bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Time to Surgery on Surgical Site Infection in Open Distal Radius Fractures: A Review of the ACS Trauma Quality Improvement Program Database
Authors: Sobba Walter , Lin Lawrence J. , Sanchez-Navarro Gerardo E. , De Tolla Jadie , Ayalon Omri , Hacquebord Jacques H.
Published: December 2024

Introduction:

Managing open distal radius fractures (DRFs) poses challenges. While preventing surgical site infection (SSI) involves prompt antibiotic administration and thorough irrigation and debridement, the impact of urgent intervention on reducing postoperative infection rates is debated. We hypothesize that timing of surgery does not significantly affect the incidence of SSI in open DRF treated within or after 24 hours from time of injury.

Methods:

We retrospectively analyzed the American College of Surgeons Trauma Quality Improvement Program from 2011 to 2021. We focused on outcome variables, including superficial SSI and deep SSI or osteomyelitis. To evaluate the relationship between time to operative intervention and SSI rates, we employed least absolute shrinkage and selection operator and multivariate regression models, adjusting for patient-specific factors and injury severity.

Results:

A total of 14 486 patients were included. Regression modeling demonstrated a 23% increase in the odds of deep SSI with each 1-day delay in surgery ( P = .010). However, no association was found between time to surgery and superficial SSI (odds ratio [OR] = 0.96, P = .768). Injury severity score (ISS) was associated with increased odds of superficial SSI (OR = 1.06, P < .001) and deep SSI (OR = 1.06, P < .001) while diabetes (OR = 3.56, P = .013) was significantly associated with increased rates of superficial SSI.

Conclusions:

Extended time to surgery correlates with a modest rise in deep SSI incidence in open DRF. However, there was no heightened risk of superficial SSI in patients with delayed surgery. Polytrauma, alcohol use disorder, and diabetes were linked to elevated SSI rates in open DRF.
Can detective fiction save liberal democracy? On the performative functions of crime control in the Czech TV series The Nineties
Authors: Walach Václav , Kupka Petr , Pehe Veronika
Published: December 2024

This study seeks to expand the criminological interest in narrative fiction by examining the functions that complex fictional stories on crime control can perform. As a case study, the article takes the Czech Television series The Nineties, which tells the story of a police investigation into murders linked to the rise of organised crime in 1990s Czechia. Broadcast in early 2022, the show became widely popular, as it was seen as not only covering real-world events but also providing an interpretation of the complicated period of postsocialism. Inspired mainly by narrative criminology and Rafe McGregor’s work on fictional narrative knowledge, we analyse the series’ representational and performative work at the level of phenomenology, counterfactuality and mimesis. We reveal how in The Nineties, these values contributed to the impact on its audiences, including its function in (de)legitimising the entire postsocialist order. We contextualise this response with the rise of right-wing populism that has shattered the postsocialist order via exploiting the established narrative of criminalising postrevolutionary developments. This makes The Nineties correspond to Travis Linnemann’s conception of the police story, where the police act as the guardian of the civilised order threatened by criminal monsters. Contrary to the series’ critics, we claim that The Nineties can be read as reinforcing the legitimacy of postsocialist liberal democracy by representing postrevolutionary developments as a battle of police with organised criminals, where not only their apprehension but an entire belonging to Western civilisation is at stake.
Improving diagnosis of primary aldosteronism through education: a modified Delphi study to identify key learning points
Authors: Widjaja Jocelyn , Yang Jun , Harrison Julia
Published: December 2024

Background:

Primary aldosteronism (PA) is the most common endocrine cause of secondary hypertension and can be effectively managed, or even cured, with targeted treatment. Despite this, it remains largely undiagnosed leaving a significant patient population with resistant hypertension and modifiable cardiovascular risk.

Objective:

To determine expert consensus on key information about PA that should ideally be taught to medical students as a step toward improving the detection of this common, underdiagnosed, and often easily treated condition.

Design:

The study employed a modified Delphi method which consisted of three rounds, the first of which contained an open-ended question about key areas that experts believe to be most important for inclusion in medical teaching resources and then progressing to assessment of individual versus group rankings of consensus items. Experts included both clinician-educator-researchers and patients with lived experience.

Results:

Nine critical knowledge areas in epidemiology, diagnostics, and pathophysiology were identified by the Delphi as consensus items, with the highest ranked being: “PA is common but often under-diagnosed – think about it with every hypertensive patient.”

Conclusion:

Experts reached a consensus, for the first time, on nine critical knowledge areas about PA that should be covered in medical education. Importantly, the consensus accounted for patients’ values and decisions. The results of this study could be used to assess medical student knowledge and their learning resources to facilitate curriculum development and medical resource updates to ensure the timely and accurate diagnosis of PA in hypertensive patients.
Anesthesia management using remimazolam for coronary artery bypass grafting and aortic valve replacement in a patient with severe cardiac dysfunction: A case report
Authors: Sagawa Tomoki , Ishida Yusuke , Sasaki Tomomi , Hosokawa Maiko , Bito Kiyoko , Oe Katsunori
Published: December 2024

