bluuebunny/crossref_metadata_2025 huggingface dataset:
Noninvasive therapeutic ultrasound to increase perfusion in chronic limb-threatening ischemia: An early feasibility study
Authors: Khalsa Bhavraj , Archie Meena , Nazer Babak , Razavi Mahmood K
Published: December 2024

Background:

Preclinical studies have demonstrated that therapeutic ultrasound (TUS) increases perfusion in peripheral artery disease (PAD). This pilot study assessed the safety and effectiveness of a noninvasive TUS device in patients with advanced PAD.

Methods:

A phased array of TUS transducers was fabricated on a wearable sleeve, designed to sonicate the posterior and anterior tibial arteries (and their collaterals) at the calf level. Twelve patients with PAD (Rutherford classes 3–5) were enrolled in a single-arm study in which they underwent 30–40 daily 90-minute TUS sessions to the diseased limb. Changes in pedal flow and tissue oxygenation (StO2) were measured by laser speckle and spatial frequency domain imaging, respectively. A subset of five patients underwent evaluation by laser Doppler, transcutaneous oximetry (TcPO2), and quality of life questionnaires (Vascular Quality of Life Questionnaire [VascuQoL] and the Walking Impairment Questionnaire [WIQ]).

Results:

Eleven out of 12 enrolled patients completed the study. During 90-minute TUS sessions pedal flow improved by 180% ( p < 0.001) on laser speckle imaging, and 18% ( p = 0.12) on laser Doppler. Tissue oxygenation improved by 18% ( p = 0.43) on TcPO2 and by 6% ( p = 0.097) on StO2. After all sessions, tissue oxygenation improved by 17% ( p = 0.020) on StO2, without significant changes in laser Doppler (+39%, p = 0.41) or TcPO2 (–3%, p = 0.70), which was largely in the normal range (56 ± 15 mmHg) at baseline. VascuQoL improved by 2.4 points (14%, p = 0.080) and WIQ improved by 8.2 points (11%, p = 0.053).

Conclusions:

TUS for patients with symptomatic PAD was safe and well tolerated. Most metrics of tissue perfusion and oxygenation improved, but future sham-controlled studies are needed and planned.
Body mass index and social media addiction as predictors of hedonic hunger in adolescents
Authors: Özbey Harun , Sezer Efe Yağmur , Bayat Meral
Published: December 2024

This study was planned to determine the relationship between hedonic hunger, social media addiction and body mass index (BMI) in adolescents. The study was conducted with 720 adolescents receiving education in high schools. Data was collected online using the Children’s Power of Food Scale (CPFS) and Social Media Addiction Scale (SMAS). Mean, percentage, t-test, ANOVA and regression analysis were used to analyse data. In the study, it was found that social media addiction explained 16.4% of the variance in hedonic hunger and had a significant impact ( F = 140.433, p ≤ 0.001). When the BMI variable was added to the model in the second step (Model II), it was determined that social media addiction and BMI significantly predicted CPFS scores ( F = 81.839, p ≤ 0.001) and explained 18.6% of the variance. The study results revealed that social media addiction and BMI significantly predict hedonic hunger in adolescents.
Analysis of the optimal heat treatment temperature for AlNiCo-based semi-hard magnetic materials based on temperature-dependent yield strength prediction model
Authors: Xiao Ling , Zhao Hua , Li Zigang , Cheng Wenjie , Liu Xiaoyu , Feng Sheng
Published: December 2024

To improve the starting characteristics of permanent magnet hysteresis motors, AlNiCo-based on semi-hard magnetic materials (ASMM) is proposed. The microstructural design is carried out by combining the advantages of soft magnetic composites (SMCs) and AlNiCo8 while choosing BaTiO3 with the negative thermal expansion property to eliminate the voids. The material composition as well as the range of heat treatment temperatures are determined by the phase transition kinetics. The temperature-dependent yield strength prediction model considering stress-equivalent magnetic fields is then developed. The model establishes the quantitative relationship between yield strength, ambient temperature, magnetostriction coefficient, elastic modulus, and Poisson's ratio. The comparisons between the model and experiments are made. It can be obtained that the yield strain is related to the microstructure and morphology, and the optimum heat treatment temperature is 680°C under the condition of ensuring the highest yield strength. This method can be used to optimize the parameters of the material preparation process and provide a reference for the optimized design of high-speed and ultra-high-speed motors.
Inferential causal explanatory journalism. A science-based bridge between outcome and cause in journalism
Authors: Svith Flemming
Published: December 2024

This paper proposes a new journalistic discipline, ‘Inferential Causal Explanatory Journalism’, which combines scientific insights and methods with journalistic practices and meets audiences’ need for knowledge about complex causal relationships affecting everyday life. The paper outlines the theoretical framework and methodology that allows journalists to infer relations between news events and their causes instead of the standard referential practice. Inferential causal explanatory journalism positions journalists as independent and credible producers of knowledge. It leverages the explosive growth in online access to scientific studies, as well as various other sources of digital data on current phenomena in recent years, and suggests that AI technologies can make it less time-consuming for journalists to arrive at causal explanations.
Role of Community–Clinical Partnerships to Promote Cancer Screening: Lessons Learned From the National Breast and Cervical Cancer Early Detection Program
Authors: Subramanian Sujha , Ekwueme Donatus U. , Heffernan Nathan , Blackburn Natalie , Tzeng Janice , DeGroff Amy , Rim Sun Hee , Melillo Stephanie , Solomon Felicia , Boone Karen , Miller Jacqueline W.
Published: December 2024

