bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Results of Os Subfibulare Resection with Ligament Repair in Chronic Lateral Ankle Instability
Authors: Suh Jae Wan , Park Youngchae , Kwon Joohan , Park Hyun-Woo
Published: December 2024

Category:

Sports; Ankle

Introduction/Purpose:

Previous studies still have conflicting views on the size of the ossicle during ligament repair after ossicle removal. However, there is no standard for measuring the size of the ossicle. Furthermore, ossicle has various sizes, shapes, and positions. This study aimed to investigate the subfibular ossicles' morphologic characteristics and correlations with variables and to determine the clinical outcomes of ossicle removal and ligament repair.

Methods:

From February 2012 to December 2022, we retrospectively studied patients who underwent ossicle removal and MBO for chronic lateral ankle instability. Patients with degenerative arthritis, a history of previous ankle ligament surgery, or bilateral subfibular ossicles were excluded. The ankle stress radiographs were taken, and anterior drawer distance and talar tilt angle were obtained. The size, location, and number of ossicles were evaluated on MRI and radiographs. The location of the ossicle was classified into three zones according to the insertion of the ankle ligaments. Ossicle size measurements in MRI were as follows: length: anterior-posterior distance, height: superior-inferior distance, width: medial-lateral distance. The greatest distance among the coronal and sagittal images was measured, respectively. Clinical results were assessed using the Karlsson-Peterson (KP) ankle score and Foot and ankle outcome score (FAOS).

Results:

Forty ankles out of 477 patients were included. As for the location of ossicles, the ATFL attachment site was the most common with 57.5% (23/40), the CFL attachment site was 17.5% (7/40), and the case that spanned both ATFL and CFL was 20% (8/40). Most showed one ossicle, but 5% (2/40) of ankles showed two. Ossicles with a length greater than 10 mm in the sagittal view were 30% (12/40). At the last follow-up, all clinical scores improved significantly. There were no significant differences in preoperative radiographic instability, ossicle size, and clinical outcomes according to ossicle location. Ossicle width showed a significant correlation with anterior drawer distance (Pearson coefficient=0.437, p=0.033). Ossicle size showed no significant correlation with clinical scores at the last follow-up.

Conclusion:

For chronic ankle lateral instability with ossicle, ossicle removal and Brostrom ligament repair can achieve good clinical results. The size and location of ossicles had no significant correlation with post-operative clinical outcomes. Depending on the width of the ossicles, instability is thought to be related to which anatomical ligaments are involved and how much.
Combined Anterior and Posterior vs Isolated Posterior Facet Fixation for Subtalar Arthrodesis: A Proportional Meta-Analysis and Systematic Review of the Literature
Authors: Izzo Antonio , Manzi Giovanni , D'Agostino Martina , Mariconda Massimo , Patel Shelain , Bernasconi Alessio
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

Subtalar arthrodesis (SA) is a common procedure to treat end-stage subtalar osteoarthritis. We set out in order to determine whether a combined direct fixation of both anterior and posterior facets during SA might influence union and complications compared to isolated fixation of the posterior facet. Our hypothesis was that a combined fixation increases the union rate and reduces the complication rate.

Methods:

In this PRISMA-compliant PROSPERO-registered systematic review, we included studies reporting data after SA stabilized with screws in adults. The characteristics of the cohort, study design, surgical details, nonunion and complication rate at the longest follow-up were recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were compared: an ANT/POST group (screws positioned both in the anterior and posterior facet) and an ONLY POST group (isolated posterior facet fixation).

Results:

Eighteen series (685 feet: ANT/POST=96, ONLY POST=589) were selected. The median follow-up was 28 months (IQR, 12-42). The pooled proportion showed a similar nonunion rate (6% vs 10%;p=0.46) and complication rate (14% vs 19%,p=0.47) in the ANT/POST group as compared to the ONLY POST group. The pooled proportion of reoperation was not different either (ANT/POST: 7% vs ONLY POST: 10%,p=0.37). Kernel regression suggested a correlation between the proportion of open/arthroscopic procedures and the nonunion rate (p=0.025) with a median nonunion rate at 10.9% and 5.9% for open and arthroscopic procedures, respectively. Mean CMS was 40.4 points (poor quality).