Remimazolam, a short-acting benzodiazepine approved for use in general anesthesia in Japan in 2020, has cardiovascular stability superior to conventional anesthetics. Anesthesia management using remimazolam of a patient with impaired cardiac function and several complications is reported. A man in his 50s with hypertension, diabetes mellitus, and chronic kidney disease (G 5) on dialysis came to our hospital with a chief complaint of exertional dyspnea and chest tightness, and a close examination showed stenoses of three coronary arteries. The patient was managed under anesthesia using remimazolam as a sedative because anesthetics could easily induce circulatory failure. Cardiopulmonary bypass was initiated without causing any circulatory failure, and coronary artery bypass grafting and aortic valve replacement were performed. The patient was successfully weaned with a small dose of catecholamine. Remimazolam was selected for this patient because of its minimal effect on cardiac rhythm, and the anesthesia was safely administered.
Hardware Removal after Lisfranc ORIF Results in Immediate Improvement in Physical Function
Authors: Sroka Oliver , Campbell Megan L. , Dong Willie , Thorne Tyler , Higgins Thomas , Rothberg David , Haller Justin , Marchand Lucas
Published: December 2024

Category:

Trauma; Midfoot/Forefoot

Introduction/Purpose:

Hardware removal (HWR) after Lisfranc open reduction internal fixation (ORIF) is often standard following successful treatment. The purpose of this study was to investigate whether HWR after Lisfranc ORIF resulted in immediate, measurable impact via PROMIS physical function (PF) and pain intensity (PI) scores.

Methods:

A retrospective review of all adult patients with surgically treated, isolated Lisfranc injuries at one tertiary level 1 trauma center between 2002-2023 was performed. Demographic data and patient reported outcomes (PROs) were recorded. Patients were excluded if they received index treatment other than ORIF, underwent secondary surgical intervention for their Lisfranc injury other than HWR, or if HWR did not occur in the standard 3-6 month interval following ORIF. Patients who underwent HWR and had PROMIS scores collected at their postoperative visit were compared to those with retained hardware by 6 months. The primary outcome was patient reported measures of PROMIS PF and PI. The Wilcoxon signed-rank test compared differences between PRO scores within the HWR removal group and the Wilcoxon ranked-sum test compared differences between HWR and no HWR groups. Distributive MCID was calculated using the 0.5 SD method.

Results:

We identified 482 patients (489 feet) with isolated Lisfranc injuries. Of these, seventy-seven feet underwent ORIF followed by HWR. Thirty feet had ORIF but did not have HWR. HWR occurred an average of 132 days (4.5 months) after ORIF. Patients who underwent HWR had a statistically significant increase in average PF scores in the immediate postoperative period, reaching the calculated MCID of 3.3 (40.2 to 45.6, p< 0.001). HWR patients also had a non-significant decrease in average PI scores (55.9 to 54.2, p=0.103). Compared to those who did not undergo HWR, the HWR group demonstrated a statistically significant net improvement in PF scores from surgery, with an average improvement of 4.7 postoperatively (P=0.003).

Conclusion:

Patients experienced immediate and significant improvement in PROMIS PF scores after HWR for Lisfranc ORIF. HWR patients also had a non-significant decrease in average PROMIS PI scores.
High-Stress Shifts Among Orthopaedic Trainees Alter Cognitive Abilities and Surgical Performance
Authors: Walley Kempland C. , Jandzinski Michal , Michaels Ross , Eichman Jack , Hake Mark , Ahn Jaimo , Holmes James
Published: December 2024

Category:

Other; Trauma

Introduction/Purpose:

The effect of sleep deprivation and environmental stresses for orthopaedic trainees can manifest as physical and mental impairment in addition to worsening psychomotor performances. Lack of sleep and rest may compromise both decision making and clinical judgement, though this area of study largely has been unstudied. The purpose of this study is to quantify the volume of clinical workload that precipitates a decline in psychomotor and cognitive performance among orthopaedic trainees.

Methods:

The study cohort was comprised of Orthopedic Surgery residents (PGYII-V) from an Level I Academic Medical System/Tertiary Care Center taking primary fracture/trauma call over 1 24 month span. Resident participants were evaluated prior to, and immediately after, 12 and 24-hour call shifts. Participants’ technical and spatial processing abilities were evaluated via targeted drilling exercises on sawbones. Cognitive performance and neuropsychology assessments were captured with a validated, cognitive testing platform. These performances were analyzed against matched-clinical workload stress-level assignments following each call shift.

Results:

Following exposure to call-shifts, residents that experienced a high-stress call shift displayed statistically significant impairments to their cognitive performances with declines in their mental flexibilities (P = 0.0079) and information processing (P = 0.0003) capabilities. High-stress call shift exposure was also associated with significantly worse performance on psychomotor testing, a proxy for surgical performances, as demonstrated by higher aiming errors (P = 0.028) and miss distances (P = 0.046) on drilling exercises. Linear regression demonstrated a protective effect of increased baseline attention on psychomotor performance following call shift exposure (P=0.0004).

