bluuebunny/crossref_metadata_2025 huggingface dataset:
Local and State Policy Action Taken in the United States to Address the Emergence of E-Cigarettes and Vaping: A Scoping Review of Literature
Authors: O’Connell Madison , Kephart Lindsay
Published: November 2020

Introduction

In response to rising rates of youth vaping and e-cigarette use, states and localities in the United States have adopted various tobacco control policies and have extended their utility to these emerging products. However, the extent to which these policies have been evaluated for their impact on youth use is unknown.

Method

Two databases (PubMed, Google Scholar) were searched for English language peer-reviewed articles pertaining to electronic cigarette policy evaluation between 2009 and 2020. Primary articles of interest were journal articles that evaluated an e-cigarette policy. Secondary articles of interest were journal articles that identified any e-cigarette policy action without a formal evaluation component, those that evaluated tobacco policy, or those that described e-cigarette behaviors and trends. Tertiary articles included gray literature that provided context for e-cigarette trends and additional policy identification.

Results

The final sample consisted of 12 relevant articles with an e-cigarette policy evaluation component and 62 relevant articles without such component, and 19 gray literature sources. Findings were synthesized based on policy type: product classification, age restrictions, smoke-free policies, flavor bans, sales restrictions, taxation, packaging, and advertising.

Conclusion

Policies that address access and use of e-cigarettes are common on the federal, state, and local level, are mostly reactionary, and mimic tobacco control efforts. Few policies have been formally evaluated for their effectiveness in reducing or preventing youth vaping. Strengthening the evidence base should be a priority for researchers going forward, given the potential of these policies to intervene on social and environmental conditions that affect youth initiation and uptake.
Theoretical study of unsteady oblique stagnation point based Jeffrey nanofluid flow over an oscillatory stretching sheet
Authors: Awan Aziz Ullah , Abid Sana , Abbas Nadeem
Published: November 2020

The numerical analysis for two-dimensional oblique stagnation point flow with the magnetohydrodynamic effects of an incompressible unsteady Jeffrey fluid model caused by an oscillatory and stretching sheet has been presented in this article. The Brownian motion and thermophoresis impacts are taken into consideration. The similarity transformation technique is implemented on the governing partial differential equations of the Jeffrey fluid model to obtain a set of nonlinear coupled ordinary differential equations and then these resulting equations are numerically computed with the help of BVP-Maple programming. The variation in the behavior of velocity, temperature, and concentration profile influenced by the governing parameters, has been explicitly explored and displayed through graphs. The numerical results are highlighted in tabular form and through these outcomes, the skin friction coefficient, Nusselt number, and Sherwood number have been investigated. These physical quantities rise for gradually increasing the Hartmann number and ratio of relaxation to retardation time. However, these reduce for gradually growing Jeffrey fluid parameter.
Research Productivity of Foot and Ankle Fellowship Faculty
Authors: Sherman Nathan , Bridge Nathaniel , Khwaja Ansab , Du Peter , Truchan Lisa
Published: November 2020

Background

Contribution to literature is critical for progress in the field of orthopaedics. No previous study has yet examined the academic productivity of foot and ankle surgery fellowship faculty.

Purpose

To evaluate the publishing productivity of foot and ankle fellowship faculty.

Methods

Faculty and program characteristics of orthopaedic foot and ankle fellowship programs across the United States and Canada were collected from American Orthopaedic Foot and Ankle Society (AOFAS) and program websites. Faculty publication productivity measures, including publications, number of publications in specific journals, number of citations, and Hirsch index (h-index) were gathered using the Scopus database.

Results

A total of 48 AOFAS foot and ankle surgery fellowship programs were identified with an associated 185 faculty members. The mean number of publications per faculty member was 44.9 (SD = 53.0; range = 0-323), with a mean h-index of 11.9 (SD = 10.6; range = 0-54). A total of 144 (77.8%) academic-affiliated faculty had a significantly greater number of publications ( P < .01), total citations ( P < .05), and publications in Foot and Ankle International ( P < .05), Journal of Bone and Joint Surgery ( P < .05), Clinical Orthopaedics and Related Research ( P < .05), and Journal of the American Academy of Orthopaedic Surgeons ( P < .05) compared to the 41 (22.2%) nonacademic faculty. There were no significant differences between measures of publication productivity between male and female faculty, except for maximum citations in a single article (67.1 vs 142.3; P < .05).

Conclusions

Academic-affiliated foot and ankle fellowship faculty have higher research productivity than nonacademic surgeons. The mean h-index of foot and ankle fellowship faculty was 11.9, which is lower than that reported in sports, joints, and spine fellowship faculty but higher than that reported for hand fellowship faculty.