Conclusion:

This proportional meta-analysis suggested that a combined direct fixation of anterior and posterior facets during subtalar arthrodesis does not significantly influence the risk of nonunion nor affects the risk of complication and reoperation as compared to isolated posterior facet fixation.
Comparison of In-Shoe Plantar Pressure Between Korean Combat Boots and Running Shoes: A Prospective Comparative Study
Authors: Yoon Youngsik , Kyung Min Gyu , Lee Dong Yeon
Published: December 2024

Category:

Basic Sciences/Biologics

Introduction/ Purpose:

Combat boots are special shoes designed for soldiers to wear during activities in rough terrains, such as long marches or military training. Combat boots cause high plantar pressure and increase the injury rate of the lower extremities. Therefore, this study aimed to compare the difference of in-shoe plantar pressure between Korean combat boots and running shoes. We hypothesized that the newest Korean combat boots would have comparable plantar pressure distribution to running shoes.

Methods:

We prospectively recruited 30 asymptomatic male participants, who are considered as candidates for military services, from the local area. Two types of shoes (newly developed Korean combat boots and running shoes) were examined. Data of pedobarographic measurements were collected using the pedar®-X in-shoe pressure measurement system. Peak pressure (PP), pressure time integral (PTI), contact area, and contact time were analyzed.

Results:

Both PP and PTI at the region of central and lateral forefoot (FF) were significantly higher in combat boots. The contact area of combat boots was significantly lower at the region of the hallux, 2-5 toes, medial FF, central FF, and midfoot. Contact time at the region of central FF and medial heel was significantly higher in combat boots.

Conclusion:

Understanding plantar pressure distribution of combat boots can be helpful in the development of combat boots and prevention of injury. Based on the results of our study, the next generation Korean combat boots should be developed to increase contact area and distribute impulse under the head of the metatarsal bone
Comparison of Outcomes of the Third Generation Minimally Invasive Chevron-Akin Procedure Between Elderly and Younger Patients with Hallux Valgus
Authors: Choi Seung-myung , Cho Byung-Ki , Bae Seung-Hwan , Choi Seo-yool
Published: December 2024

Category:

Bunion; Other

Introduction/Purpose:

Hallux valgus is known to be more prevalent and present with greater severity in the elderly population compared to the younger age group. However, surgical treatment of hallux valgus in the elderly carries a risk of suboptimal results owing to porotic bone quality and multiple comorbidities typical of this age group. Although the third-generation minimally invasive Chevron and Akin osteotomy (MICA) technique, which features minimal soft tissue disruption and rigid internal fixation, may be an attractive option for surgical treatment of hallux valgus in the elderly, its outcomes have not been thoroughly investigated. This study sought to compare the outcomes of third-generation MICA procedures in patients aged 65 and older with those in the cohort under 65 years of age.

Methods:

In this retrospective cohort study, 76 patients (79 feet) who underwent the third generation MICA procedure for hallux valgus and were followed up for at least 1 year were stratified into 2 groups: ≥65 years old (Group 1: 36 feet) and < 65 years old (Group 2: 40 feet). Radiographic assessments included HV angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Postoperative complications, including recurrence of the deformity, reduction loss and reoperation, were assessed.

Results:

The average age at the time of surgery in group 1 was 70.9 ± 5.8 (range 65~90) years, and in group 2, 50.2 ± 2.8 (range 21~ 63), respectively. In the elderly group, Bone Mineral Density (BMD) was measured -2.9. The mean HVA, IMA and DMAA significantly improved at the final follow-up in both groups, respectively (all P < .001). Both preoperative and postoperative HVA were significantly greater in group 1 (both, P < .001), and the change of this parameter after surgery was also lower in group 1 than in group 2 (P < .001). There were significantly higher rates of reduction loss (16% vs 2.5%) and recurrence (11.1% vs 0.5%). However, clinical scores and patient satisfaction rates did not differ significantly.

Conclusion:

The present study demonstrates that chronological age, specifically categorized as 65 years or older, exhibits no substantial influence on the clinical outcomes following third-generation MICA surgery. Nevertheless, it is imperative to adequately apprise patients of the potential for reduction loss and recurrence, possibly due to age-associated bone fragility.
Comparison of Surgical Outcomes Between Bioabsorbable and Metal Screw Fixation for Distal Tibial Physeal Fracture in Children and Adolescents
Authors: Kim Woo Sub , Sung Ki Hyuk , Choi Yoon Hyo
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Metal screws for fixation often necessitate a second surgery for removal, posing challenges in orthopedic care, which adds to treatment costs, introduces potential complications, and increases the psychological burden on patients. In pediatric cases, the need for repetitive general anesthesia during the second operation heightens the risk of neurotoxicity, creating an unsatisfactory experience for both the patients and their parents. We aimed to compare the surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescents, in the radiographic and clinical aspects. Additionally, we sought to compare the length of hospital study and medical cost between the two groups.