Conclusion:

Following high-stress call shifts among orthopaedic trainees, one can expect declines in neurocognition and technical performance independent of length of call shift and sleep deprivation. This study demonstrates a statistically significant and potentially clinically important relationship between increased clinical workload and decline in psychomotor performance and cognitive function. Higher baseline attention may be protective against this decline.
Impact of Early Weightbearing after Autologous Osteochondral Transplantation for Osteochondral Lesion of the Talus– A Systematic Review and Meta-Analysis
Authors: Chiet Hong Choon , Pearce Christopher J.
Published: December 2024

Category:

Sports;n Arthroscopy

Introduction/Purpose:

The influence of early weightbearing after autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesion of the talus (OLT) remains unclear. We aim to provide a comprehensive systematic review and meta-analysis to determine the impact of early weightbearing on the clinical outcomes of AOT for OLT with secondary aims to review the rate of return to sports and/or activities and complications. Methods: A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the PRISMA guidelines. Publications were divided into Group A where patients were allowed early weightbearing within the first 6 weeks while Group B consisted of patients who were only allowed weightbearing after 6 weeks. Unweighted estimates were calculated instead of quantitative random-effects meta-analysis due to the high heterogeneity and low level of evidence of the included studies.

Results:

A total of 35 studies with 1457 ankles were included. There were 20 studies in Group A and 15 studies in Group B. Both the AOFAS and VAS scores were not affected by early weightbearing after AOT for OLT. There were also no differences in rate of return to sports and/or activities found although late weightbearers were more likely to have complications compared to early weightbearers (19% vs 8.4%; RR=0.44, 95% CI:0.32-0.61, p< 0.01). Notably, late weightbearers were 1.79 times (RR=0.56, 95% CI:0.13-2.48, p=0.45) more likely to have postoperative ankle stiffness with/without pain. They were also twice more likely to require repeat surgery for the ankle (11.8% vs 5.4%; RR=0.46, 95% CI:0.28-0.73, p=0.001). The commonest cause for repeat surgery was ankle arthroscopy and debridement for postoperative impingement or pain.

Conclusion:

Early weightbearing after AOT for OLT yielded similarly good clinical outcomes and return to sports and/or daily activities when compared to late weightbearing. Late weightbearers were significantly more likely to suffer from complications and twice as likely to require repeat surgery.
Impact of Surgeon Specialty on Ankle Arthrodesis Readmission, Complication, and Infection Rates: A Medicare Analysis
Authors: Nixon Devon , Ko Hyunkyu , Martin Brook
Published: December 2024

Category:

Ankle Arthritis; Other

Introduction/Purpose:

Ankle arthrodesis (AA) remains a reliable treatment option to address end-stage ankle pathology in appropriately selected patients. When successful, AA surgeries can yield high patient satisfaction and marked improvements in patient-reported outcomes. AA can be performed by orthopedic surgeons (MD or DO) and non-orthopedic surgeons (DPM). However, no prior study has compared surgical safety indicators of AA based on surgeon specialty.

Methods:

Utilizing Medicare claims from 2016 to 2019, we retrospectively identified patients ≥65 years of age who underwent AA based on CPT coding. Patients on Medicare Health Maintenance Organization (HMO), End-Stage Renal Disease (ESRD), age under 65, and dual-eligible patients were excluded. Within this dataset, provider specialty was identified from Part B (provider claim), allowing for comparisons between orthopedic and non-orthopedic surgeons. We compared groups based on readmission, all-complication, and infection rates within 1-year of AA using logistic regressions controlling for age, sex, race, and Charlson Comorbidity Index (CCI). To help mitigate bias, we also performed a propensity matched model with the same variables. Data were reported as percentage point (PPT) differences (95% CI) between groups, with a positive number indicating higher rate of complications among patients treated by non-orthopedic surgeons.

Results:

During our timeframe, 3,274 AA procedures were performed by orthopedic surgeons and 614 by non-orthopedic surgeons. Non-orthopedic surgeons performed AA on patients with greater comorbidities (CCI scores: 0, 1, 2+: 34.7%, 20.4%, 44.8%) compared to orthopedic surgeons (CCI scores: 28.2%, 16.4%, 55.4%) (p< 0.001). AA performed by non-orthopedic surgeons, compared to orthopedic surgeons, had higher all-cause readmission rates (46.1% vs. 39.4%, p=0.008), all-complication rates (72.3% vs. 63.7%, p< 0.001) as well as complications with readmission (49.9% vs. 43.9%, p=0.019) and without readmission (55.0% vs. 43.1%, p< 0.001). All-cause infection risk within 1-year was higher in non-orthopedic surgeons (16.2% vs. 9.3%, p< 0.001), and persisted in our propensity-matched analyses (6.9 ppt higher (CI: 2.2, 11.7), p=0.004). Differences in the other safety measures were largely attenuated in the propensity-matched analysis.

Conclusion:

AA performed by non-orthopedic surgeons had greater all-complication, readmission, and infection rates as compared to AA done by orthopedic surgeons. Infection risk most notably persisted in analyses controlling for comorbidities. Infection following AA can lead to devastating outcomes for patients. The implication of findings like these will require further study to better understand how foot and ankle care is administered to patients at a policy-level.
In Silico Assessment of the Influence of Talus Osteochondral Lesion Size and Location on Ankle Joint Stability using Tilted Talar Dome Plane Orientations
Authors: Aslan Lercan , Subasi Omer , Karaismailoglu Bedri , Gedik Cihad C. , Yuruk Batuhan , Ashkani-Esfahani Soheil , Eren Ilker
Published: December 2024

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

Osteochondral lesions of the Talus (OLTs) are among the most common injuries that occur in the ankle joint and can be detrimental to the overall function. The size of the lesion is critical in determining the surgical treatment; for smaller lesion sizes, microfracture can be considered but for larger lesions joint level restoring surgical intervention might be required. In this study, talus OLTs with different areas and locations are modeled to biomechanically evaluate the ankle joint stability. Our study aims to evaluate the stress distribution and joint stiffness effect of OLTs on all the 9-cell partition zones of the talar dome in three different ankle positions during gait.