Community–clinical partnerships are an effective approach to connecting primary care with public health to increase disease prevention and screenings and reduce health inequities. We explore how the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) award recipients and clinic teams are using community–clinical linkages to deliver services to populations who are without access to health care and identify barriers, facilitators, and lessons that can be used to improve program implementation. We used purposive sampling to select nine state recipients of the NBCCEDP and a clinic partner for each recipient. The data collection was implemented through a multimodal approach using questionnaires, semistructured interviews, and focus groups. Partnerships between award recipients and clinic teams enhanced planning as clinics were able to optimize the use of electronic medical records to identify women who were not up to date with screening. Partnerships with community organizations, hospital systems, and academic institutions were important to increase community outreach and access to services. These partnerships offered a source of client referrals, a forum to deliver in-person education, a platform for joint dissemination activities to reach a wider audience, collaborations to provide transportation, and coverage for clinical services not available at NBCCEDP participating clinics. In conclusion, partnerships between various organizations are important to enhance planning, increase outreach, and improve access to cancer screening. Internal organizational and external support is important to identify appropriate partners, and technical assistance and training may be beneficial to maintain and optimize community partnerships to address health disparities.
Reframing the “Migration Crisis” as a Humanitarian and Public Health Emergency
Authors: Latz Isabel , Lusk Mark
Published: December 2024

The current narrative of a “migration crisis” has so severely misdirected the understanding of the fundamental human safety, security, and health challenges that confront migrants, that we feel compelled to reframe the issue as a public health and humanitarian emergency. By looking at migrants as an economic threat or as an “invasion” that threatens the American way of life,” it becomes difficult to view their humanity as vulnerable individuals who confront a host of challenges at the border, including abuse, dehumanization, and incarceration. The forced migration of thousands of individuals and families who flee their countries of origin to escape violence and insecurity to then be demonized and retraumatized at the border is a public health emergency. We propose a set of guiding principles for a more just and humane immigration reform, including the need to provide appropriate, trauma-informed care for migrants in detention, an expansion of access to alternatives to detention, especially for children, and the need for an alignment of immigration policy with national law and international human rights treaties.
Beyond “pleasant lies”: The “fictionalizing tendencies” in family members’ narratives of men’s violence
Authors: Umamaheswar Janani
Published: December 2024

Researchers have examined how perpetrators of harm—and those close to them—grapple with moral questions related to culpability and victimhood, often by developing excuses and justifications that “neutralize” the damage inflicted. Building on this research, I use 18 in-depth interviews with family members of men incarcerated for a violent offense to explore the “fictionalizing tendencies” in their accounts of their loved ones’ harm. Drawing on scholarship in philosophy and literary theory, I illuminate how the imposition of a narrative structure commonly found in fiction facilitated family members’ sense-making processes as they confronted their loved ones’ actions. Participants’ fictionalizing tendencies speak to the tensions embedded in perspectival narratives that aspire to truth, and situating knowledge about these tendencies alongside research focused on how harm is justified or excused can deepen our understanding of why and how people blur the boundaries of reality.
Against the machine – Deep-seated beliefs about the purpose and identity of European student radio
Authors: Hautaniemi Ari
Published: December 2024

This study uses Edgar Schein's organisational culture theory to analyse the organisational culture and identity of three European student radio stations in Finland, Austria, and Ireland. The research aims to uncover the core cultural assumptions influencing these stations’ internal integration and external adaptation. Schein's model of artefacts, values, and underlying assumptions provides the theoretical framework to examine how student radio organisations sustain continuity and adapt to external pressures. Semi-structured interviews were conducted with station managers, student volunteers, and faculty, followed by qualitative content analysis. The findings reveal that, despite geographical differences, all stations share core assumptions emphasising creativity, community engagement, and freedom of expression. Each station fosters a sense of belonging and distinctiveness from mainstream media.
Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy
Authors: Havey Robert M. , Patwardhan Avinash G. , Stuck Rodney M. , Keen Stephanie A. , Muriuki Muturi G.
Published: December 2024

Background:

Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection. Patient RCW removal for hygiene and wound care can lead to decreased adherence and treatment effectiveness. This study evaluated a new system for wear-time adherence measurement using multiple sensor types.

Methods:

An electronic wear-time monitor was developed, which included internal and external temperature sensors, an accelerometer, and capacitive proximity foot and ankle sensors. Time-stamped and date-stamped data were saved once per minute for up to 22 days. Ten healthy volunteer subjects were recruited to wear an RCW for two weeks while keeping a diary of don/doff times. Sensor data were then compared with volunteers’ wear diaries using confusion matrix predictive analytics.