Level of Evidence:

Level IV
Advances in community-acquired pneumonia
Authors: Jones Barbara , Waterer Grant
Published: November 2020

Community-acquired pneumonia is one of the commonest and deadliest of the infectious diseases, yet our understanding of it remains relatively poor. The recently published American Thoracic Society and Infectious Diseases Society of America Community-acquired pneumonia guidelines acknowledged that most of what we accept as standard of care is supported only by low quality evidence, highlighting persistent uncertainty and deficiencies in our knowledge. However, progress in diagnostics, translational research, and epidemiology has changed our concept of pneumonia, contributing to a gradual improvement in prevention, diagnosis, treatment, and outcomes for our patients. The emergence of considerable evidence about adverse long-term health outcomes in pneumonia survivors has also challenged our concept of pneumonia as an acute disease and what treatment end points are important. This review focuses on advances in the research and care of community-acquired pneumonia in the past two decades. We summarize the evidence around our understanding of pathogenesis and diagnosis, discuss key contentious management issues including the role of procalcitonin and the use or non-use of corticosteroids, and explore the relationships between pneumonia and long-term outcomes including cardiovascular and cognitive health.
The Relationship Between Personality Traits and Interracial Contact on Campus
Authors: Diehl David K.
Published: November 2020

It is not well understood why, on diverse college campuses, some students are more likely than others to engage in interracial contact. While research has begun to examine the role of individual differences like personality traits, results have thus far been mixed. This article asks if this might be the result of confounding different forms of interracial contact. Using a sample of nearly 500 university students and drawing on distinctions made in research on diversity in higher education, models examining the relationships between the five-factor model (FFM) of personality traits and four types of interracial contact are presented: positive and negative cross-racial interactions (CRIs), and two ways of estimating interracial friendships (IRFs)—self-reported composition of close friends as well as the count of ego-network connections. Results show that having an Agreeable personality is associated with perceiving more positive and fewer negative CRIs, while no personality traits are associated with IRFs.
Effect of different preparation designs and all ceramic materials on fracture strength of molar endocrowns
Authors: Haralur Satheesh B , Alamrey Alaa Ali , Alshehri Shatha Abdulrahman , Alzahrani Danyah Saeed , Alfarsi Mohammed
Published: November 2020

Objective:

The aim was to compare the fracture strength of Molar endocrowns fabricated from different all-ceramic materials and various preparation designs.

Materials and methods:

Ninety extracted human molar teeth were root canal treated and randomly divided into three groups according to the all ceramic materials used for fabrication of the endocrowns ( n = 30): (1) Lithium disilicate (IPS e.max Press); (2) Polymer infiltrated ceramic (Vita Enamic); (3) High translucency zirconia (Ceramill Zolid HT). Each group was subdivided into 3 subgroups ( n = 10) according to the preparation design as 2 mm occlusal reduction, 4.5 mm occlusal reduction, and 4.5 mm occlusal reduction with 2 mm radicular extension. The endocrowns from each material were fabricated and surface treated according to the manufacturer’s recommendations. After cementation with self-adhesive resin luting cement, the specimens were stored in a humid environment for 72 hours and subsequently subjected to 5000 thermal cycles. After, a compressive, static-axial load was applied using a universal testing machine until failure. Load-to-failure was recorded (N) and the specimens were examined under a stereomicroscope to determine the failure type. The data was statistically analyzed using One-way ANOVA and Tukey HSD tests at p < 0.05.

Results:

The Lithium Disilicate endocrowns recorded the higher mean fracture strength for 4.5 mm occlusal thickness and 2 mm radicular extension at 3770.28 N and 3877.40 correspondingly. The High translucency zirconia endocrowns at conventional 2 mm thickness showed the highest mean fracture load (3533.34 N). Even though polymer infiltrated ceramic endocrowns displayed comparatively lesser fracture load; they recorded the predominantly favorable fractures.

Conclusions:

Increased occlusal thickness showed a significant improvement in fracture strength of lithium disilicate and polymer infiltrated ceramic molar endocrowns. Although the 2 mm radicular extension had the substantial enhancement of fracture strength in high translucency zirconia, it resulted in more unfavorable failure types.
Managing Mutual Fund Portfolio—the Franklin Templeton Credit Risk Fund Debacle
Authors: Uppily Ramabadran , Ramaratnam M. S.
Published: November 2020

Franklin Templeton started its Indian operations in the year 1996. On 24th April 2020 it made an announcement that it would be winding up Franklin India Credit Risk Fund and five other funds. This case is about the debacle of Franklin India Credit Risk Fund. Liquidity crisis in the debt market due to various events that happened in 2019, exposure towards debt instruments that turned risky (such as Yes Bank and Vodafone), reduction of inflows, redemption pressure, debt market becoming illiquid due to COVID-19 pandemic, were cited as some of the reasons for winding up of Franklin India Credit Risk Fund. The important thing to note is that when other credit risk funds have not taken the decision of winding up, why Franklin India Credit Risk Fund took this call? This case presents an opportunity to the students to analyse the factors that have contributed to the debacle and whether the decision taken is correct?
Osteochondral Autograft Transplant as a Potential Salvage Procedure for Articular Cartilage Defects of the Lateral Compartment in Lateral Meniscus–Deficient Knees: Results From a Country With Limited Availability of Meniscal Transplant
Authors: Nishitani Kohei , Nakagawa Yasuaki , Matsuda Shuichi
Published: November 2020

Background:

The treatment of a meniscus-deficient knee is challenging, especially when patients are young and active and are not favorable candidates for prosthetic joint replacement.