Methods:

A simplified ankle geometry of an adult female was computationally modeled with 1 mm of cartilage at both sides of the tibiotalar contact. Lesion geometries were created on the talar dome with 4.5, 6.4-, and 9-mm lesion diameters, at each grid partition location on the talus sectioned 1 (anterior) to 9 (posterior). To enhance lesion area fidelity, tilted talar planes were utilized to consider the curvature of the talar dome. The modified models were then transferred to finite element analysis software. The maximum and average von Mises stresses, and stiffness were the biomechanical parameters investigated.

Results:

Utilizing the design parameters designated for this study, 81 different OLTs are modeled and computationally simulated. It is revealed that the stress parameters are highly misleading and do not predict ankle stability. However, stiffness is found to be a more reliable parameter that has an inverse correlation with the lesion diameter. Zones 8 (posteromedial) and 7 (Figure) on the posterior, and zone 3 on the anterolateral, were observed to be the most critical zones with lesser stiffness which meant decreased ankle joint stability in neutral, dorsiflexion, and plantarflexion, respectively. Zone 9 (posteromedial) was found to be the least critical zone in regard to stiffness.

Conclusion:

In our Finite Element study, we have found that during the walking gait, lesions in zones 8, 7, and 3 significantly impact joint stability compared to other zones of the same lesion size. This suggests that certain areas have a more pronounced effect on joint stability than others. Our findings challenge the commonly accepted threshold of 150mm² for transitioning from microfracture to other cartilage-restoring surgeries, as it may not be universally valid for all zones.
Interim Analysis of a Prospective Multicenter Study Assessing Radiographic and Patient Outcomes Following a Mini-Open Triplanar Tarsometatarsal Arthrodesis with Early Weightbearing
Authors: Daigre Justin L. , Santrock Robert D. , Chhabra Avneesh , McAlister Jeffrey , Taylor Robert , Farber Daniel C. , Raissi Abdi , Steinke Paul , Allen Marque , Shane Amber , Kile Deidre , McAleer Jody P.
Published: December 2024

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

The majority of hallux valgus (HV) corrections have been historically performed via a two-dimensional, transverse plane-focused approach, which has demonstrated high rates of recurrence. Recently there has been a trend towards less-invasive approaches and an instrumented 1st TMT system was developed to perform a triplanar 1st TMT arthrodesis through a mini-open incision. Therefore, the purpose of this study is to assess the radiographic and patient-reported outcomes for HV correction performed with this system through a mini-open approach (≤4cm) with early return to weightbearing.

Methods:

This is an interim analysis of a prospective multicenter study on patients with symptomatic HV and no prior history of HV surgery on the operative foot. Patients were treated with an instrumented 1st TMT procedure through a mini-open (≤4cm) dorsal incision (which is approximately 50% smaller than the system’s prior-generation open incision) utilizing a biplanar locking plate construct with protected early weightbearing. The primary endpoint of this study is radiographic recurrence of HV, with recurrence reported using two different thresholds commonly utilized in the literature: post-operative HVA >15° and HVA >20°. Changes in radiographic measurements, return to weightbearing and activities, Manchester-Oxford Foot Questionnaire (MOxFQ), patient-reported pain (VAS), and forefoot circumference were also evaluated for statistically significant post-operative improvements through 12-month follow-up.

Results:

105 patients (mean [range] age: 41.0 [14-57] years) underwent a mini-open TMTA, with 92 and 70 patients completing 6- and 12-month visits, respectively. Mean (SD) incision length was 3.5cm (0.27). Mean (95% CI) time to protected weightbearing and unrestricted activity were 7.9 (6.7, 9.1) days and 3.6 (3.4, 3.8) months, respectively. Significant improvements in HVA, IMA, and TSP were maintained through 12 months (Table 1). Applying recurrence definitions of HVA >15° and >20°, 12-month recurrence rates were 4.8% (3/62) and 0% (0/62), respectively. Significant improvements in VAS and MOxFQ were observed through 12 months (N =65). Twelve-month mean (95% CI) change in forefoot circumference was -0.8cm (-1.2, -0.5), N =64. One (1.0%) of 105 patients required reoperation (HWR due to pain) and no patients experienced symptomatic nonunion.

Conclusion:

The interim results of this prospective, multicenter study on a mini-open 1st TMT system with early weightbearing demonstrated statistically significant improvements in radiographic alignment and patient-reported outcomes, and minimal forefoot swelling. This study will follow the patients for a total of 24 months postoperatively.
Intermediate-Term Clinical Outcomes of Novel Distal Tibial Rotational Osteotomy for Varus Ankle Osteoarthritis
Authors: Murahashi Yasutaka , Mori Yuta , Takahashi Katsunori , Watanabe Kota , Teramoto Atsushi
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Distal tibial oblique osteotomy for ankle osteoarthritis is an effective procedure with joint preserving. However, there is the risk of nonunion due to open wedge osteotomy and complication associated with autogenous bone harvesting. We performed distal tibial rotational osteotomy (DTRO) for ankle osteoarthritis, which modified osteotomy design is expected to reduce the risk of nonunion without autologous bone grafting and soft tissue complications. We evaluated the clinical and radiographical outcome of DTRO.