Results:

Algorithms were developed for data processing. Correlation coefficients between algorithms and diaries were calculated for individual and multiple sensor combinations. Differential temperature and accelerometer algorithms were significantly better at predicting subject wear-time than individual temperature sensor algorithms ( P = .009, P = .001, respectively). Foot proximity had significantly better correlation with subject diaries than temperature ( P = .024), and acceleration algorithms ( P = .005). Multi-sensor analysis showed high correlation (.96) with wear-time from subject diaries.

Conclusions:

Removable cast walker wear-time can be accurately determined using an electronic data recorder and multiple sensors. Wear-time measurement accuracy can be improved using algorithms that operate on data from multiple sensors that use a variety of sensor technologies.
Impact of a nurse practitioner-led dedicated outpatient parenteral antibiotic therapy clinic on patient outcomes and administrative workload: a retrospective cohort study
Authors: Ibaraki Makoto , Gruss Zachary , Wings Emily , Geronimo Jaclyn E. , Varnes Janine M. , Kammeyer Joel A.
Published: December 2024

Background:

Outpatient parenteral antibiotic therapy (OPAT) enhances patient safety, improves outcomes, and reduces healthcare costs by decreasing 30-day readmissions and adverse events. However, the optimal structure and follow-up protocols for OPAT programs remain undefined. Identifying high-risk patients for readmission and managing adverse drug events (ADEs) are critical components of OPAT care.

Objectives:

This study aimed to evaluate the impact of a dedicated OPAT clinic on hospital readmissions, and quantified the administrative workload required to manage patients on OPAT post-discharge.

Design:

A retrospective, pre-post cohort study compared patient outcomes before and after the implementation of a dedicated OPAT clinic across a single clinic and multiple hospitals.

Methods:

Patients discharged on OPAT from October 2018 to March 2019 (control group) and from September 2021 to February 2022 (intervention group) were included. The primary outcome was 30-day hospital readmission. Secondary outcomes included administrative workload measured by telephone calls and nursing tasks. Data were analyzed using univariate and multivariate logistic regression models to identify independent risk factors for readmission.

Results:

A total of 361 patients were included (median age 63 years, 62.1% men). Of these, 239 patients (66.2%) received OPAT post-clinic implementation. Common diagnoses included bacteremia (17.7%) and osteomyelitis (17.5%), with MRSA (17.2%) and Streptococci (14.4%) as predominant pathogens. The median OPAT duration was 14 days, and the median hospital stay was 7 days. Readmissions within 30 days occurred in 24.9% of patients, while 27.7% visited the emergency department. ADEs were reported in 18.9% of patients. Readmission rates decreased from 30.5% in the pre-clinic cohort to 20.1% in the post-clinic cohort ( p ⩽ 0.05). The OPAT clinic managed 690 calls, illustrating the substantial administrative burden associated with coordinating care. Most calls addressed lab results (22.6%) and peripherally inserted central catheter-related issues (11.3%).

Conclusion:

The implementation of a dedicated OPAT clinic was associated with reduced readmissions and improved patient management, suggesting that structured follow-up care may improve outcomes. This study highlights the administrative challenges of OPAT, emphasizing the need for dedicated personnel and efficient coordination. Future research should focus on optimizing OPAT care models and establishing sustainable funding strategies.
Clinical cues for distinguishing bullous fixed drug eruption from Stevens–Johnson syndrome: A case report
Authors: Samman Luna , Fernandez Chloe , Dukharan Victoria , Dominguez Patrick
Published: December 2024

This case report discusses two clinical encounters of a 62-year-old Hispanic woman initially hospitalized with suspected Stevens–Johnson syndrome, later correctly diagnosed with bullous fixed drug eruption during an outpatient visit for a similar eruption. The first encounter involved an extensive evaluation and an 11-day hospital stay, while the second was managed successfully as an outpatient with oral prednisone. This report highlights the importance of differentiating bullous fixed drug eruption from Stevens–Johnson syndrome/toxic epidermal necrolysis and emphasizes the need for a collaborative approach between Primary Care Providers and Dermatology to ensure optimal patient care.
What do I need to say to get your signature? Adding draft resolution text to the UN General Assembly Sponsorship Dataset
Authors: Mesquita Rafael
Published: December 2024

This article introduces a text extension to the UN General Assembly Sponsorship Dataset. It consists of a corpus with the full text of draft resolutions presented by member states from 2000 to 2020, which allows conducting content and text-as-data analyses of over 7000 L-documents (or 5000 draft resolutions). We demonstrate the utility of the new data via applications that map the salience of topics, measure sentiment, and identify the effects of changes to the text between revisions on attracting new sponsors. The article concludes by discussing potential uses of the data in future research.
The Impact of Lecturer Incivility on Student Academic Performance and the Role of Social Support in Vietnamese Higher Education
Authors: Nguyen-Viet Bang , Nguyen Phuc My
Published: December 2024