Hypothesis:

We hypothesized that osteochondral autologous transplant (OAT) alone can be considered a salvage treatment for patients with cartilage damage of the lateral compartment of the knee, even with lateral meniscal deficiency, if the knee alignment is close to neutral.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients with lateral meniscal deficiency, whose femorotibial angle was 170° to 180° and who underwent OAT on the lateral compartment of the knee without concomitant realignment osteotomy, were retrospectively included in this study. The International Knee Documentation Committee (IKDC) subjective score and the Japanese Orthopaedic Association score for knee osteoarthritis (JOA knee score) were recorded. The International Cartilage Repair Society (ICRS) cartilage repair assessment was used to evaluate the repaired cartilage at second-look arthroscopy.

Results:

The study included 10 patients (mean ± SD age, 31.7 ± 19.7 years; 3 men and 7 women) who had ICRS grade 4 cartilage lesions (mean size, 3.5 ± 1.7 cm2); the mean follow-up was 73.8 ± 42.5 months. From preoperative assessment to final follow-up, the mean IKDC subjective score improved significantly from 53.5 ± 10.0 to 85.4 ± 10.1, and the mean JOA knee score improved significantly from 81.0 ± 8.4 to 95.6 ± 5.3 ( P = .004 for both). One patient with a femorotibial angle of 170° underwent revision distal femoral osteotomy owing to prolonged symptoms and progression of the valgus deformity, and 2 other patients with femorotibial angles of 170° and 171° also exhibited progression of valgus malalignment or low clinical scores postoperatively. Patients with a favorable femorotibial angle (174°-178°) exhibited relieved symptoms and preservation of femorotibial angle alignment within 1° of change at follow-up. At second-look arthroscopy (n = 8 patients), 6 patients had an ICRS score of nearly normal or normal.

Conclusion:

In the study patients, for which a meniscal allograft was unavailable, the OAT procedure was able to relieve the symptoms associated with cartilage lesions, even with lateral meniscal deficiency, when the femorotibial angle alignment was close to neutral.
Development of cardiotoxicity model using ligand-centric and receptor-centric descriptors
Authors: Patel Chirag N , Kumar Sivakumar Prasanth , Rawal Rakesh M , Thaker Manishkumar B , Pandya Himanshu A
Published: November 2020

Background:

Bioinformatics and statistical analysis have been employed to develop a classification model to distinguish toxic and non-toxic molecules.

Aims:

The primary objective of this study is to enumerate the cut-off values of various physico-chemical (ligand-centric) and target interaction (receptor-centric) descriptors which forms the basis for classifying cardiotoxic and non-toxic molecules. We also sought correlation of molecular docking, absorption, distribution, metabolism, excretion, and toxicology (ADMET) parameters, Lipinski rules, physico-chemical parameters, etc. of human cardiotoxicity drugs.

Methods:

A training and test set of 91 compounds were applied to linear discriminant analysis (LDA) using 2D and 3D descriptors as discriminating variables representing various molecular modeling parameters to identify which function of descriptor type is responsible for cardiotoxicity. Internal validation was performed using the leave-one-out cross-validation methodology ensuing in good results, assuring the stability of the discriminant function (DF).

Results:

The values of the statistical parameters Fisher Discriminant Analysis (FDA) and Wilk’s λ for the DF showed reliable statistical significance, as long as the success rate in the prediction for both the training and the test set attained more than 93% accuracy, 87.50% sensitivity and 94.74% specificity.

Conclusion:

The predictive model was built using a hybrid approach using organ-specific targets for docking and ADMET properties for the FDA (Food and Drug Administration) approved and withdrawn drugs. Classifiers were developed by linear discriminant analysis and the cut-off was enumerated by receiver operating characteristic curve (ROC) analysis to achieve reliable specificity and sensitivity.
Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage
Authors: Cunningham Daniel J. , Ryan Sean , Adams Samuel B.
Published: November 2020

Category:

Ankle Arthritis; Ankle; Diabetes

Introduction/Purpose:

Total ankle arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis. Wound complications following these procedures, while rare, can have a significant impact on patient morbidity, particularly when they require return to the operating room and flap coverage. We sought to determine the risk factors associated with the need for flap coverage over TAA, and hypothesized that intraoperative variables such as additional procedures to provide angular correction would play a more important role than patient-specific variables.