Methods:

A total of 23 feet (4 males and 19 females) who underwent DTRO for ankle osteoarthritis in our institutions between 2016 and 2022 was included. All patients required a minimum of one year follow-up. As a surgical procedure, tri-plane osteotomy was performed using anteromedial approach. Then, the distal tibial fragment was rotated distally in the 3D plane until ankle stability was achieved, and the prominence of the medial tibia was resection after the correction. A medial tibial locking plate was applied for stabilization after filling opening gap with synthetic bone blocks. We evaluated demographic data, radiographical measurements, classification of arthritis severity, and the rate of nonunion, wound complications and reoperation. In addition, JSSF scale (Japanese Society for Surgery of the Foot ankle) and SAFE- Q (Self-Administered Foot Evaluation Questionnaire) were assessed preoperatively and at the latest follow-up.

Results:

Subjects had an average age of 64 years, an average follow-up period of 42 months, and were classified as stage 2/3a/3b in 1/19/2 feet preoperatively. The average of tibial anterior surface angle changed from 83.7° to 93.5°, and the tibial lateral surface angle changed from 81.0° to 81.9° in pre- and postoperative radiography. The JSSF scale significantly improved from 49.1 to 88.2 (p< 0.01) and the SAFE-Q showed significant improvement in all subscales at the latest follow-up. Bone union was obtained within 3 months in all cases, and no nonunion was observed. Delayed wound healing was observed in 1 case (4.4%). Ankle arthrodesis was needed in 1 case of deep infection and in 1 case of arthritis progression stage 3b to 4.

Conclusion:

In general, the distal tibia has poor soft tissue and blood flow that may lead the nonunion and soft tissue complications for distal tibial osteotomy. The advantage of DTRO was to maintain tibial bone contact after the osteotomy which may be favorable for bone stability and union, and to resect the medial bone prominence which reduce the tension of soft tissue. In this study, bone union was obtained in all cases without harvesting autogenous bone, and wound complications were low at 4.4%. Good intermediate-term outcomes were obtained, and DTRO can be a favorable surgical procedure for ankle osteoarthritis.
Low Rates of Return to Sport and Reduction in Performance Following Acute Achilles Tendon Ruptures in Athletes Participating in Major League Soccer
Authors: Butler James J. , Nasir Bader , Lin Charles , Robertson Djani , Samsonov Alan P. , Kennedy John G.
Published: December 2024

Category:

Sports; Other

Introduction/Purpose:

The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by athletes participating in the Major League Soccer (MLS).

Methods:

Athletes participating in the MLS who sustained an AATR were identified using a publicly available database, match reports and injury reports. The years of inclusion was from 2008-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, assists, goals, passes, pass %, crosses, shots, shots on target and shot %.

Results:

Twenty-six athletes sustained an AATR in the MLS (0.008564 per 10,000 athlete-exposures). The mean age was 25.8±8.4 years and the mean BMI was 22.5±6.6kg/m2. There were 15 (57.7%) AATRs sustained by defensive players, 5 (19.2%) AATRs sustained by midfield players, 3 (11.6%) AATR sustained by forwards and 3 (11.6%) AATR sustained by goalkeepers. All athletes (100%) underwent surgical intervention. The mean number of games played prior to injury was 164.7±154.9. The RTP rate to the MLS was 73.1% at mean time of 11.1±5.5 months. The mean number of games missed due to injury was with 30.1±11.7 games. There was a statistically significant decrease in the mean number of games played, goals scored and shots taken following RTP.

Conclusion:

This current study found that AATRs were an uncommon injury in the MLS with an incidence of 0.008564 per 10,000 athlete-exposures. Sustaining an AATR was associated with a 73.1% return to play rate to the MLS at a mean time of 11.1 ± 5.5 months. There was a statistically significant deterioration in key performance metrics such as mean games played, goals scored and shots taken. This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.
Low Rates of Return to Sport and Reduction in Performance Following Acute Achilles Tendon Ruptures in Elite Rugby Union Players
Authors: Butler James J. , Aratikala Adarsh , Samsonov Alan P. , Wingo Taylor , Calder James , Kennedy John G.
Published: December 2024

Category:

Sports; Other

Introduction/Purpose:

The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by elite rugby union players.

Methods:

Elite rugby union players who sustained an AATR were identified using a publicly available database, match reports and injury reports. "Elite rugby union" was defined as a player who played professional rugby in the following competitions: United Rugby Championship, Top 14, English Premiership, Super Rugby and international rugby for a top 20 ranked team. The years of inclusion was from 2015-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, tries scored, points scored.

Results:

Nintety-three elite rugby union players sustained an AATR between 2015-2022 (0.0146 per 10,000 athlete-exposures). The mean age was 27.8±10.1 years and the mean BMI was 30.5±7.6kg/m2. There were 61 (65.5%) AATRs sustained by forwards and 32 (34.5%) AATRs sustained by backs. Forty-five (48.3%) of AATRS occurred during the in-season and 48 (51.7%) AATRs occurred during training. All athletes (100%) underwent surgical intervention. The most common mechanism of injury was a non-contact injury (86.4%). The RTP rate was 68.9% at mean time of 8.9±3.9 months. There was a statistically significant decrease in the mean number of games played, tries scored and points scored following RTP.