This study examined the impact of lecturer incivility on students in Vietnam and the moderating role of social support in academic settings. Using a quantitative approach, surveys were conducted among 1,158 students in Ho Chi Minh City who regularly faced lecturer incivility. Results showed a significant link between lecturer incivility and decreased academic performance (β = .123) and self-efficacy (β = −.354), but not with emotional exhaustion. Student performance was also directly influenced by self-efficacy (β = .451). Furthermore, the effect of lecturer incivility on self-efficacy was moderated by support from friends (β = −.103) and significant others (β = −.061), but not from family. This study highlights the importance of addressing lecturer incivility and the unique role of social support in higher education.
Dynamic behavior and stability analysis of fluid-conveying nano-spiral shells: Modeling, simulation, and parametric study
Authors: Siavashi Mostafa , Dardel Morteza , Pashaei Mohammad Hadi
Published: December 2024

This paper presents a study on a fluid-conveying nano-spiral shell’s free vibration and stability analysis. The nano-spiral shell with Archimedean cross-section shape is modeled according to the first-order shear deformation (FSDT) and modified coupled stress (MCST) theories. Van der Waals force is modeled based on the Leonard Jones potential for atomic interactions. The fluid-structure interaction equation is derived based on the assumption of slip boundary conditions for the fluid. The Rayleigh-Ritz method is used to obtain the natural frequencies of a macro-size spiral shell to be validated with the finite element method (FEM). The parametric vibration analysis is performed for a nano-spiral shell conveying fluid. The results show that the natural frequencies decrease as the distance between the layers of the nano-spiral shell increases. Additionally, an increase in length results in a decrease in natural frequencies. Stability analysis is conducted, and flutter and divergence bifurcations are accurately studied. The results show that the shell with clamped boundary conditions is more stable than the supported boundary condition due to its higher bending stiffness. As the distance between the layers of the fluid-conveying nano-spiral shell increases, instability occurs at a lower fluid velocity. Conversely, as the thickness of the shell increases, the nanostructure becomes unstable at higher fluid velocities.
Changes in Foot Width in Minimally Invasive Bunionectomy
Authors: El Masry Seif , DiGiovanni Grace , Srikumar Syian , Boden Allison L. , Palma Joaquin , Johnson A. Holly
Published: December 2024

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Hallux Valgus (HV) is a common foot condition often requiring surgical intervention. Minimally invasive bunionectomy (MISB) has gained popularity for HV correction. While previous research has focused on distal foot width changes following surgery, this study introduces a novel midshaft measurement to assess proximal transverse midfoot width. The study aims to provide a comprehensive evaluation of foot width changes post-MISB.

Methods:

A retrospective review of prospectively collected data was conducted for 44 patients who underwent MISB for HV via an institutional outcome registry. Demographic data, surgical details, radiographs, and foot width measurements were collected. Changes in hallux valgus angle (HVA) and intermetatarsal angle (IMA) were also measured. The novel midshaft bony and soft tissue foot width measurements were included. Two independent observers conducted all preoperative and postoperative measurements.

Results:

Intraclass correlation coefficients (ICCs) demonstrated high interobserver reliability (all ICCs >0.70) for all measurements. MISB resulted in a consistent reduction in distal foot width, both bony (8.17%) and soft tissue (5.24%)(p < 0.001). These reductions correlated with changes in HVA and IMA, suggesting the extent of deformity correction influenced distal foot width (all r > 0.375, p < 0.05). However, the study revealed that proximal foot width, as measured by midshaft bony width, increased (5.27%) in the majority of cases (p < 0.001). Changes in midshaft foot width showed no correlation with HVA or IMA alterations.

Conclusion:

MISB for HV leads to an increase in midshaft foot width due to the unique mechanics of the procedure. Simultaneously, there is a decrease in distal foot width, which correlates with the extent of deformity correction. This results in a more uniform foot width. These findings may influence patient satisfaction, comfort, and shoe wear capabilities post-surgery. Further research should assess patient perception and comfort regarding these foot width changes after MISB.
Changes in the Subtalar Joint Alignment after Supramalleolar Osteotomy for Varus Ankle Arthritis
Authors: Zhang Ming-Zhu
Published: December 2024

Category:

Ankle; Hindfoot

Introduction/Purpose:

The subtalar joint may compensate for tibio-talar deformity, but what would happen to the joint after the deformity was corrected is not well known. Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of varus deformity of ankle arthritis. The objective of this study was to investigate the subtalar joint alignment pre and postoperatively following SMOT, and the factors which influenced the alignment of the subtalar joint.

Methods:

Thirty-one patients with varus ankle arthritis (Takakura stage 2, 3a and 3b) who were treated using SMOT were retrospectively reviewed. The subtalar and ankle joint alignment was measured on weightbearing radiograph and weightbearing computerized tomography (WBCT).

Results:

The foot ankle offset (FAO), tibial articular surface angle (TAS), tibio-talar surface angle (TTS), subtalar vertical angle (SVA) and subtalar inclination angle (SIA) were significantly corrected (P<0.05). There were 19 cases with the subtalar joints shifted medially after surgery (ΔSIA=-4.27±3.23°), and the other 12 cases with the subtalar joints moved to the lateral side (ΔSIA=2.79±1.68°). The shift of subtalar joint (ΔSIA) showed an inverse correlation with the preoperative FAO (P<0.001, r=-0.621).

