bluuebunny/crossref_metadata_2025 huggingface dataset:
Triceps brachii insertional footprint: Under-estimated complexity
Authors: Kamineni Srinath , Pooley Joseph , Bachoura Abdo , Yoshida Ruriko , Cummings Jason
Published: November 2022

Background

The detailed complexity of triceps brachii insertional footprint continues to challenge surgeons as evidenced by continued reports of triceps-associated complications following elbow procedures. The purpose of this study is to describe the three-dimensional footprint of the triceps brachii at its olecranon insertion at the elbow.

Methods

22 cadaveric elbows were dissected leaving only the distal insertion of the triceps intact. The insertion was defined and probed with a three-dimensional digitizer to create a digital three-dimensional footprint allowing width, height, and surface area of the footprint to be recorded relative to the bare area. The insertional soft tissues of tendon versus muscle along with the shape of the footprints were qualitatively described.

Results

The mean width and surface area of the lateral segment was greater in males than in females (30.07 mm vs. 24.37 mm, p  =  0.0339 and 282.1 mm vs. 211. 56 mm, p  =  0.0181, respectively). No other statistically significant differences between the sexes were noted. The triceps insertional footprint was “crescent-shaped” and consisted of three regions: central tendon, medial muscular extension, and lateral muscular extension.

Discussion

These findings can help explain the importance of avoiding these muscular structures during triceps-off approaches and provides the framework for future clinical studies. Clinical Relevance: Basic Science, anatomy study, cadaver dissection.
Patient-reported outcomes measurement information system depression psychometrically underperforms compared to legacy measures and is poorly associated with postoperative functional outcomes in shoulder arthroplasty patients
Authors: Huddleston Hailey P , Mehta Nabil , Lavoie-Gagne Ophelie Z , Maheshwer Bhargavi , Fu Michael C , Cole Brian J , Verma Nikhil N , Forsythe Brian , Yanke Adam B
Published: November 2022

Background

The purpose of this study was to investigate the associations between each mental health patient-reported outcome measure with postoperative functional outcomes following shoulder arthroplasty, and to compare psychometric properties of patient-reported outcomes measurement information system depression to the legacy (VR-12 Mental) patient-reported outcome measure.

Methods

Patients who underwent primary shoulder arthroplasty from July 2018 to February 2019 were retrospectively reviewed. Patient-reported outcomes measurement information system depression and VR-12 Mental were administered preoperatively; American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation were administered at 6-month and 1-year postoperatively. Rasch partial credit modeling analysis was used to compare psychometric properties of legacy versus patient-reported outcomes measurement information system instruments in assessing mental health.

Results

Ninety-three patients who underwent total shoulder arthroplasty ( n = 52), reverse total shoulder arthroplasty ( n = 39), or hemiarthroplasty ( n = 2) were included. Preoperative VR-12 Mental scores were moderately associated with American Shoulder and Elbow Surgeons at 6-months (coefficient: 0.52, P = 0.026) and 1-year (coefficient: 0.65, P = 0.002), while preoperative patient-reported outcomes measurement information system depression scores were not. Patient-reported outcomes measurement information system depression demonstrated significant floor effects (16%); VR-12 Mental demonstrated minimal floor and ceiling effects (1.1% for both). VR-12 Mental demonstrated broader coverage of mental outlook on Rasch modeling than patient-reported outcomes measurement information system depression and had adequate model fit after one round of reiterative item elimination.

Discussion

Patient-reported outcomes measurement information system depression was poorly associated with postoperative American Shoulder and Elbow Surgeons scores, demonstrated significant floor effects, and had limited coverage of mental health on Rasch modeling with reiterative elimination.

Level of Evidence

IV
Pediatric fractures following implant removal: A systematic review
Authors: Padgett Anthony M , Howie Cole M , Sanchez Thomas C , Cimino Addison , Williams Kevin A , Gilbert Shawn R , Conklin Michael J
Published: November 2022

Objectives:

To evaluate the available literature for postoperative fracture rates following implant removal in the pediatric population.

Methods:

A systematic review of articles in the PubMed and Embase computerized literature databases from January 2000 to June 2022 was performed using PRISMA guidelines. Randomized controlled trials, case-control studies, cohort studies (retrospective and prospective), and case series involving pediatric patients that included data on fracture rate following removal of orthopedic implants were eligible for review. Two authors independently extracted data from selected studies for predefined data fields for implant type, anatomic location of the implant, indication for implantation, fracture or refracture rate following implant removal, mean time to implant removal, and mean follow-up time.

Results:

Fifteen studies were included for qualitative synthesis. Reported fracture rates following implant removal vary based on several factors, with an overall reported incidence of 0%–14.9%. The available literature did not offer sufficient data for conduction of a meta-analysis.