Conclusion:

This current study found that AATRs were an uncommon injury in elite rugby union players with an incidence of 0.0146 per 10,000 athlete-exposures. Sustaining an AATR was associated with a 68.9% return to play rate at a mean time of 8.9±3.9 months. There was a statistically significant deterioration in key performance metrics such as mean games played, tries scored and points scored This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.
Minimally Invasive (MIS) TTC Fusions: A 52 Patient Case Series with High Rate of Limb Salvage
Authors: Miller Christopher P. , MacDonald Tom , Ndu Anthony , Abicht Brad , Raza Marium , Ranganathan Noopur
Published: December 2024

Category:

Ankle Arthritis; Hindfoot

Introduction/Purpose:

TTC fusion is a common procedures to address complex hindfoot and ankle pathologies. It is a versatile procedure and can be used in many situations as either a primary procedure or limb salvage. Additionally, TTC is often used in the setting of neuropathy, Charcot deformities and failed ankle fracture ORIF. Given the medical and surgical complexity of the patient population, minimally invasive surgery (MIS) procedures may offer a option to more safely address these complicated problems, but only if the procedure can address all aspects of the deformity correction as well as successful fusion. We present the results of the largest case series of all MIS TTC fusions. We hypothesize that the surgical outcomes will be on par if not superior to traditional technique.

Methods:

This retrospective case series presents all patients MIS TTC fusion between January 1, 2019, and June 1, 2023 as part of a multi-center retrospective review of cases. Patients were identified through the operating room (OR) schedule, and their data was collected from medical charts stored in the institution's EHR. We report on demographics, complications, and fusion outcomes of TTC fusions for this population. Of the 52 cases, 27 cases (52%) also required osteotomies of the malleoli or midfoot for deformity correction which was also performed with an MIS technique when needed.

Results:

There were 52 patients included in the study. The primary diagnosis was Charcot ankle deformity in 11/52 (21%), Neuropathic ankle fracture in 15/52 (29%), Acute trauma in medical frail patient was 9/52 (17%), arthritis in 13/52 (25%) and other in 4/52 (8%). 26/52 (50%) had severe peripheral neuropathy. 40/52 (76%) patients had some combination of ESRD, poorly controlled diabetes, severe peripheral vascular disease, extremely poor soft tissue coverage. 45/52 (86%) patients achieved successful radiographic fusion. 2/52 (4%) achieved a stiff, asymptomatic pseudo arthrodesis. There were 9/52 (17%) complications: 2 patient deaths, 1 infection, 2 periprosthetic fractures, 1 nail subsidence, 2 delayed healing, 1 wound complications requiring flap closure. limb salvage was achieved in 47 of the 50 (94%) patients who survived to a surgical endpoint.

Conclusion:

MIS TTC fusion minimizes wound healing complications and infection. Deformity correction was performed with osteotomies when needed. The prevelence of medical comorbidities in this population is underscored by the 2 of patients who died within the early postoperative period (< 1 month). However, the high rate of limb salvage (94% of living patients, 90% of all patients) demonstrates the value of this technique to achieve deformity correction and bony union even in such a compromised patient population. The authors believe that MIS TTC fusion is a critical skill that will assist in treating many of our sickest and most complex patients.
Minimally Invasive Three-Column Fixation for Displaced Intra-Articular Calcaneal Fractures
Authors: Yan Alan Y. , Drazick Anthony , Wei Baofu , Lou Shulei , Li Zhenyu
Published: December 2024

Category:

Trauma; Hindfoot

Introduction/Purpose:

Calcaneus can be morphologically and biomechanically constructed of medial column, lateral column and a connecting beam acting as transverse column. The fracture of the three columns of intra-calcaneal depression fracture divides the calcaneus into four major fracture fragments, namely the anterior tuberosity fragment, the sustentaculum fracture fragment, the posterior articular fracture fragment, and the posterior tuberosity fracture fragment. Minimally invasive three column fixation with screws was designed to manage the displaced intraarticular calcaneal fractures without extensile exposure. The timely use of the external distraction is key to restore the morphological index of the calcaneus. Frequently, the posterior articular fragment was reduced and fixed through a tarsal sinus approach.

Methods:

Thirty-five patients with 37 feet (33 xSanders type II, 4 x type III) of acute displaced intraarticular calcaneal fractures were managed with minimally invasive three column fixation. Böhler’s angle, Gissane angle and calcaneal varus angle (CVA) were measured preoperatively and postoperatively. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score.

Results:

Thirty-five patients with average follow-up time of 8 (range 6–12) months were included. All incisions healed primarily with no incision-related complications. The radiographs demonstrated successful corrections of the Böhler’s angle, Gissane angle and CVA from preoperative status to postoperative status. At average 8-month follow-up, the mean AOFAS score was 90.2 + 17.7 (range 70–98) and considered as the good and excellent rate of 89.7%.