Methods:

We performed a single center retrospective review of primary total ankle arthroplasties from April 2007 - February 2019. Patients demographics and medical comorbidities were collected in addition to concomitant procedures performed at the time of TAA such as tibial osteotomies, removal of hardware, and subtalar fusion. Multivariable, main effects logistic regression models were performed to evaluate the impact of specific concomitant procedures during primary TAA on the rate of subsequent flap coverage with adjustment for age, sex, and medical comorbidities.

Results:

2,124 TAA resulted in 29 flaps after an average of 1.1 (range 0-5) surgeries and 89.7 (range 18-591) days after the index arthroplasty. The most common flap was a radial forearm free flap performed in 15 (51.7%) patients. Patients requiring flap coverage were significantly older (p=0.044), were more likely to be diabetic (p=0.029), and were more likely to present to the ED and be readmitted within 90-days of their surgery (p<0.001). In a multivariable model controlling for age, gender, and diabetes diagnosis, patients with flaps were more likely to have a concomitant osteotomy (OR 3.720, 95% CI 1.693-8.177; p=0.001) at the time of there TAA. Other concomitant procedures did not show a significant association with subsequent need for flap coverage.

Conclusion:

Simultaneous procedures during TAA may place patients at higher risk of wound breakdown, specifically requiring flap coverage. In particular, osteotomies, namely tibial osteotomies for realignment, carry a special risk for wound healing difficulty. This should be considered as the indications for TAA continue to expand. [Table: see text]
Portable Dynamic Ultrasonography Versus Fluoroscopy for the Evaluation of Syndesmotic Instability: A Cadaveric Study
Authors: Hagemeijer Noortje , Lubberts Bart , Saengsin Jirawat , Bhimani Rohan , Sato Go , Waryasz Gregory R. , Kerkhoffs Gino , DiGiovanni Christopher W.
Published: November 2020

Category:

Ankle; Trauma

Introduction/Purpose:

Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The purpose of this study was to determine the association between tibiofibular clear space (TFCS) values measured with 1) a portable ultrasound (US) device and 2) fluoroscopy during applied external roation stress for the evaluation of syndesmotic instability.

Methods:

Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. Portable US device (Butterfly iQ, Butterfly Network Inc) images and fluoroscopic images taken by a mini C-arm were used to evaluate the ankle syndesmosis in the intact stage, and after sequentially sectioning of the anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL) at 7.5Nm torque. A Pearson’s correlation was performed to investigate the correlation between the TFCS among the two modalities. A paired t-test was used to compare TFCS values measured with US or fluoroscopy. Three cadavers were measured by two independent observers to assess reliability of the measurements for each diagnostic modality and analyzed using intraclass correlation coefficients (ICC). P-values of < 0.05 were considered significant.

Results:

The mean TFCS (+- SD mm) values measured with the US and fluoroscopy are presented in Table 1. TFCS values obtained with the US and fluoroscopy correlated (rho 0.60). Between the imaging modalities similar TFCS values were found in the intact state (difference 0.81+-1.0, p-value 0.061). Compared with fluoroscopy, the TFCS values measured using US increased significantly after sequential transection of the AITFL (0.039), IOL (p=0.004) and PITFL (p<0.001). The ICC for measuring the TFCS with US was 0.86 and 0.84 with fluoroscopy indicating excellent agreement.

Conclusion:

During application of an external rotation force to the ankle, US and fluoroscopic TFCS measurements among different stages of syndesmotic ligamentous injury correlate. However, compared with fluoroscopy, a portable US ultrasound device seems to be a more sensitive diagnostic technique to evaluate subtle syndesmotic instability. [Table: see text]
Robotic Arm Assistances in the Foot and Ankle Surgery: A Prospective Study
Authors: Angthong Chayanin
Published: November 2020

Category:

Other; Ankle; Trauma

Introduction/Purpose:

Little is known about the robotic assistance in the foot and ankle surgery. The present study was to report the robotic arm innovation and its utilization in the foot and ankle surgery.

Methods:

The robotic arm has been developed to serve for the tasks in foot and ankle surgery. This robot was called as ‘Limb- lifting assistance via robotic arm (LARA)’. It was designed to be a strong base with up and down movement of the trunk using the controller with safe level of electricity to lift its arm to support the ankle or leg during the perioperative period as the surgeon demanded as an attached picture. LARA was prospectively applied in the healthy volunteer and patients with foot and ankle diseases or injuries. The satisfaction levels were collected from the patient and user regarding LARA application. The physical and mental effort levels were also collected from the user during the use of LARA. The related complications were collected in all patients.

Results:

There were no reported complication from the healthy volunteer. Froma total of 10 patients, there was a scratch at the skin of one patient’s ankle area but it was no need of treatment. Other 9 patients did not report the related complication from the LARA. There was no difference of significant complication between the healthy volunteer and the patients. Based on the data availability, the mean physical and mental effort levels were 5 from 100 (highest level = 100; lowest level = 0). The mean satisfaction level was 100 and 90 from the patient and user perspectives (highest = 100; lowest = 0) respectively.