Conclusion:

Our systematic review demonstrates that fracture following implant removal in pediatric patients is a relatively frequent complication. In children, the forearm and femur are the most commonly reported sites of fracture following removal of implants. Traumatic fractures treated definitively with external fixation have the highest reported aggregate rate of refracture. Knowledge of the incidence of this risk is important for orthopedic surgeons. There remains a need for well-designed studies and trials to further clarify the roles of the variables that contribute to this complication.
The Competitive Situation of the Cheminformatics Industry Based on Porter’s Model in Iran
Authors: Asemi Asefeh , Asemi Adeleh , Ko Andrea
Published: November 2022

The purpose of this study was to analyze the competitive situation of the cheminformatics industry using Porter’s competitive model and to determine the priority and weight of each competitive force in this industry. In addition to qualitative analysis of data collected from library surveys and the Delphi method, multicriteria decision-making techniques (MCDM) were used to determine the rank and weight of forces (criteria). A preference judgment questionnaire was used to collect data. This researcher-made questionnaire was sent to cheminformatics specialists in Iran. Using the process of hierarchical analysis (AHP), Porter's competitive forces in this industry were investigated. The criteria, subcriteria, alternatives, and relation between them were drawn using the analytical decision tree model. Then, the priority and weight of each force were calculated. Then, the effect of each force on each other was investigated. The results showed that the decision-making priorities of cheminformatics industry managers in the competitive market concerning the management of competitive forces of the Porter model are as follows: (1) competitive rivalry condition between current competitors, (2) the threat of the entry of alternative products (the threat of substitutes), (3) the threat of new entrants (potential competitors), (4) the bargaining power of customers, and (5) the bargaining power of suppliers. We concluded that due to the prevailing economic conditions, companies active in the field of cheminformatics in the present study, to ensure profitability, should prioritize the competitive situation between competitors and consider this priority in strategic planning. Finally, we recommend that the present study be repeated in other countries and companies active in this industry.
Status of Women’s Reproductive and Menstrual Health: A Socio-psychological Household Prognostication of Meena Tribal Community of Karauli, Rajasthan
Authors: Chaudhary Sambhawna , Chandna Vaneeta , Pathak Usha K. , Pandey B. W.
Published: November 2022

The present study hovers around the socio-cultural factors among the women of Meena tribe which pose a grave threat to their reproductive health and also takes into account subjects like menstrual hygiene. Reproductive health and hygiene have always remained stigmatic and dogmatic topics of discussion. The significance of the proverb ‘Prevention is better than cure’ is a saying whose importance cannot be overemphasised. Hygiene then is the foremost requirement for a healthy and good life.

The key issues of reproductive rights include the basic right to decide the birth timing space between successive births (or what is known as the pregnancy gap), and also the right to decide the number of offspring in marital life. Some other basic reproductive rights are access to methods of family planning and access to hygienic conditions, health services, education and information. Due to gross misinformation, ignorance and deep-seated taboos, the subject of reproductive health has eluded people for long. The most noticeable detriments are maternal mortality and unhygienic menstrual conditions, thereby leading to women’s lower status not just socially but also mentally and physically.

This study reveals how the socio-cultural position of tribal Meena women affects them and adds to the misery and risks faced by them with respect to their health, menstrual hygiene and their selection of health services. This is established by conducting on-field surveys and interviews. The research also derives its findings from various primary and secondary data along with necessary sample collections.
Qualifying Work Experience in England and Wales: The Opportunities and Risks Presented to University Law Clinics
Authors: Todd Andrea , Blackburn Lucy
Published: November 2022

This commentary details the sweeping changes to the route to qualification as a solicitor in England and Wales brought about in September 2021 and considers the opportunities and risks presented to university law school clinics by one aspect of this route: the new system of Qualifying Work Experience (QWE). The article reflects on the opportunities for law clinic development, innovation and recognition offered by QWE and weighs these up against the potential risks that will need to be managed carefully to avoid them becoming a threat to law clinic enhancement. The article considers the results of an early data gathering exercise to garner clinician and student volunteer perspectives on QWE within its first year of operation.
Incorporating water quality into land use scenario analysis with random forest models
Authors: Goodspeed Robert , Wang Runzi , Lizundia Camilla , Du Lingxiao , Jaipuria Srishti
Published: November 2022

Emerging research has begun to document the nuanced ways that urban form can influence water quality in urban areas. To facilitate the greater consideration of water quality by planning practitioners, this paper illustrates a two-step method to predict the water quality performance of land use scenarios through the presentation of a case study in the Huron River watershed in Michigan, USA. First, random forest models are used to relate 38 urban form variables to three water quality outcomes within the watershed: total suspended solids (TSS), total phosphorus (TP), and Escherichia coli ( E. coli) concentrations. Second, the calibrated random forest models are used to predict the water quality performance for three land use scenarios for a local jurisdiction. The case study illustrates how even scenarios describing additional urbanization can result in predicted improvements to water quality. The methods contribute to the greater consideration of water issues in urban planning practice.
Clinical and Radiological Results of a Human Bone Graft Screw in Tarsometatarsal II/+III Arthrodesis
Authors: Bock Peter
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Osteoarthritis of the lesser Lisfranc joints is a debilitating foot condition. Arthrodesis is a well known procedure to eliviate pain and improve quality of life of the affected person. The use of a transplant screw made of allogenic human bone material is considered a new technique for lesser Lisfranc joint arthrodesis. This article investigates the clinical outcome and radiological integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III.

Methods:

This is a prospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw. A Visual Analogue Scale (VAS pain and function), Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society Outcome Score (AOFAS) and Foot and Ankle Outcome Score (FAOS) were used as measures to compare preoperative with postoperative results. Radiologic integration in the recipient bone was also evaluated.