Conclusion:

The shift of subtalar joint after SMOT could maintain the neutral position of the hindfoot and showed a negative correlation with the preoperative FAO. The ΔSIA was greater in the severer preoperative hindfoot deformity. Figure 1 The varus deformation of the ankle joint was corrected by the supramalleolar osteotomy, and the increased SIA after surgery resulted in the stenosis of the lateral joint space. (A and C, preoperative; B and D, postoperative, the pre and postoperatively SIA were 3 degrees and 10 degrees; the pre and postoperatively FAO were -5.77% and -1.89%). Abbreviations: TAS, tibia articular surface angle; SIA, subtalar inclination ankle; FAO, foot ankle offset.
Characteristics of Anterolateral Ankle Impingement Due to a Distal Fascicle of Anterior Inferior Tibiofibular Ligament
Authors: Park Chul Hyun
Published: December 2024

Category:

Arthroscopy; Ankle

Introduction/Purpose:

The pathomechanism of anterolateral ankle impingement (ALAI) due to a distal fascicle of the anterior inferior tibiofibular ligament (DF-AITFL) has not been fully elucidated. In addition, due to its rarity, no definitive diagnostic criteria have been established for ALAI by DF-AITFL. This study was performed to document the symptom characteristics, MRI and arthroscopic findings, and postoperative clinical outcomes of ALAI due to a DF-AITFL.

Methods:

Twelve patients (5 males and 7 females of mean age 34.4 years (range 21-76 years)) diagnosed with ALAI due to DF-AITFL from November 2017 to August 2021 and treated surgically were included in this study. Symptom characteristics and symptom-related medical histories were evaluated. Clinical outcomes were assessed using a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scale, and foot function index (FFI). In addition, magnetic resonance imaging (MRI) and arthroscopic findings were evaluated.

Results:

All 12 patients had a history of ankle sprain prior to symptom onset. Mean VAS, AOFAS ankle-hindfoot functional scale, and FFI improved significantly postoperatively. DF-AITFL was confirmed by MRI in all cases (Fig. 1). Bone edema of the talus was observed in two cases (16.7%), and cartilage abnormalities in three (25%). Arthroscopy showed that the DF-AITFL contacted the anterolateral aspect of the talar dome during ROM in all cases and that the AITFL was bent where it contacted the anterolateral dome of the talus in 3 cases (25%). Partial tear or adhesion of the DF-AITFLwas noted in seven cases (58.3%), and cartilage deformation at the anterolateral talar dome in 4 cases (33.3%).

Conclusion:

ALAI due to DF-AITFL should be considered a possible cause of anterolateral ankle pain, especially in cases of ankle sprain. Figure 1. (A) The coronal oblique plane was prescribed for the DF-AITFL (arrow) using standard axial planes parallel to the AITFL (arrowhead). (B) The axial oblique plane was prescribed using coronal oblique planes parallel to the AITFL. The DF-AITFL was in contact with the anterolateral dome of the talus. Abnormal findings, including bone edema (asterisk) (C) and cartilage abnormalities (circle) (D) related to DF-AITFL were evaluated by MRI.
Clinical Outcomes of All-Inside Arthroscopic Lateral Ankle Ligament Reconstruction for Chronic Lateral Ankle Instability: A Prospective Series with Minimum 12 Month Outcomes
Authors: Lewis Thomas L. , Vignaraja Vikram , Franklin Samuel , Ferreira Gabriel , Nunes Gustavo Araujo , Lam Peter , Ray Robbie
Published: December 2024

Category:

Ankle; Sports

Introduction/Purpose:

Chronic lateral ankle instability (CAI) is a common condition that can be effectively treated with lateral ankle ligament reconstruction to restore ankle stability and function. The aim was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analog Score (VAS) and Euroqol-5D-5L (EQ-5D) patient-reported outcome measures (PROMs).

Methods:

This prospective series included 36 consecutive patients who underwent isolated arthroscopic lateral ligament reconstruction for CAI between November 2020 and November 2022 with minimum 12-month follow up. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, and 12 months postoperatively. The MOXFQ is a validated foot and ankle-specific PROM that assesses foot and ankle function, the VAS measures pain and the EQ5D evaluates general health-related quality of life

Results:

Patients were followed up for 12-25 months. In all patients, there was significant improvement in all post-operative PROMs (p < 0.05). The MOXFQ index decreased from 59.1±19.2 to 13.5±18.1 (p < 0.01), EQ-5D index increased from 0.607±0.224 to 0.854±0.175 (p < 0.01) and VAS pain decreased from 36.6±22.3 to 13.6±18.4 (p < 0.01).

Conclusion:

Arthroscopic lateral ankle ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes.
Combined Randomised and Observational Study of Surgery for Type B Ankle Fracture Treatment (CROSSBAT) Minimum 5 Year Follow-Up
Authors: Mittal Rajat , Symes Michael , O'Keefe Ryan , Naylor Justine , Harris Ian
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Isolated Type B ankle fractures are common. The study (CROSSBAT: Combined Randomised and Observational Study of Surgery for Type B Ankle Fracture Treatment) demonstrated that surgical management was not superior to non-surgical management for the treatment of 44-B1 ankle (fibula) fractures with minimal talar shift at one-year post-injury. The current study presents longer term results of that cohort with a minimum 5-year follow-up. It aims to determine whether surgical management confers improved outcomes for participants with isolated AO type 44-B1 distal fibula fractures when compared with non-surgical management at minimum 5 years post- injury.