Conclusion:

Based on the results of this study, LARA was safe and effective to apply in the perioperative use for the foot and ankle surgeries with low-level of human user effort in both physical and mental aspects.
Outcome of Bunion Correction with First Tarsometatarsal Arthrodesis in Adult Acquired Flatfoot Deformity Correction
Authors: Bemenderfer Thomas B. , Boersma Jacob B. , Pryor Michael J. , Maskill John D. , Bohay Donald R. , Anderson John G.
Published: November 2020

Category:

Bunion; Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Arthrodesis of the first tarsometatarsal (TMT-1) joint is a widely accepted procedure for treatment of hallux valgus (HV) with medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high intermetatarsal angles (IMA). This study aimed to evaluate clinical and radiographic outcomes in patients with mild-to-severe HV who underwent TMT-1 arthrodesis and proximal hindfoot correction for adult acquired flatfoot deformity (AAFD).

Methods:

All patients with symptomatic HV and AAFD who failed conservative management underwent TMT-1 fusion and proximal hindfoot correction (medial displacement calcaneal osteotomy, lateral column lengthening, subtalar fusion, or tibiotalocalcaneal fusion) by one of three senior foot and ankle surgeons at a single tertiary center between January 2006 and December 2018 were included in our retrospective case series. Demographics, clinical outcomes, patient comorbidity information, and radiographic outcomes including hallux valgus angle (HVA), IMA 1-2, hallux valgus interphalangeus angle, distal metatarsal articular angle, and sesamoid station were collected. The primary outcome was change in HVA measured as the difference between final postoperative and preoperative weight bearing HVA measurements. Secondary outcomes were reoperation, minor complications (local wound care, use of antibiotics, and skin dehiscence), and change in radiographic measurements.

Results:

With an average follow up of 26 months, 155 patients (17.4% male, 82.6% female; average age 59.0 years old, range 18 to 84) met inclusion. The average change in HVA was -18.6 degrees (range +15.8 to -81.0). There was a total of 85 reoperations in 35.5% (n=55; 48 hardware removal). Minor complications were present in 18.7% (n=29; 25 local wound care, 23 use of antibiotics, and 10 skin dehiscence). 44.5% (n=69) had no evidence of recurrent HV while mild, moderate, and severe grade bunions were present in 40.0% (n=62), 5.2% (n=8), and 0.6% (n=1). Improvement in overall bunion grade was maintained in 69.7% (n=108) with no change in 19.4% (n=30). Hallux varus was present in 9.7% (n=15; 3 underwent TMT-1 arthrodesis).

Conclusion:

The present study demonstrates a significant improvement in HVA following TMT-1 arthrodesis and proximal hindfoot correction for AAFD. The majority of patients undergoing TMT-1 arthrodesis and proximal hindfoot correction for AAFD obtain and maintain improvement in the radiographic severity of their bunions. However, patients should be counseled concerning expectations with regards to outcomes associated with complex AAFD reconstructions.
Leg-Length-Evening Device Improves Balance in Patients Wearing a Controlled Ankle Motion Boot: A Multicenter Randomized Controlled Trial
Authors: Bohl Daniel D. , Mehraban Nasima , Idarraga Alexander J. , Wu Kevin J. , Patel Milap , Vora Anand M. , Kadakia Anish R. , Lee Simon , Hamid Kamran S.
Published: November 2020

Category:

Other

Introduction/Purpose:

Patients are often made weight-bearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg-length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg-length evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot.

Methods:

Patients made WBAT in a CAM boot were randomized to either the leg-length-evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for two weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance).

Results:

Out of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups (p>0.05 for each). Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0+-1.5 versus 3.2+-1.8, p=0.001; as-treated analysis: 2.1+-1.7 versus 3.0+-1.7, p=0.009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score (p>0.05 for each).

Conclusion:

This multicenter randomized controlled trial found that adding a limb-length-evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improves balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain.
Radiographic Characterization of Midfoot and Transverse Tarsal Joint Osteoarthritis
Authors: Caughman Alexander , Gross Christopher E.
Published: November 2020

Category:

Midfoot/Forefoot

Introduction/Purpose:

The burden of midfoot arthritis is staggering. Foot osteoarthritis affects over 16% of all adults over the age of 50, interfering with activities of daily living and leisure. Non-operative management often culminates in fluoroscopic guidance injections. Its management is troublesome for surgeons as conservative treatment is maximized because its surgical solution is oftentimes fraught with nonunions and other complications. The purpose of this study was to see how well surgeons are able to predict midfoot and transverse tarsal joint osteoarthritis on x-rays as it compares to CT and MRI scans.