Results:

A significant mean pre- to postoperative improvement of all evaluated scores has been observed (P< .05) after a mean follow-up of 16 months (12-33). VAS (pain) decreased from 7.6 points to 1.4 points, VAS (function) from 7.25 points to 1.8 points. The FFI improved from 62.3% to 16.7%, the AOFAS score from 29.7 points to 79.9 points of the. In all surveyed subscales of the FAOS score an increase was observed: symptoms: 55.2 to 85.6; pain: 30.5 to 86.9; function: 33.1 to 88.3; quality of life: 27.8 to 79.7. The radiologic evaluation did not show any pseudarthrosis at last follow-up. Moreover, in 19 of 20 feet (95%) a complete radiological integration of the screw into the receiving bone was seen after a minimum follow-up time of 12 months and was no longer distinguishable from the original bone.

Conclusion:

With these first results of the use of an allogenic bone screw in TMT II/+III arthrodesis, a significant improvement from preoperative to postoperative clinical status was confirmed and a full radiographic integration demonstrated in all feet.
Risk Factors for Surgical Site Infection after Operative Management of Pilon Fractures
Authors: Boyd Brandon , Wilson Anthony L. , Cichos Kyle , Murali Sudarsan , Mihas Alexander K. , Patch David A. , McGwin Gerald , Johnson Michael D. , Spitler Clay A.
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Pilon fractures are complex injuries that most commonly result from high-energy trauma. The extensive soft tissue damage and high rates of associated infection seen in these injuries remains a challenging concern for surgeons. The purpose of this study is to identify risk factors associated with surgical site infection (SSI) following operative management of pilon fractures.

Methods:

A retrospective review of all operatively managed pilon fractures at a single level 1 trauma center from 2014 to 2019 was performed. Minimum six-month follow-up and skeletal maturity was required for inclusion. Patients with amputation prior to definitive fixation were excluded. SSI consisted of superficial (defined as infection resolving with oral antibiotics) and/or deep infections (defined as return to the operating room for debridement with positive cultures). Patients were grouped based on presence or absence of SSI. Demographics, injury and operative characteristics, and surgical outcomes were compared between the two groups.

Results:

A total of 279 patients met inclusion criteria for the study, with 40 patients developing SSI (14.3%). Average follow-up was 3.2 years. Patients that developed SSI had a significantly higher proportion of open fractures (47.5% vs 23.4%, p=0.003); however, there were no significant differences in Gustilo-Anderson classification or open wound location compared to controls. The SSI group required significantly higher rates of skin grafts (25.0% vs 4.2%, p<0.001) and muscle flap coverage (20.0% vs 1.7%, p<0.001). Average operative time was significantly longer in the SSI group (283.1 vs. 222.3 minutes, p=0.002). Patients with SSI displayed significantly higher rates of nonunion at six-month follow-up compared to those without SSI (55.0% vs 10.9%, p<0.001). There were no significant differences in mechanism of injury, AO/OTA fracture classification, associated ipsilateral lower extremity injuries, bone grafting, surgical approach, or presence of medial column fixation between the two groups.

Conclusion:

The present study showed that SSI after pilon fractures can lead to significant morbidity, with 55% of patients having nonunion at six months. Risk factors for SSI in these patients included open fracture, need for soft tissue coverage, and longer operative times. Future multicenter studies are needed to further investigate risk factors for SSI after operative management of pilon fractures.
Dual Approach to Talar Body Fractures Increases Talar Dome Access for Fracture Care without Osteotomy
Authors: Campbell Megan L. , Lenz Amy L. , Peterson Andrew , DeKeyser Graham J. , Haller Justin , O'Neill Dillon C.
Published: November 2022

Category:

Trauma; Ankle; Hindfoot

Introduction/Purpose:

No consensus surgical treatment algorithm exists for talar body fractures, with authors recommending both soft-tissue and osteotomy-based approaches. This study evaluated the utility of dual approaches to the talar dome through anterolateral transligamentous (ATL) and modified posteromedial (mPM) approaches, both with and without distraction.

Methods:

Ten cadaveric legs (5 matched pairs) were included. A mPM approach, between FHL and Achilles tendon, and an ATL approach, utilizing an anterolateral incision with transection of the ATFL and CFL fibular insertions, were performed on each specimen. Order of approach was alternated within each pair. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire at the visualized talar dome margin both with and without 4mm of tibiotalar distraction. Specimens were analyzed by micro-computed tomography. Primary outcome was total accessible DSA. Student's t-tests compared DSA accessed by different exposure methods.