Methods:

A multi-centre, randomised controlled trial with an observational cohort was conducted. Participants were recruited from 22 hospitals across Australia and New Zealand. Participants consenting to follow-up but not randomisation formed the observational cohort. SURGICAL GROUP: Fracture fixation using a plate and screws. Post-operatively, ankles were splinted and participants were non-weight-bearing for 2 weeks, then weight-bearing was allowed; NON-SURGICAL GROUP: Ankles were splinted and participants were allowed to weight-bear. OUTCOMES: All participants were followed with a minimum 5-year follow-up. Primary outcomes were the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (FAOQ) and the physical component score (PCS) of SF-12v2 general-health survey at 12 months. The randomised and observational cohorts were analysed separately.

Results:

Between August 2010 to October 2013 160 people were randomised (80 surgical and 80 non- surgical). 276 formed the observational cohort (19 surgical and 257 non-surgical). At minimum 5 year follow-up, 75 (47%) and 103 (37%) in the randomised and observational cohort respectively were contactable. Surgery was not superior for ankle function score or SF-12v2 compared with non-surgical group in the randomised or observational cohorts.

Conclusion:

Surgical management was not superior to non-surgical management in patients who sustained a distal fibula fracture with minimal talar shift.
Comparison Between Operative Methods in Treatment of Isolate Lisfranc Injury - Various Flexible Fixation of Subtle Lisfranc Ligament Injury
Authors: Yi Young , Chun Dongil , Kim Saintpee
Published: December 2024

Category:

Midfoot/Forefoot; Sports

Introduction/Purpose:

Recently, various suture button technique were introduced for isolated Lisfranc ligament(ILL) fixation. However, a few clinical and radiologic study focused on suture button fixation on the ILL injury has been reported. This study is comparative between conventional screw fixation versus various types of suture button(TightRopeTM, Internalbrace®) for the ILL ligament injury.

Methods:

This is a multicenter, retrospective study included patients were divided into two groups according to the treatment method: 35 conventional screw group, 34 TightRopeTM group and 30 internal brace fixation group. In terms of the clinical outcome, VAS score and AOFAS midfoot scale were used, evaluated at preoperative, postoperative 6 months, and last follow up period. In order to evaluate the radiologic outcome, weight bearing foot AP radiograph and weight bearing CT were taken to compare diastasis and side to side difference. Plantar foot pressure was measured in all the patients included after postoperative 6 months in three groups. Postoperative complications detected until the last follow up were analyzed between the three groups.

Results:

Two suture button groups showed better clinical outcome to conventional screw fixation group at postoperative 6 month follow up period. However, no significant difference between all groups was found at postoperative 1 year, and last follow up period. And no difference between three groups was found with regards to diastasis and side to side difference measured at weight bearing AP radiograph. Dorsal and plantar diastasis measured on WBCT were not significant different between three groups as well. Foot pressure was significantly elevated on conventional screw fixation group at forefoot then the other groups. Recurrent Lisfranc joint diastasis was found in a single case in conventional screw group and two cases in TightRopeTM group. but Internalbrace group was not found recurrent diastasis.

Conclusion:

Our investigation suggests that utilizing suture button fixation in the treatment of ILL injuries may offer reliable fixation stability with a few complications compare with standard screw fixation. And it may bring out better patient satisfaction in ILL in early postoperative follow up period.
Comparison of Ankle Fracture Outcomes Treated with Fibular Nail vs Conventional Fixation
Authors: Geiger Bryanna , Okonkwo Jude , Nwankwo Chima , Idris Maksat , Vosseller J. Turner , Chien Bonnie Y.
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Ankle fracture fixation can benefit from minimizing postoperative complications, particularly with wound healing and infection. Less invasive implant options necessitating smaller incisions have emerged, including the fibular intramedullary nail (i.e. Arthrex Fibulock) to minimize incisions and potentially allow earlier mobilization. The purpose of this study is to investigate the efficacy and clinical outcomes of a fibular intramedullary nail (Arthrex Fibulock) in ankle fracture treatment across a diverse patient cohort.

Methods:

A retrospective chart review from 2018 to 2022 was conducted in order to determine eligible patients. Inclusion criteria included adult patients treated for an ankle fracture with at least 3 months of follow-up and sufficient imaging available. Exclusion criteria included open fractures, other concomitant injuries, pilon and tibial shaft fractures, or previous ankle surgery.

Results:

A total of 132 patients were consecutively included, 44 in the conventional fixation group (33.33%) and 88 in the fibular nail group (66.67%). 4 out of 88 fibular nail patients (4.55%) and 3 out of 44 conventional patients (6.82%) had a postoperative infection (P = .43). 8 fibular nail (9.09%) and 6 conventional (13.64%) fixation patients underwent hardware removal postoperatively, which was not statistically significantly different (P = .55).