Methods:

We reviewed the records of 117 patients (146 feet) with a diagnosis code of midfoot osteoarthritis who were treated from 2015 to 2019 at an academic medical center by a single surgeon. The mean age was 63.2 +- 10.7 years. The average BMI was 31.2 +- 6.4. Each of those patients had both plain radiographs and either a CT or MRI scan. Patients had weight-bearing anteroposterior and lateral radiographs according to a standardized protocol. Radiographs and advanced images were graded separately for the presence of joint space narrowing, subchondral cysts, and other signs of arthritis. We then compared how frequently a radiograph predicted an arthritic midfoot or transverse tarsal joint as compared to a CT scan or MRI using a paired t test.

Results:

The most common joints affected by arthritis were the 2nd TMT (83.5% by X-ray; 88.4% by CT) and 3rd TMT (71.9% by X-ray; 68.4% by CT). Advanced imaging showed a significantly higher rate of arthritis in the 1st, 4th, and 5th TMT as compared to X-rays. Only 20.2% of patients’ radiographs had a direct correlation with their CT scan. A CT scan showed one or two more affected joints by 23.6% and 17.6 % respectively, and rarely showed one or two less joints affected by arthritis, 6.8% and 0.6% respectively. Based on this data, a radiograph’s sensitivity and specificity vary wildly-from 86.0% and 57.8%, respectfully in the 3rd TMT to 43.8% and 96.0%, respectfully in the 1st TMT.

Conclusion:

Radiographs vary quite drastically in their sensitivities and specificities in diagnosing osteoarthritic joints in the midfoot and transverse tarsal joints. If intending to treat midfoot osteoarthritis with fluoroscopic injections, we recommend not relying on plain radiographs, but advanced imaging.
Anterior Talofibular Ligament Reconstruction could Produce Comparable Functional Outcomes with or without Calcaneofibular Ligament Reconstruction for Chronic Lateral Ankle Instability
Authors: Feng Shi-Ming
Published: November 2020

Category:

Ankle; Arthroscopy; Sports

Introduction/Purpose:

This study evaluates the effects on functional outcomes of with or without calcaneofibular ligament reconstruction when reconstructing the ATFL for chronic lateral ankle instability

Methods:

This retrospective cohort study included 48 chronic lateral ankle instability patients with later ligament reconstruction that underwent either with or without a calcaneofibular ligament reconstruction using an ipsilateral free semitendinosus tendon autograft from June 2014 to October 2017. The Visual Analogue Scale score, the American Orthopaedic Foot & Ankle Society score, Karlsson Ankle Functional Score and Anterior Talar Translation in both groups were compared.

Results:

All patients were followed up for at a mean of 30 months, Visual Analogue Scale score, the American Orthopaedic Foot & Ankle Society score, Karlsson Ankle Functional Score and Anterior Talar Translation between two the groups were not statistically significant different.

Conclusion:

There are no differences at 2.5 years in postoperative ankle function and stability when an ipsilateral free semitendinosus tendon autograft is used to manage CLAI with anterior talofibular ligament reconstruction with and without reconstructing the calcaneofibular ligament.
Patient Reported Outcomes and Recurrence following 127 Primary Lapidus Surgeries for Hallux Valgus
Authors: Galli Sara H. , Johnson Nick , Davis W. Hodges , Anderson Robert B. , Jones Carroll P. , Cohen Bruce E.
Published: November 2020

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Treatment for symptomatic hallux valgus encompasses a spectrum of surgical options to appropriately address the degree of deformity. The modified Lapidus has emerged as a powerful surgical option to address moderate to severe deformity as well as hallux valgus with 1st ray hypermobility. Unlike metatarsal osteotomies, the literature is lacking in clinical and radiographic outcomes. Previous retrospective series have reported recurrence rates less than 15%, but our experience found a higher recurrence rate. We aimed to evaluate the effect of radiographic recurrence on patient reported outcome measures and satisfaction.

Methods:

After obtaining institutional board review approval, patients were identified by procedural billing codes from 2012- 2016. Only primary Lapidus surgeries were included. All patients were contacted and invited to return to obtain patient reported outcome scores (AOFAS, FAAM) and assess satisfaction. HVA>=20 at final follow-up was used to define recurrence. Data was analyzed utilizing statistical analysis software (SAS v9.4).328 surgeries were identified with 255 eligible and contacted for follow-up. 77 surveys were completed in person and 50 were completed over the phone or via email with total response rate of 50%.

Results:

Average follow-up was 59 months. 38% had radiographic recurrence (48/127), 24% perceived recurrence (30/125), and 9.5% had reoperation for recurrence (12/126). AOFAS scores were lower with radiographic recurrence (p=0.01) and perceived recurrence (p=0.003). FAAM-ADL scores were not different in radiographic recurrence (p=0.79) but were lower in perceived recurrence (p=0.001). Overall, satisfaction was good-excellent in 74% and fair-poor in 26%. For radiographic (p=0.03) and perceived recurrence (p<0.0001), there was lower satisfaction reported. 78% would repeat surgery. Decision to repeat surgery was not different for radiographic recurrence with 81% without vs 74% with recurrence (p=0.37) saying they would have surgery again. However, it was different for perceived recurrence with 84% without vs 59% with recurrence saying they would have surgery again (p=0.01).