Results:

An initial mPM approach allowed access to 25.6% and 33.6% of DSA without and with distraction (p=0.002). An initial ATL approach provided access to 47.0% and 58.1% of DSA without and with distraction, respectively (p=0.003). No significant difference in DSA accessibility were observed for either approach when they were performed second. Accessibility via dual approaches was 71.7% and 93% of DSA without and with distraction with an initial ATL approach and 71.3% and 87.5% of DSA without and with distraction with an initial mPM approach (p=0.96 and 0.37, respectively). (Figure 1)

Conclusion:

Dual approaches provided access to greater than 70% and 85% of DSA without and with distraction. Order of approach did not change access. These results may promote soft-tissue only treatment strategies in talar body fracture care.
Ultrasound Guidance vs Anatomical Landmark for Ankle Arthroscopic Portal Insertions: A Cadaveric Study
Authors: Cheong Wei Lun , Mehta Kinjal V.
Published: November 2022

Category:

Arthroscopy

Introduction/Purpose:

Ankle arthroscopy can be used for a variety of ankle pathology including soft tissue and bony impingement, loose bodies, osteochondral defects, ankle fractures, osteoarthritis and instability. However, complication rates associated with ankle arthroscopy range from 3.4 to 9%, with half of them consisting of neurovascular and tendon injuries due to arthroscopic portal placement. The purpose of the study is to determine the safety and efficacy of using ultrasound in topographic marking of the neurovascular structures and tendons in the foot and ankle and identification of a safe zone for arthroscopic portal creation, compared to using anatomical landmarks.

Methods:

Twelve cadaveric samples were divided into two groups of six. The first group underwent ultrasound assessment by a board certified radiologist, who identified zones of safety for ultrasound guided insertion of anteromedial, anterolateral and posteromedial arthroscopic portals. Ankle arthroscopy was then performed. The other group underwent similar ankle arthroscopy assessment utilizing conventional anatomical landmarks. Straws were used to delineate arthroscopy portal tracts. The cadaveric samples were then dissected. The following distances were measured between the portals and important anatomical structures: the anterolateral portal and superficial peroneal nerve (SPN) as well as extensor digitorum longus (EDL); anteromedial portal and the great saphenous vein (GSV) as well as tibialis anterior (TA); and the posteromedial portal and the flexor hallucis longus (FHL).

Results:

No neurovascular structures or tendons were injured in all twelve cadaveric samples. Compared with the non- ultrasonography group, the group that underwent ultrasonography assessment had statistically significant larger distance of the SPN, EDL and TA from the anterolateral and anteromedial arthroscopic portals (p values = 0.045, 0.046 and 0.025 respectively). No difference was found between the distance of the GSV from the anteromedial arthroscopic portal, as well as the distance of the FHL from the posteromedial arthroscopic portal.

Conclusion:

Ultrasound assessment and topographic identification of the safe zone for ankle arthroscopic portal creation is a safe and effective process that may reduce the risk of iatrogenic injury to neurovascular structures and tendons in anterior and posterior ankle arthroscopy.
Limited Open Achilles Repair without Instrument Guided Assistance: A Surgical Technique
Authors: Chopra Aman , Parekh Aarav S. , Parekh Selene G.
Published: November 2022

Category:

Sports

Introduction/Purpose:

The limited open Achilles tendon repair technique has recently gained popularity as a treatment option for acute Achilles tendon ruptures. This surgical technique video describes a limited open Achilles tendon repair without instrument guided assistance, demonstrating improved clinical outcomes for patients while also reducing reliance on operative equipment, cost, and the duration of surgery.

Methods:

The indications for this limited open Achilles tendon repair technique include an Achilles tendon rupture less than six weeks from injury occurring in the watershed area. The patient is prone and a two to three centimeter longitudinal incision is made over the Achilles tear. In the proximal stump, three non-absorbable sutures are passed horizontally from proximal to distal direction. In the distal stump, the same is done in a non-locking manner. The stumps are then reflected and the deep fascial compartment is released. The foot is plantarflexed to reduce tension on the repair site. The non-locking sutures are tied sequentially from distal-distal to proximal-proximal direction. A running box suture using a non-absorbable suture followed by 0- Vicryl around the rupture site is performed.

Results:

This technique has demonstrated, at a median follow-up of 3.7 years, restored preinjury function along with no wound complications, reruptures, or reoperations in 33 patients. The median time from injury to surgery was 10 (range, 1-45) days and the mean time for returning to preinjury level of activity was 5.6 (range, 1.7-22.1) months. After the procedure, patients demonstrated significant improvements in mean Foot and Ankle Disability Index (49.1 to 98.4), mean Visual Analog Scale pain score (4.8 to 0.2), and mean Foot and Ankle Outcome Score (FAOS) subscales such as FAOS pain (54.8 to 99.2), FAOS symptoms (84.6 to 97.0), FAOS activities of daily living (61.4 to 97.2), FAOS sports and recreational activity (39.5 to 98.5), and FAOS quality of life (39.7 to 88.7).

Conclusion:

Patients who underwent a limited open Achilles tendon repair without instrument guided assistance demonstrated significant improvements in outcome scores with minimal complications.
Cross-Cultural Adaptation and Validation of the Short Musculoskeletal Function Assessment (SMFA) into Spanish (Chile)
Authors: Cortes Aaron , Espinoza Carolina Avilés , Escudero Mario I. , Carcuro Giovanni M. , Pellegrini Manuel J. , Chaparro Felipe R. , Ortiz Cristian A. , Mombello Franco L.
Published: November 2022

Category:

Other; Ankle; Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

The purpose of this study is to adapt and validate the English version of the Short Musculoskeletal Function Assessment (SMFA) into Chilean Spanish according to the WHO guidelines.