Conclusion:

This study shows no difference between the fibular nail device and a conventional plate and screw fixation approach in the treatment of ankle fractures when looking at postoperative infection and removal of hardware rates. The rate of postoperative infection and hardware removal trended higher in the conventional fixation patients but did not reach statistical significance. As such, the use of the fibular nail may offer a viable alternative for all patients undergoing ankle fracture operative treatment.
Comparison of Elasticity and Load to Failure for Three Different Syndesmosis Devices: A Biomechanical Study
Authors: Younger Alastair S.E. , Parekh Selene G. , Morgan Steven , Wedam Brandon
Published: December 2024

Category:

Basic Sciences/Biologics; Trauma

Introduction/ Purpose:

A syndesmosis injury can result in degenerative change and poor outcomes after an ankle fracture. This can occur in combination with an ankle fracture, with a proximal fibular fracture or with separation of the tibia and fibula without a fracture being present. Fixation of the fibula to the tibia can be rigid with a screw or flexible with a suture device. Flexible syndesmosis fixation has been shown to have superior outcomes and less hardware removals compared to fixed devices. However a more elastic device may result in opening of the syndesmosis before healing. A device with a lower failure load may fail in a heavier patient being more active. Three commercially available suture devices were therefore tested to assess their elasticity and failure load.

Methods:

Eight each of three commercially available syndesmosis suture devices were tested: Acumed Acu-Synch Knotless (AAK), Arthrex Tightrope (AT) and Zimmer Biomet ZipTight (ZT). An Instron testing machine was used to apply cyclical load through mounting blocks to the suture devices configured to match the distance between the tibia and fibular anchor points. The anchors were inserted based on the operative technique. Synthetic bone blocks with cortical and cancellous bone densities were used. The blocks were preloaded to 53 N with the displacement reset to zero. The specimens were cycled from 53 to 113 N at a rate of 2 Hz for 420,000 cycles and the displacement measured. Testing was discontinued if the suture, fibula button or flip button broke. If 3 mm or greater elongation occurred the specimen was considered failed. For the specimens not failing by 420K cycles load was applied until failure. The mode of failure was recorded.

Results:

The ZipTight (ZT) devices failed at an average of 122 +/- 185K cycles with 6 of 8 specimens failed by 3 mm. The ultimate load was 424 +/- 122 N. The Acu-Sinch Knotless (AAK) devices all completed 420 +/- 0 K cycles. The displacement 1.9 +/- 0.26 mm. The ultimate load to failure was 1018 +/- 46N. The Tightrope (AT) devices all completed 420 +/- 0 k cycles. The displacement averaged 1.97 +/- 0.16 mm. The failure load was 890 +/- 118 N. The ZT device had fewer cycles to failure than the AAK and AT devices. The ZT device had a greater degree of displacement on repeat loading compared to the AA and AT devices.

Conclusion:

The ZT device had a lower failure load compared to the AA and AT devices. The AA and AT devices had the same cycles to failure and the same displacement to failure. The AA device was significantly stronger than the AT device in failure mode. The AA and AT flexible syndesmosis fixation showed better mechanical properties than the ZT fixation. The AA device had a higher load to failure than the AT device. The mechanical properties could be relevant in clinical fixation with regards to failure of surgical stabilization.
Comparison of Percutaneous Repair and Open Repair for Delayed Treatment of Achilles Tendon Rupture
Authors: Choi Seung-myung , Cho Byung-Ki , Bae Seung-Hwan , Choi Seo-yool
Published: December 2024

Category:

Sports; Hindfoot

Introduction/Purpose:

Delays in diagnosis or treatment of acute Achilles tendon rupture are relatively frequent either due to the injury being misdiagnosed or the patient disregarding its severity. In the delayed presentation of Achilles tendon rupture, open repair is generally recommended for mobilization of the adherent and retracted tendons from the thickened paratenon layer repair although this introduces the risk of wound complications. Although a minimally invasive technique for acute Achilles tendon rupture has demonstrated lower infection rates, with functional results equivalent to those of open repair, their use in patients presenting in a delayed fashion has not been thoroughly investigated. The objective of this study is to compare the outcomes of percutaneous and open repair in cases of delayed presentation of acute Achilles tendon rupture.

Methods:

This was a retrospective study of prospectively collected data on consecutive patients who underwent either percutaneous or open repair for delayed presentation of Achilles tendon rupture and were followed up for at least one year. Delayed Achilles tendon rupture was defined as if patients underwent surgery 14 to 30 days after the injury and had received no treatment before surgery. The percutaneous repair was a modified Bunnell suture with an additional incision enough to permit mobilization of the tendon ends and core suture. An identical postoperative rehabilitation protocol was implemented in both groups: with below-knee cast in maximum plantarflexion, full weightbearing on the metatarsal heads was immediately allowed as tolerated. Postoperatively, the AT Resting Angle (ATRA), patient-reported functional outcomes using the AT Rupture Score (ATRS), and Calf circumference difference were evaluated. Postoperative complications, including re-rupture, wound infection, and sural nerve injury, were assessed.