Conclusion:

Despite a high radiographic recurrence rate (38%), only a portion perceived a recurrence (24%) and an even smaller proportion (9.5%) had a reoperation for the recurrence. Nonetheless, these results suggest radiographic and clinical outcomes are not as high as previously reported for the modified Lapidus procedure.
Outcome Following Lower Extremity Nerve Block during Foot and Ankle Surgery: A Systematic Review
Authors: Gianakos Arianna L. , Romanelli Filippo , Badri Malaka , Rao Naina , Lubberts Bart , Guss Daniel , DiGiovanni Christopher W.
Published: November 2020

Category:

Ankle; Other

Introduction/Purpose:

The purpose of this study was to perform a systematic review of the current literature assessing the management of pain with various block techniques in the perioperative period during elective foot and ankle surgery.

Methods:

A review of the literature was performed according to the PRISMA guidelines. Medline, Embase, and Cochrane databases were searched on October 1, 2019. Studies were identified by using synonyms for ‘foot’, ‘ankle’, ‘pain management’, ‘opioid’ and ‘nerve block’. Inclusion criteria were studies that 1) reported and compared the outcomes following various types of peripheral nerve blocks in in foot and ankle surgery, 2) were published in the English language, and 3) were published within the last 10 years.

Results:

Twenty-four articles evaluating 4,640 patients were included. Sixty-seven percent were randomized controlled trials, 17% were prospective comparison studies, and 17% were retrospective comparison studies. Nerve block techniques included: femoral, adductor canal, sciatic, popliteal, saphenous, and ankle. Ropivacaine and bupivacaine were most commonly utilized. Postoperative opioid consumption and postoperative pain levels were reduced with use of PNB when compared with systemic/local anesthesia, in patients receiving combined popliteal/femoral block, and in patients receiving continuous infusion popliteal block [Table 1, Table 2]. Studies demonstrated higher satisfaction with PNB, continuous infusion, and dual injections [Table 3]. One study reported 7% neurologic related complication risk and demonstrated a higher complication rate when with popliteal versus ankle block. All other studies were equivocal or failed to mention complications.

Conclusion:

Optimal pain management for elective foot and ankle surgery remains controversial and an ideal protocol from a risk-benefit perspective regarding use of PNB has yet to be established. Our study demonstrates improvements in postoperative pain levels, opioid consumption, and length of stay in patients receiving a PNB when compared with systemic anesthesia. Combined PNB and dual catheter administration may improve outcomes. Unfortunately, little data has been published on risks and tradeoffs in order to help guide patients and surgeons with a well informed shared decision making model. Future studies are needed to better clarify any respective tradeoffs to these options. [Table: see text]
Percutaneous and Minimally Invasive Surgical Technique for Achilles Tendon Repair
Authors: Hoskins Tyler , Goyette David , Patel Jay , Mazzei Christopher , Gianakos Arianna L. , Koss Justin , Wittig James , Epstein David M.
Published: November 2020

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

Achilles tendon rupture is a traumatic injury that can cause considerable morbidity and reduced function. The optimal treatment method for this injury remains controversial. Non-operative intervention puts patients at higher risk of re-rupture whereas surgical intervention has risks of infection and iatrogenic nerve injury. Recently, surgeons have established a less invasive surgical approach to repairing the achilles tendon. The ‘Percutaneous or Mini-Invasive’ technique was adopted in order to reduce infection rates and wound breakdown. However, due to the scarce amount of literature reported, the efficacy of this procedure still remains under scrutiny. The goal of this study was to examine the functional outcomes of patients treated at our facility for a ruptured achilles tendon using the percutaneous and minimally invasive surgical technique.

Methods:

From 2014 to 2020 eighty-one patients underwent a percutaneous or mini invasive surgery at our facility for the treatment of a ruptured achilles tendon. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05.

Results:

The mean follow up for our patient cohort was 36.40 months (range, 6 to 71). The average age was 41.46 years (range, 17- 65). Mean pre-op AOFAS and ATRS were 45.60 and 47.18 respectively, compared to 90.29 and 87.97 after surgery (p-value <0.05). There were two significant complications reported post-operatively. One patient re-ruptured their Achilles tendon four months post-operatively. This patient was successfully treated with a mini invasive approach and reconstruction of the tendon. A second patient developed a superficial infection ten months post-operatively. This patient successfully underwent irrigation and debridement of the wound.

Conclusion:

The pre-op and post-op AOFAS and ATRS scores were deemed statistically significant. A percutaneous and mini invasive approach to repair a ruptured achilles tendon, although new, offers promising functional outcome results and remains a viable treatment option to decrease the incidence rate of post-operative infection and iatrogenic nerve injury. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.
Major Mistakes in Current Scientific Presentations
Authors: Manoli Arthur
Published: November 2020

Category:

Other

Introduction/Purpose:

The purpose of this presentation is to demonstrate to the orthopaedic surgeon many of the disturbing, current trends often seen in today’s oral paper presentations. Many of these are superfluous, confusing, offensive, not pertinent, difficult to interpret or unnecessary. These mistakes are often copied from other poor presentations, inhibiting adult learning in the audiences.