Methods:

Cross-sectional study where through 897 surveys of patients with non-trauma surgical orthopaedic pathologies, internal consistency, validity and acceptability were evaluated, including correlation with the short form 36 (SF-36) medical score.

Results:

The preliminary version resulted from the forward and back-translation and a pilot administration. The validation response rate was 99,66%. The SMFA-CL had excellent internal consistency (Cronbach's α = 0.962). The dysfunction and discomfort items showed a value of 0,952 and 0,884 respectively, eliminating one item in the dysfunction sub-scale. The principal component analysis was forced to four factors explaining 55.5% of the variance. SMFA-CL sub-scales significantly correlated with SF-36 components and subcomponents.

Conclusion:

The first version of the SMFA-CL version (Spanish-Chilean) scale is reported. This culturally adapted score, demonstrated a high rate of reliability, validity and ability to objectively evaluate foot and ankle pathologies.
Metal Allergy in Foot & Ankle: A Systematic Review
Authors: Cristofaro Caroline , Halai Mansur , Daniels Timothy R. , Pinsker Ellie
Published: November 2022

Category:

Basic Sciences/Biologics; Other

Introduction/Purpose:

Metal hypersensitivity is common in the general population, affecting between 10-15%. Many different metals are constituents of orthopaedic devices used for foot and ankle surgery; therefore, it is expected to influence patient outcomes. A variety of different reactions, both systemic and localized, have been reported, along with treatment strategies. However, there is no accepted protocol to evaluate, diagnose and manage patients with suspected metal hypersensitivity reactions. Current literature characterizing metal hypersensitivity in foot and ankle and guidance on management is lacking.

Methods:

A comprehensive literature search of Ovid MEDLINE and EMBASE was performed from inception to 23-Nov-2021 using MeSH search terms focusing on the foot and ankle, orthopaedic surgeries, a variety of metal types, and hypersensitivity reactions. A total of 43 studies were identified. All full-text, English, experimental and observational studies, reporting on metal hypersensitivity in the context of foot and/or ankle surgeries using metal-containing orthopaedic devices were included. Article screening, quality assessment, and data extraction was performed by two reviewers. Disagreements were resolved by discussion or the vote of a third reviewer.

Results:

A total of 45 patients (18 male and 27 female) were included from 15 papers. Mean age was 55.5 years. There were 42 static and three arthroplasty implants included. Metal hypersensitivity diagnosis was performed with specialist consults, and most commonly, patch testing (e.g. with standard array or implant components). Patch testing was most commonly positive to nickel (thirteen), followed by cobalt (four), vanadium (three), and other less commonly used metals. Mean follow up was 20.8 months. Fifteen patients (12 with a positive patch test, 1 with a negative patch test and two not tested), all symptomatically improved following metallic implant removal; four patients had implants removed for unclear reasons; one patient remained symptomatic despite implant removal but had a negative patch test. The remaining 25 patients retained their implants without significant symptoms regardless of patch test result.

Conclusion:

Metal hypersensitivity in the context of foot and ankle surgery is not widely reported. It should be considered as a differential diagnosis in patients who present with hypersensitivity-type symptoms with previous surgery with metallic implants, after infection and mechanical failure have been ruled out. Patch testing can be helpful in identifying these patients. Removal of static implants after fracture union in trauma cases typically resulted in symptom resolution. Metallic arthroplasty implant removal presents more of a clinical challenge. Future research should focus on creating a framework to identify at risk patients and diagnose foot and ankle patients with metal allergy.
Current Literature Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review
Authors: Dallman Johnathan , Wolf Megan R. , Campbell Tanner , Herda Trent J. , Tarakemeh Armin , Vopat Bryan G.
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

Treatment for lateral ankle instability (LAI) varies drastically from conservative to operative management depending on the individual's injury, symptoms, and lifestyle. Typically, surgical treatment is recommended when conservative treatments fail for LAI. The importance of determining the most effective treatment is necessary due to LAI costing $2 billion annually within the health care system [1]. Furthermore, residual physical disability following failed treatment for LAI occurs in up to 70% of patients [2]. Unfortunately, despite exceedingly high incidences and economic impact, a standard definition of failure for the surgical treatment of LAI alludes clinicians and researchers. Therefore, the purpose of this project is to identify LAI treatment 'failure' definitions that are currently in the literature and work towards standardization of the definition.

Methods:

A systematic search of Medline, SportDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for lateral ankle instability and included information about surgical failures. Studies with level of evidence I to IV were included for this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinion were excluded. These studies were then reviewed for definitions of failure of any surgical procedure used to correct lateral ankle instability.

Results:

Of the 1,200 studies, 3.5% (42/1,200) studies published between 1984 and 2020 met inclusion criteria and were analyzed. After reviewing the data, numerous definitions were found in the literature for LAI surgical failure. The most common was 'recurrent instability' (40%, 17/42) followed by 're-rupture' (24%, 10/42). For the original operation, the Modified Brostrom Gould technique was used most frequently (40%, 17/42) in cases treated operatively. The failure rate of this procedure ranged from 1.1% to 45.2% depending on the definition of 'failure.'

