher quality comparative studies are warranted to determine the optimal surgical technique for Freiberg's infraction.
Outcomes following Surgical Treatment for Symptomatic Accessory Navicular: A Systematic Review
Authors: Randall Grace W. , Butler James J. , Fur Rachel Lai Fat , Konar Kishore , Rampersad Chelsea , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The purpose of this systematic review was to examine the clinical and radiological outcomes of various surgical treatments for symptomatic accessory naviculars.

Methods:

During February 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical treatment for symptomatic accessory navicular. Data regarding surgical characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analyzed. 26 studies were included for review.

Results:

In total, 520 patients (614 feet) underwent surgical treatment for the management of symptomatic accessory navicular. The weighted mean age was 28.18 ± 8.18 and the weighted mean follow-up time was 46.23 ± 34.76 months. The mean AOFAS score was 49.9 ± 7.39 preoperatively and 88.9 ± 5.61 postoperatively. The mean complication rate at final follow-up was 9.02% and the failure rate was 4.23%, with only 2.7% of patient ultimately requiring a further procedure. We also compared outcomes in patient who underwent a Kidner or Modified Kidner procedure (n=245) with those treated with a different surgical technique such as fusion or simple excision (n=275). There was no significant difference in outcome scores, complication rates, failure rates, or secondary surgical procedure rates between these cohorts.

Conclusion:

This systematic review demonstrated improvement in clinical outcomes following surgical treatment for symptomatic accessory naviculars. The markedly low complication and failure rates further indicate that surgical intervention is beneficial in the management of symptomatic accessory naviculars. Kidner and Modified Kidner procedures resulted in equivocally good outcomes compared with other surgical approaches such as fusion and simple excision. However, the marked heterogeneity between the included studies and few high level comparative studies limits the generation of any robust conclusions for optimal surgical technique. Further research is warranted to determine whether the Kidner procedure confers any particular advantages over other approaches.
Patient Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5 Year Follow Up
Authors: McCrosson Matthew J. , Sanchez Thomas , Scheinberg Mila , Sisk Morgan , Shah Ashish
Published: December 2023

Category:

Hindfoot; Sports

Introduction/Purpose:

The purpose of this study is to demonstrate five-year patient-reported outcomes following the Broström- Gould procedure for the treatment of CAI in the general population. This is the first study utilizing PROMIS and FAAM scores at a minimum followup of five years and will provide valuable insight into the long term efficacy of the BG procedure. Additionally, our regression analysis portrays information on which individual patient factors independently influence patient reported outcome scores.

Methods:

Following approval from our institution’s IRB, the electronic medical record was queried for CPT code 27698 (Broström-Gould) from Jan 2010 to June 2017. Patients were included if they had a preoperative diagnosis of chronic lateral ankle instability and failed nonoperative management. Patients were excluded if they had undergone any surgeries since their BG repair (except revision BG repair), had a follow up of less than five years, were under the age of 18, or declined to answer all PROMIS and FAAM surveys. Surveys were conducted in the clinic and through phone interviews. Utilizing the EMR, patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). Comorbidities including, but not limited to, tobacco use, diabetes, hypothyroidism, rheumatoid arthritis were also recorded.

Results:

Our results show that the minimum 5-year patient reported PROMIS scores for patient’s following a Brostrom-Gould procedure are as follows: PROMIS PF - 50.5, PROMIS PI, 48.2, and PROMIS D - 38 2. This indicates, at a minimum, that patients 5-years removed from the procedure are within one standard deviation of the general population in regards to PROMIS physical function and pain. Our patient reported FAAM, ADL, and FAAM S scores were 59.6 and 13.0 respectively.

Conclusion:

This study is the first paper to report minimum five year patient reported PROMIS scores following the Broström- Gould procedure. We believe it is a valuable contribution to the literature as it provides both the treating surgeon and patient with evidence that the BG is a safe and effective procedure at the 5-year mark. Additionally, we have isolated potential factors that independently correlate with PROMIS outcomes including tobacco use, diabetes, and sports participation. We have shown the efficacy of the BG at 5-years and have provided the framework for future comparison studies hoping to utilize the PROMIS system to assess outcomes.
Patient Reported Outcomes with the Use of Fibular Nail Fixation, Retrospective Review of 41 Cases
Authors: Rodriguez-Materon Solangel , Lopez Kyra E. , Trynz Samantha , Fleites Jorge , Chapman Cary , San Giovanni Thomas P. , Hodgkins Christopher
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

Traditionally, open reduction and internal fixation of unstable lateral malleolus fractures with plate and screw constructs has been considered the gold standard treatment. More recently, the use of an intramedullary fibula nail has gained popularity as an alternative treatment method using a mini open incision to obtain anatomic reduction. The minimally invasive nature of this technique and the no profile load bearing/sharing implant is reported with very low complication rates and a much lower incidence of implant irritation and removal. We report our surgical and patient reported outcomes for a cohort of single surgeon consecutive fibula nails with proximal and distal locking fixation.

Methods:

We retrospectively reviewed prospectively collected data on 41 patients that were implanted with the Fibulock® Fibula Nail (Arthrex, Naples, Florida, USA). All nails were implanted by a single surgeon. Intraoperative reduction quality was recorded, and patients were followed post operatively with radiographs that were assessed for maintenance of reduction, healing, and complications. Patient reported outcome questionnaires (PROMs) were collected preoperatively and at 3, 6, 12, and 24 months postoperatively. The Foot and Ankle Ability Measure (FAAM) assessed the patient’s functional status in terms of activities of daily living and sports. The Visual Analogue Score (VAS) was also collected.

Results:

All 41 patients had one- to two- year follow-up (14.68 months ± 5.92). Demographics are listed on table 1. Forty of the patients were reduced via mini open incision and one was reduced closed. There were no conversions to a plate, no intraoperative complications, and no cases of loss of reduction postoperatively. No patient required revision surgeries, no cases of delayed union or nonunion, and zero superficial or deep postoperative infections. Statistical analysis revealed a significant difference between preoperative and postoperative FAAM scores overall (+67.52, p < 0.001), within activities of daily living (+68.07, p < 0.001), and sport (+65.95, p < 0.001). Also, there was a significant difference between preoperative VAS and postoperative VAS (+4.73, p < 0.001).

Conclusion:

Our results support existing literature that fixation of fibula fractures with an intramedullary nail with proximal and distal locking capabilities is an alternative option to a plate and screw construct, with a very low incidence of hardware related complications requiring removal, and favorable patient reported outcomes.