Conclusion:

Minimally invasive three-column fixation of calcaneal fracture is a three-dimensional fixation, which can effectively obtain and maintain the anatomical reduction of calcaneal alignment, length, height, width and posterior articular surface reduction. Timely use of the medial or lateral based external distraction and direct tarsal sinus incision approach can achieve full or near anatomical reduction of calcaneal fractures. Meanwhile the minimally invasive approach effectively avoided complications associated with lateral extensile incisions. There was no need for prolonged wait period before skin condition to improve which may complicate the reduction and fixation due to early malunion.
Minimally Invasive Ultrasound Guided Percutaneous Fasciotomy for the Treatment of Chronic Plantar Fasciitis
Authors: Encinas Rodrigo , Gauthier Chase , Cantrell Anthony C. , Zhang Yuqing , Jackson J. Benjamin , Gross Christopher E. , Gonzalez Tyler , Scott Daniel J.
Published: December 2024

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

Plantar fasciitis is one of the most common causes of foot pain among the United States’ population. There are several treatment options including both nonoperative and operative approaches. Recently, minimally invasive (MIS) percutaneous plantar fasciotomy has come on the market with anecdotally good patient outcomes but limited published literature. This study aimed to review the patient outcomes, complications, and revision rates in patients undergoing MIS ultrasound-guided percutaneous plantar fasciotomy for the treatment of chronic plantar fasciitis.

Methods:

A multicenter retrospective chart review of patients undergoing MIS ultrasound-guided percutaneous fasciotomy using the Tenex device (Trice Medical, Lake Forest California) from January 2020 to December 2022 was performed. The main data points collected were patient-reported outcomes, follow-up times, revision surgery, and complications. Continuous variables were defined as a mean and were compared using Paired Student’s T-Test. Multivariable linear regression analysis was utilized to determine specific factors that influenced outcomes when controlling for confounding variables. All P< 0.05 were considered significant.

Results:

There were 56 (42 female/14 male) patients that underwent 60 procedures. The average age and BMI were 48.6 years (range 19–80), and 33.2 kg/m2 (range 19.7–58.6), respectively. There were two (3.3%) complications of wound-healing delays and one (1.7%) complication of nerve damage noted. There were two (3.3%) revisions. The average follow-up was 27 months (range 13.3–48.6). The average improvement in pain, physical function, and mobility Patient-Reported Outcomes Measurement Information System (PROMIS) scores were 5.2 (range: -5.1–25.8), P< 0.01), 3.6 (range -7–30.7, P=0.01), and 3.1 (range -6–25, P=0.01). Overall, over 90% of patients had no to minimal pain at the final follow-up. No specific demographic factors were significantly associated with an improvement in PROMIS scores or overall pain at final follow-up.

Conclusion:

MIS ultrasound-guided plantar fasciotomy appears to be a reliable surgical treatment option for chronic plantar fasciitis with high patient satisfaction, minimal complications, and low revision rates.
Modern Treatment of Hallux Rigidus by Cheilectomy: A Systematic Review of Minimally Invasive Patient-Reported Outcomes
Authors: Semelsberger Scott D. , Lee Michael , Dobson Cale , Miller Christopher P. , Gianakos Arianna
Published: December 2024

Category:

Arthroscopy; Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus is a degenerative disorder of the first metatarsophalangeal (MTP) joint. Patients with this condition experience symptoms including pain, stiffness, and reduced range of motion of the 1st MTP joint. Cheilectomy is a surgical treatment option that removes dorsal periarticular osteophytes to alleviate pain and improve range of motion. Minimally invasive cheilectomy is becoming a more prominent surgical approach due to its clinical benefits including smaller incisions, reduced complications, and faster return to function. This systematic review aims to analyze and present the current literature on patient-reported outcomes (PROs) following MIS cheilectomy for mild to moderate hallux rigidus.

Methods:

A systematic review of the literature was conducted using articles pulled from PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases in December 2023 using the search term “cheilectomy.” ​​This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in Prospero (Blinded ID:XX). Articles were included in the systematic review if they reported on preoperative or postoperative patient-reported outcomes in patients undergoing minimally invasive cheilectomy (MIS) in English. Minimally invasive was defined as an arthroscopic or percutaneous approach. The primary outcome measure was scored patient-reported outcomes. The secondary outcome measures included complications, secondary surgeries, surgical techniques, qualitative patient experiences, and grades of hallux rigidus.

Results:

Eight studies met the inclusion criteria, and a total of 284 patients were evaluated. 130/284 underwent an MIS percutaneous approach with burr, 70/284 underwent arthroscopy with shaver, and 84/284 had a combination of both techniques. Most patients (79%) had Coughlin-Shurnas grade one or two hallux rigidus (range: 1-3). The mean American Orthopaedic Foot & Ankle Society scores improved from 57.7 (range: 43-71) to 90.1 (range: 87-97). The mean range of motion (dorsiflexion) improved from 28.5 (range: 8-42) to 49.5 (range: 30-73) degrees. Complication rates were low at 18/284 (6%). The most common complication was numbness, affecting 6/284 (2%) patients. Four out of eight articles reported zero complications. 113/125 (90.4%) patients would recommend the procedure.