Conclusion:

There were multiple definitions of failure for surgical treatment of lateral ankle instability and is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from a standardization of ankle instability treatment 'failure' definition. This definition should incorporate multiple facets, including history, physical examination findings, outcome scores, imaging, and surgical findings for an inclusive understanding of failure.
Treatment of Moderate to Severe Hallux Valgus without Osteotomy or Arthrodesis
Authors: Deckey David G. , Verhey Jens , Haglin Jack , Carlson Alicia , Kile Todd A. , Hinckley Nathaniel
Published: November 2022

Category:

Bunion

Introduction/Purpose:

Hallux valgus is a multi-planar deformity that has historically required osteotomies to correct a soft tissue deficiency. We present a novel technique for the treatment of moderate to severe hallux valgus and subsequent radiographic results of a method to correct the intermetatarsal abnormality without utilizing osteotomies or arthrodesis.

Methods:

One hundred and thirty-six patients undergoing primary metatarsal re-alignment with modified McBride for moderate to severe hallux valgus were included. After each patient underwent standard distal soft tissue procedure via modified McBride bunionectomy, the first metatarsal was manually reduced and brought parallel to the second. It was then held temporarily with a K-wire and position assessed to ensure the first and second metatarsal heads are in the same transverse plane to prevent relative plantar or dorsiflexion of the first ray. A bioabsorbable screw was then placed obliquely from the base of the first into the bases of the second and third metatarsals. Patients were assessed pre-operatively, at 2 weeks, 6 weeks, and 3 months for early clinical outcome, complications, and radiographic evaluation. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were recorded and used to monitor any progression or change over time.

Results:

This procedure allows for significant correction of moderate and severe hallux valgus deformities with little radiographic evidence of loss of reduction in early clinical follow-up. One and two-year follow-up was included for patients where available. Pre-operative assessment of HVA and IMA were 32.3° (95% CI: 31.1-33.5) and 14.8° (95% CI: 14.2-15.3), respectively. Post- operative HVA was significantly improved at 2 weeks (10.4°), 6 weeks (11.1°), and 3 months (12.1°). IMA was improved at 2 weeks (6.0°), 6 weeks (6.8°) and 3 months (7.8°). One (48 patients) and two-year follow-up (20 patients) show maintenance of correction of both HVA (1yr: 12.7°, 2yr: 10.8°) and IMA (1yr: 7.9°, 2yr: 8.0°). Complications were few including iatrogenic hallux varus (2/136, 1.4%), peri-implant fractures at the second metatarsal base (3/136, 2.2%), and valgus relapse, which was the only complication requiring re-operation (3/136, 2.2%).

Conclusion:

When combined with modified McBride bunionectomy, this proximal metatarsal realignment procedure provides a simple and effective method for the treatment of moderate to severe hallux valgus deformities. Additionally, there is minimal radiographic evidence of loss of reduction over time. This procedure is simple to perform, easy to learn, and does not 'burn any bridges' with regards to future surgery.
Low Ankle Arthroscopy Procedural Volume Amongst Graduating Orthopedic Surgery Residents
Authors: Garber Hollie , Sudah Suleiman , Michel Chris , Faccone Robert D. , Dijanic Christopher M. , Kerrigan Daniel J. , Gabisan Glenn
Published: November 2022

Category:

Ankle; Arthroscopy; Sports

Introduction/Purpose:

The purpose of this study was to evaluate trends in graduating orthopedic resident case volume and variability for ankle arthroscopy.

Methods:

The Accreditation Council for Graduate Medical Education surgical case log data from 2016 to 2020 for graduating United States orthopedic surgery residents was assessed. Arthroscopy procedures of the leg/ankle were identified. The average number of cases performed per resident was compared from 2016 to 2020 to determine the percent change in case volume. The 10th, 30th, 50th, 70th, and 90th percentiles of case volumes from 2016 to 2020 were presented to demonstrate case volume variability.

Results:

There was no significant change in the average number of leg/ankle arthroscopy cases from 2016 to 2020 [6.2 +- 5 [range 0 to 35] vs. 6.1 +- 6 [range 0 to 76] [p=0.732], despite a 19% increase in the average number of total leg/ankle procedures performed over time (168.4 +- 47 [range 55-414] in 2016; 200.8 +- 57 in 2020 [range 67-601], p <0.001). There was wide variability in ankle arthroscopy case volume amongst residents. The 90th percentile of residents performed 13 cases in 2020, compared to 5 in 50th percentile, and 1 in the 10th percentile.

Conclusion:

Despite the growing popularity of ankle arthroscopy, orthopedic resident exposure to this technical procedure remains generally low. Understanding trends in case volume and variability is important for programs to ensure that orthopedic residents are gaining adequate exposure to increasingly popular procedures. Implementing minimum case requirements for ankle arthroscopy during orthopedic residency may be helpful to increase exposure to ankle arthroscopy and reduce variability in experience.
2-Octyl Cyanoacrylate Adjuvant Use in Calcaneal Tendon Repair: Comparative Experimental Study in Rabbits
Authors: Gomes Rogério d. , Padua Bruno J. , Gomes Anderson H. , Magalhães João Murilo B. , Fonseca Wagner V.
Published: November 2022

Category:

Basic Sciences/Biologics; Ankle; Sports

Introduction/Purpose:

The best alternative for treating calcaneal tendon rupture is still controversial. The treatment can be conservative or surgical; the latter is better indicated in high-performance athletes. The pursue of faster recovery, reductions in skin complications and re-ruptures have brought about improvements to the tendon repair technique and to early assisted rehabilitation programs. Our goal was to check whether or not the adjuvant use of 2-octyl cyanoacrylate provides additional mechanical resistance to the calcaneal tenorraphy, when compared to suture alone, using the same tenorraphy technique.