Results:

There were no significant differences in demographic data between the percutaneous repair group (N =23) and the open repair group (N =23). The elapsed time from injury to surgical treatment and the gap between the proximal and distal stumps assessed on the MRI between the groups were similar. there were no statistically significant differences observed in ATRA (-2.9 ± 1.8 vs -2.1 ± 1.7, p = 0.687), ATRS (92.2 ± 2.5 vs 93.1 ± 2.6, p = 0.814), or calf circumference difference. Additionally, there were no cases of re-rupture in either group. A deep wound infection occurred in one patient in the open repair group. Symptoms related to sural nerve injury were observed in two patients in the percutaneous repair group, which resolved with conservative treatment.

Conclusion:

In cases of delayed presentation of Achilles tendon rupture, the percutaneous tendon repair technique is considered to yield comparable outcomes to the open tendon repair technique.
Depressive Disorder and Trimalleolar Fractures: An Analysis of Outcomes and Costs
Authors: Fudala Maddie , Blank Lindsay , Tabbaa Ameer , Rodriguez Ariel Nicolas , Conway Charles , Lam Aaron , Razi Afshin , Abdelgawad Amr
Published: December 2024

Category:

Trauma; Hindfoot

Introduction/Purpose:

The prevalence of depression is rising globally, and it has been noted in recent literature that the COVID-19 pandemic has exacerbated the increase in depressive disorders. Studies have suggested a strong association between depression and poor outcomes following various orthopedic surgeries, particularly joint arthroplasties. However, depression’s impact on complications following open reduction/internal fixation (ORIF) of Trimalleolar fractures has not been elucidated, despite the high complication rate of this procedure. Therefore, the aims of this study were to determine whether depression is associated with higher rates of 1) readmissions and 2) medical complications following ORIF of Trimalleolar fractures.

Methods:

Using the Mariner nationwide database from January 1, 2010, to March 31, 2021, a total of 50,154 adults aged 18 or older were identified as having undergone Trimalleolar ORIF using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) coding. Patients with depression were matched 1:1 to controls without depression by age, sex, COPD, anxiety, diabetes, hypertension, obesity, and tobacco use. Primary endpoints compared 90-day all-cause readmissions and medical complications. Logistic regression was used to calculate odds-ratios (OR) of the effect of depression on readmissions and medical complications. A p-value of less than 0.05 was significant.

Results:

Patients with depression who underwent ORIF of Trimalleolar fractures had significantly higher odds of being readmitted within 90-days of the initial procedure (OR: 1.37; 95%CI: 1.27 – 1.48; p< 0.0001). 90-day odds of developing medical complications were significantly higher (OR: 4.61; 95%CI: 4.38 – 4.86; p< 0.0001) in patients with depression compared to patients within the control group.

Conclusion:

This study demonstrated that patients with depression undergoing Trimalleolar ORIF are at an increased risk of readmission and a multitude of postoperative complications. This information is crucial for orthopedic surgeons considering the already high burden of complications following ORIF of Trimalleolar fractures and increasing prevalence of depression worldwide.
Diabetic Neuromuscular Foot and Ankle Deformities Reconstructed with Long-Segment and Rigid Internal Fixation Lead to Optimal Outcomes
Authors: Haldar Anil , Kwok Iris HY , Hester Thomas , Kavarthapu Venu
Published: December 2024

Category:

Hindfoot; Diabetes

Introduction/Purpose:

Severe neuromuscular foot and ankle deformities can develop due to progressive muscle imbalance on the background of diabetic peripheral neuropathy not related to Charcot neurarthopathy (CN). Our unit has a concentrated experience of treating severe deformities arising from diabetic CN using the principles of durable, long segment and rigid internal fixation with optimal opposition. We present a series of diabetic neuromuscular deformities reconstructed using these principles.

Methods:

This was a single centre, retrospective study including 20 patients who had diabetic neuromuscular foot and ankle deformities, in the absence of CN, operated on between October 2009 to December 2021. The deformity was corrected using wedge bone resections and tendon balancing procedures, followed by fixation. Data was collected on clinical and radiographic outcomes with a minimum 1-year follow-up.

Results:

20 cases were included with a mean age of 53.7 years and follow-up of 42.1 months (range 12-94). 9 patients had Type 1 and 11 patients had Type 2 diabetes. Mean pre-operative HbA1c was 8.1. 15 had pre-operative ulceration. There were 6 isolated hindfoot, 2 midfoot and 12 combined hindfoot and midfoot deformities. All pre-operative ulcers healed and all achieved a stable and plantigrade foot. Full bone union was noted in 1/2 midfoot, 5/6 hindfoot and 10/12 combined corrections 12 months post-surgery. 15/20 patients returned to full weight bearing, 12 of whom were in surgical shoes. Metal work failure was noted in 5 patients. No recurrent or new ulcers in the reconstructed areas were noted and no patients developed Charcot activation during the post-operative period.

Conclusion:

Reconstruction of neuromuscular foot and ankle deformities due to diabetic peripheral neuropathy using principles of durable, long-segment and rigid internal fixation with bone opposition provided good radiological and clinical outcomes with good bone fusion rates, low complications, no ulcer recurrence and no Charcot activation.