Conclusion:

Treatment of hallux rigidus with MIS cheilectomy appears to result in favorable and safe outcomes when performed for patients with early degenerative disease who have failed conservative treatment. Patients reported high satisfaction rates, significant symptomatic improvements, and experienced low complication rates.
Natural Course of Long-Term Radiographic Indices in Primary Degenerative Ankle O.A
Authors: Kim Jinkyung , Lee HoSeong , Seo JaeHyeon , Shin MyoungYeol
Published: December 2024

Category:

Ankle Arthritis

Introduction/Purpose:

The prevalence of degenerative ankle arthritis is approximately 1% based on the population of patients visiting hospitals. When considering individuals with early-stage arthritis who may not exhibit any symptoms or only mild discomfort, this figure is likely even higher. Degenerative arthritis of the ankle, mainly secondary to fractures, is well-documented, while primary degenerative ankle arthritis is relatively rare, with limited reports on its etiology and natural course. However, in a disease like degenerative ankle arthritis, long-term follow-up of ten years or more is crucial, yet research on this subject remains scarce. This study analyzed the follow-up results of primary degenerative ankle O.A.(Takakura classification I,II,IIIA) patients without surgery for natural course.

Methods:

We retrospectively investigated 169 patients with degenerative arthritis who visited the hospital from May 2009 to November 2023. Among them, 32 patients, who did not undergo surgery and were followed up for a minimum of 10 years, underwent clinical and radiological examinations . Initial patients included those with Takakura classification stage IIIA or lower. The degree of Takakura classification stage change was compared between the first and final visits. Hindfoot views and whole lower extremity assessments were also conducted. Visual analogue scale (VAS), Foot Function Index (FFI) scale were measured, respectively.

Results:

Among the initial 169 patients, 32 patients(43 ankles) had completed ten years or more of follow-up. According to the Takakura classification, 5 ankles had no change in Stage I, while 1 ankle progressed to Stage II. In Stage II, 13 ankles had no change, and 2 ankles progressed to Stage IIIA. In Stage IIIA, 13 ankles showed no change, 7 ankles deteriorated to Stage IIIB, and 3 ankles progressed to Stage IV. Overall, out of 43 ankles, 31 remained unchanged, 10 deteriorated by one stage, and 2 deteriorated by two stages. At the initial visit and the final follow-up, the FFI scores were 57 and 51, VAS scores were 4.6 (1-9) and 3.5 (0-8).

Conclusion:

This study analyzed the long-term outcomes of patients with Takakura stage IIIA or lower degenerative ankle arthritis over a minimum of 10 years. The radiological progression was minimal, and most of cases were improvement in clinical pain and functional scores. Therefore, in primary degenerative arthritis of the ankle, it is essential to investigate whether ankle pain is due to arthritis then should be considered carefully in the surgical treatment of degenerative ankle arthritis.
Navigating Total Ankle Replacement: A Patient's Guide Through the Web
Authors: Van Vleet Jared , Shepard Samuel , Patel Amar , OBrien Cameron , Hughes Griffin
Published: December 2024

Category:

Ankle; Arthroscopy

Introduction/Purpose:

Ankle osteoarthritis, primarily posttraumatic, affects younger patients with extended life expectancies, significantly impacting their physical and mental quality of life. Surgical interventions, such as ankle fusion and ankle replacement, are crucial for managing end-stage ankle osteoarthritis. Ankle fusion has been the gold standard, providing consistent symptom relief, while total ankle arthroplasty (TAA) has evolved with improved designs and biomechanical properties. Studies indicate a notable increase in TAA rates compared to total knee and hip arthroplasty. However, the debate continues regarding the long-term outcomes and risk-benefit analysis of TAA versus ankle fusion, with individual patient characteristics and functional demands playing a significant role in treatment decisions.

Methods:

We conducted a study to analyze information related to total ankle replacement procedures. Using Google searches and the SEO minion Chrome extension, we collected and categorized 100 FAQs from reliable sources. We used the Rothwell classification for FAQ transparency, evaluated source transparency using the JAMA benchmark tool, and assessed source quality with Brief DISCERN. Statistical analysis was performed in R(4.3.1) and RStudio, including descriptive statistics, Fisher’s exact test for JAMA Benchmark item presence, and the Kruksal-Wallis test for website category differences in Brief Discern Scores. Dunn’s test was used for post-hoc analysis with Holm correction for multiple comparisons.

Results:

Our Google search returned 100 unique FAQs after removing duplicates and unrelated FAQs. The majority were classified as fact-based questions (47/100, 47%), followed by value (30/100, 30%) and policy questions (23/100, 23%). Overall, the most common topic searched was related to the timeline of recovery (17/47, 36.2%). The frequent answer sources were medical practice/hospital (44/100, 44%), followed by academic (27/100, 27%) and government (24/100, 24%). The Kruksal-Wallis test revealed a significant difference in mean quality scores among the 4 source types (H(3) = 8.7445, p = 0.03) with medical practices/hospitals averaging the worst score (16/30) compared to academic sources which were found to have the highest score (22/30).

Conclusion:

When seeking online information regarding total ankle replacement surgery, patients using Google most often searched fact-based questions pertaining to the timeline of recovery. Medical practices and hospitals were the most common sources for this information but scored the lowest in quality and transparency. When publishing online information, sources should refer to established criteria such as the JAMA benchmark tool and Brief DISCERN. Based on our results physicians should be informed of the fact that patients do not commonly encounter high-quality information. This emphasizes the importance of well-informed, evidence-based patient counseling prior to treatment.