Methods:

We used 45 three-month-old New Zealand rabbits, distributed into three groups of 15 animals each. The rabbits underwent two surgical procedures at a 30-day interval. In the first procedure, we performed the complete calcaneal tendon section on the right side, and then we repaired it using three different techniques: suture alone in group 1, suture with 2-octyl cyanoacrylate in group 2, and 2-octyl cyanoacrylate alone in group 3. After 30 days, we slaughtered the rabbits, and resected their right-side calcaneal tendon, and sent the specimen for pathology analysis. Then, we performed a cross section of the left calcaneal tendon, and used the same three repair techniques. After 15 minutes, we subjected the repaired tendons to the linear traction mechanical strength test.

Results:

The results from the linear strength test showed that suture with glue outperformed suture alone (p = 0.0427), and glue alone (p <0.0001). There was no rupture pattern difference between the groups, whether due to suture rupture or slipping. The pathology results were evaluated according to inflammation, repair process and tendon thickness. The report mentioned a high- intensity mixed inflammatory pattern (acute and chronic), outstanding neovascularization, tissue necrosis and abscess in most of the cases that used cyanoacrylate. However, there were no local or systemic clinical signs of an infectious process, or difference in tendon thickness between the three groups.

Conclusion:

2-octyl cyanoacrylate added immediate mechanical strength to the calcaneal tendon repair in the rabbits, without increasing local complications, despite pathological changes (focal necrosis, microabscesses and granulomatous reaction) in up to 30 days after the repair.
Portable Ultrasound Equals Arthroscopy for Assessment of Syndesmotic Instability
Authors: Hagemeijer Noortje , Sato Go , Bhimani Rohan , Lubberts Bart , Elghazy Mohamed Abdelaziz , Sierevelt Inger , Waryasz Gregory R. , Kerkhoffs Gino , DiGiovanni Christopher W. , Guss Daniel
Published: November 2022

Category:

Ankle; Arthroscopy

Introduction/Purpose:

Syndesmotic instability, when subtle, can be challenging to diagnose-and often requires visualization of the syndesmosis during applied stress. Portable ultrasonography is increasingly used to evaluate ankle instability at the point of care. This study aims to evaluate 1) whether portable ultrasonography (P-US) can diagnose syndesmotic instability in the sagittal plane, and 2) how P-US measurements compare to arthroscopic evaluation.

Methods:

Eight fresh, above-knee cadaveric specimen were used. The syndesmosis was evaluated with P-US and arthroscopy in the intact state, and thereafter with progressive sectioning of, 1) anterior-inferior tibiofibular ligament (AITFL), 2) interosseous ligament (IOL), and 3) posterior-inferior tibiofibular ligament (PITFL). Sagittal plane translation was simulated with 100N of anterior to posterior (A to P) and posterior to anterior (P to A) directed force using a bone hook. Separately, a 50N manual force was applied to the fibular tip and measured with P-US to simulate a fibular 'shuck test' performed in the clinical setting.

Results:

When all three syndesmotic ligaments were transected, there was a significant increase in fibular motion in the sagittal plane when evaluated using portable ultrasonography with application of 50N of manual pressure and when applying a 100N hook test when measuring total sagittal plane motion (p=<0.001 and p=0.009). Arthroscopy demonstrated significant increased motion with a 100N hook test when measuring total sagittal plane motion (p<0.001).

Conclusion:

P-US performed similarly to arthroscopy when diagnosing syndesmotic instability in the sagittal plane. P-US also offers several advantages over arthroscopy, including availability, non-invasiveness, low cost, and affording contralateral comparison. The promise of this technique suggests it should be further explored as a potential future standard for the diagnostic assessment of occult syndesmotic instability in the sagittal plane.
Radiographic Correction of Bunionette Deformity using Minimally Invasive Fifth Metarsal and Akinette Osteotomy
Authors: Hurst Kaitlyn M. , Neufeld Steven K. , Cuttica Daniel J. , Sanders Thomas H.
Published: November 2022

Category:

Midfoot/Forefoot; Lesser Toes; Other

Introduction/Purpose:

Bunionette Deformity is defined as a painful lateral prominence of the fifth metatarsal head. Conservative treatment entails footwear and activity modification. Symptoms can be exacerbated in the athletic population and activities with specific footwear such as cycling, winter sports and water sports. In refractory cases, patients may pursue operative intervention. Historically, open surgical correction carried risks of wound complications, prolonged recovery time, and nonunion risk. Minimally invasive techniques have gained popularity due to the decreased risk of wound complications, preservation of blood supply and healing potential, and faster operative and recovery times. The purpose of the current study is to examine radiographic and clinical outcomes of minimally invasive bunionette correction with a sliding distal 5th metatarsal osteotomy and lateral closing wedge proximal phalanx (Akinette) osteotomy.