Methods:

Observing large numbers of presentations at many local, regional and national meetings has led the authors to notice many disturbing trends that have insidiously crept into many of the paper presentations in recent years. Difficult to read fonts, low contrast slides, poor backgrounds, superfluous ornamentation, excessive wordiness, poor graphs, full sentences (actually read aloud!) in large numbers of bullet points, distracting animation, showing every detail or every case, family and pet photos, and unreadable bibliographies flashed quickly at the end have all been seen. Common clichés, such as ‘I realize this is a busy slide…‘ is commonly used, prefacing a table with multiple columns and rows and unreadable numbers, often with standard deviations! Even though it is unreadable, the presenter shows it anyway!

Results:

Many of the disturbing trends that have been seen add nothing to the presentations, and, in fact, are distracting, taking away from the basic messages of the paper. While the presenter may think these items are important to add and necessary for completeness, they severely distract from the presentation’s effectiveness. Many of them make the audience give up and ‘tune out.’ Effective learning is minimal. As a result, audiences have become less connected and increasingly disinterested. Simplicity clarity are important to one’s message.

Conclusion:

Efficient, clear, non-distracting presentations are essential for adult learning. Currently, information overload and poor design threaten to obfuscate scientific sessions. The illustrated items should be eliminated and not copied from paper to paper.
Early Functional and Patient Reported Outcomes following Suture Tape Augmented Brostrom
Authors: Martin Kevin D. , Huh Jeannie , Robinson William , Martin Kevin D.
Published: November 2020

Category:

Ankle

Introduction/Purpose:

Immediately following a lateral ligament reconstruction the strength of the repair is far less than the native anterior talofibular ligament (ATFL). With early functional rehabilitation the repair has shown increased laxity. We hypothesized that a Brostrom augmented with a suture-tape construct would allow early functional rehabilitation while maintaining patient reported outcomes within a military population.

Methods:

This study is a retrospective cohort of 90 consecutive patients with chronic lateral ankle instability were treated with a Brostrom procedure augmented with a suture-tape construct. All had a preoperative MRI demonstrating ligament insufficiency, and was examined by an orthopaedic foot and ankle surgeon. Subjects were evaluated at 2, 6 and 12 weeks postoperatively. Demographics including Foot and Ankle Disability Index (FADI), Visual Analog Scale (VAS), and clinical measures including single- leg hop and single-leg heel raise were recorded. The population included (14 women [18%], 76 men [84%] mean age of 29.47, BMI 27.3) active duty service members.

Results:

The mean FADI score pre-operatively (67) improved to 86 and 89 at 6 and 12 weeks. The VAS scores pre-operatively (4.8) improved to 1.4 and 1.3 at 6 and 12 weeks respectively. 95.5% (86/90) of patients were able to complete a single-leg hop and single-leg heel raise at 6 and 12 weeks.

Conclusion:

Our results suggest that a Brostrom augmented with suture-tape can allow for early functional rehabilitation in an active duty Military population.
Radiographic Outcomes in the Treatment of Type II Adult Acquired Flatfoot Deformity Following Lateral Column Lengthening with a Titanium Wedge versus Autograft or Allograft
Authors: O’Connor Casey M. , Anoushiravani Afshin , Richardson Kyle , Anderson Matthew , Rosenbaum Andrew J.
Published: November 2020

Category:

Midfoot/Forefoot

Introduction/Purpose:

Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction occurring in patients with stage IIB Adult Acquired Flat Foot Deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus which is then filled with autograft, allograft, or a titanium wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes in the setting of stage IIB AAFD with the use of LCL.

Methods:

All patients who underwent LCL from October 2008 until October 2018 were retrospectively reviewed. Preoperative weight bearing radiographs, initial postoperative radiographs and 1-year weight bearing radiographs were reviewed. The following radiographic measurements were recorded: talonavicular uncoverage angle, incongruency angle, and calcaneal pitch.

Results:

A total of 44 patients were included in our study. The mean age of the cohort was 54 (range 18-74). The study cohort was divided into two groups. There were 17 (38.7%) patients that received a titanium wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (p=0.006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (p=0.013). There were no significant differences in post-operative talonavicular uncoverage angle, incongruency angle or calcaneal pitch at 6 months or 1 year.

Conclusion:

Adult acquired flat foot deformity is a difficult disorder to treat surgically. Lateral column lengthening is a common surgical procedure used to treat forefoot abduction that occurs. Our results show that at 6 months and 1 year no radiographic difference exists between autograft/allograft bone substitutes versus titanium wedge in LCL. Future research should evaluate the differences in patient reported outcomes between autograft/allograft versus titanium wedge bone substitutes. [Table: see text]