Methods:

A retrospective review examined 36 feet in 28 patients who underwent minimally invasive bunionette correction from 01/2021 to 12/2021. The study patients were treated at a single center by 3 participating providers trained in minimally invasive techniques. All patients underwent a distal 5th metatarsal osteotomy and Akinette osteotomy of the proximal phalanx. Length of follow up ranged from 3 to 12 months. Radigraphic measurements including 4,5 intermetatarsal angle (IMA), 5th metatarsophalangeal angle, and osteotomy displacement (mm) were compared pre and postoperatively. Patients were asked to complete postoperative satisfaction survey and lesser toe American Orthopaedic Foot & Ankle Society (AOFAS) score.

Results:

Preliminary analysis shows a radiographic 4,5 IMA correction of 4.9 degrees to 3.4 degrees. Fifth metatarsophalangeal angle was corrected from 20.3 degrees preoperatively to 5.3 degrees postoperatively. Average medial displacement of the metatarsal osteotomy was 2.64 mm. There was one nonunion of the 5th metatarsal in a revision case that had previously been treated at an outside facility with open techniques, which was treated with bone grafting. Two other patients underwent revision surgery for complications from concomitant procedures that were performed (1 lapidus nonunion and 1 lapidus wound dehiscence). There were no wound or neurovascular complications involving the 5th ray.

Conclusion:

Our data shows that minimally invasive bunionette correction with sliding 5th metatarsal and Akinette osteotomy leads to reliable radiographic correction and clinical improvement. This operation has favorable safety profile with low incidence of complications and a high union rate.
Lateral Joint Distraction Through Distal Fibula Lengthening Osteotomy for Lateral Compartment Ankle Osteoarthritis
Authors: Im Jemin , Jung Hong-Geun , Lim Jung-Won
Published: November 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Lateral compartment ankle OA, commonly due to trauma such as ankle fracture, is not very rare. However there's no definite established surgical treatment option. In this study, we suggest distal fibula lengthening osteotomy for lateral joint distraction as one of treatment surgical option. We have experienced favorable clinical outcome for 3 cases of post- traumatic lateral compartment ankle OA with joint space narrowing treated with distal fibula distraction osteotomy. We report the case series with the surgical technique and the clinical-radiological outcome.

Methods:

From April 2016 to August 2021, three ankles which underwent distal fibula distraction osteotomy were included in this study. All three ankles had a history of OR/IF due to fractures in the ankle joint and were diagnosed with lateral compartment OA. We defined lateral compartment OA when clinical symptoms and radiologic findings were consistent. Clinically, the point of pain was characterized as the lateral compartment of the ankle joint, not the syndesmosis or peri fibular area. Radiologically, joint space narrowing is showed in X-ray, and CT arthrography or MRI confirmed cartilage denudation of the lateral compartment.

Results:

1) Clinical outcomes (Table 1) Case 1: The AOFAS score improved from 69 preoperatively to 93 postoperatively, and the Pain vas score improved from 7 to 0. According to patient's subjective expression, daily activity became 'Boxing available' from 'Hard to run'. Case 2: The AOFAS score improved from 73 preoperatively to 91 postoperatively, and the Pain vas score improved from 5 to 0. According to patient's subjective expression, daily activity became 'No pain on daily activity' from 'Hard to walk'. Case 3 is not described because there has been no progress for more than 1 year after surgery. 2) Radiologic outcomes (Table 2) Lateral joint space, talocrural angle, talar tilt angle and tibia axis-talar dome angle were all changed close to the contralateral ankle index after surgery.

Conclusion:

Painful ankle OA localized to the lateral compartment in young age is uncommon and there is no definite surgical method. Distal fibula distraction osteotomy is reasonable surgical method that does not burden patients and surgeon. In our study, distal fibula distraction osteotomy showed favorable clinical-radiological outcomes. So, we recommend this method for painful lateral compartment OA in young ages.
The effect of the emergency service work environment on the patient safety attitudes of nurses
Authors: Kizir Nuriye , Ozsaker Esma
Published: November 2022

Background

A safe working environment in the health sector contributes significantly to employee and patient safety and supports positive patient outcomes. Nurses play an important role in improving the healthcare quality related to patient safety practices. This study aimed to investigate the effect of the emergency service work environment on nurses’ patient safety attitudes.

Methods

This cross-sectional study was conducted in the emergency departments of 15 tertiary public hospitals and university hospitals in Izmir, Turkey. 288 nurses who worked 6 months or more in emergency departments were included in the sample. The personal information form, safety attitudes questionnaire, and work environment scale were used in the data collection.

Results

The total mean score for the safety attitudes questionnaire was 136.69 ± 22.14, and the total mean score for Work Environment Scale was 84.51 ± 12.02. A positive correlation was detected between the Safety Attitudes Questionnaire total score and Work Environment Scale total score ( r = 0.38, p < 0.001).

Conclusion

The patient safety attitudes of the emergency room nurses were moderately positive, the nurses evaluated the working environment positively, and positive work environments affected patient safety attitudes positively.