Methods:

Consecutive 67 children and adolescents who underwent open reduction and internal fixation using metal or bioabsorbable screws for the distal tibia physeal fracture were included. All patients underwent preoperative radiographs, three-dimensional computed tomography scans, and postoperative follow-up teleradiogram. Patients were divided into metal (N =40) and bioabsorbable groups (N =27). We compared the surgical outcomes between the two groups in terms of clinical and radiographic outcomes, length of hospital stays, and medical cost.

Results:

Age at surgery and follow-up duration were significantly older and longer in the metal group than those in the bioabsorbable group. There was no significant difference in the incidence of growth arrest after surgery between the two groups. There were no significant differences in the scores of the Oxford Ankle and Foot Questionnaire between the two groups. However, the total hospital stay was significantly longer in the metal group (5.2 ± 4.8 days) compared to the absorbable group (2.6 ± 0.5 days). Medical costs were significantly higher in the absorbable group than in the metal group with a difference of 397 US dollars.

Conclusion:

The use of bioabsorbable screws exhibited therapeutic effects equivalent to that of metal screws for pediatric distal tibia physeal fractures regarding clinical and radiological outcomes. Moreover, it had the advantage of avoiding the need for repeated general anesthesia and secondary operation for implant removal. Therefore, the use of bioabsorbable screws may be a favorable surgical option for treating pediatric fractures.
Contact Pressures of the Posterior Heel in Lower Extremity Splints: A Biomechanical Study
Authors: Nakken Erik R. , Walley Kempland C. , Talusan Paul , Walton David , Holmes James
Published: December 2024

Category:

Basic Sciences/Biologics; Trauma

Introduction/Purpose:

Immobilization using lower extremity splints is a ubiquitous tool in orthopaedic care in the emergency department, operating room, and outpatient clinic settings. Prolonged use of these splints may result in skin changes or ulceration of the heel if not padded or positioned correctly. There is currently no biomechanical study in the literature measuring posterior heel contact pressure in lower extremity splints. The purpose of our study is to measure the contact pressure differences in the posterior heel with increasing layers of cotton padding, with and without the heel floating. We hypothesize that increased layers of padding will decrease contact pressure, but improvement will plateau. We predict that floating the heel will also considerably offload contact pressure.

Methods:

Short leg splints were applied to six limbs in three healthy subjects with an underlying pressure transducer (Tekscan I-Scan system) on the skin surface of the posterior heel. Peak contact pressures were measured after 0, 2, 4, and 6 layers of cotton padding were applied behind the heel in positions both with and without the heel freely floating. Each limb served as their own control, as pressure changes were compared to each limb’s baseline measurement (splint applied with all padding removed).

Results:

Over a 3-fold decrease in peak contact pressure was observed after the application of 4 or 6 layers of cotton padding. This escalated to over a 6-fold decrease with 2, 4, or 6 layers of padding while the splint was positioned with the heel freely floating. Splints with 4 and 6 layers of padding decreased heel contact pressure similarly (reduced to 29% and 28% from baseline, respectively), improved from 2 layers of padding (51% decrease from baseline). The mean contact pressure with 6 layers of padding (28% from baseline) remained higher than the mean contact pressure with 0 layers of padding with the heel floating (21% from baseline).

Conclusion:

Lower extremity splints with 4 or 6 layers of cotton padding provided a meaningful decrease in peak posterior heel contact pressure. The greatest decrease in heel contact pressure was observed in splints with the heel floating, even with all layers of cotton padding removed. This was more optimal than all layers of cotton padding tested. This study emphasizes the critical nature of patient counseling regarding the importance of proper splint positioning with the heel floating when at rest. Neglecting to do so may put the patient at increased risk for posterior heel skin complications.
Convolutional Neural Networks Accurately Diagnose Lisfranc Injuries on Weightbearing and Nonweightbearing Radiographs
Authors: Sawatzke Alexander B. , Khela Monty , Ellis David , Windle John , Windle Thomas , Peng Dongming , Ma Jihyun , Antonson Neil
Published: December 2024

Category:

Other; Midfoot/Forefoot

Introduction/Purpose:

Convolutional neural networks (CNNs) predict Lisfranc injuries on weightbearing radiographs. Lisfranc injuries can be misdiagnosed 20%-50% of the time, thus leading to long-term sequela such as midfoot arthritis. Often Lisfranc injuries present to the Emergency department or general practitioner's office where Lisfranc injuries are more frequently misdiagnosed, and weightbearing films are less frequently obtained. CNNs are utilized to classify images, in particular, CNNs are successful at radiographic diagnosis of fractures, Lisfranc injuries, and classification of medical imaging. We aim to utilize CNNs to accurately diagnose Lisfranc injuries on both weightbearing and nonweightbearing films in a generalizable population of patients presenting to the emergency department, general practitioner, and orthopaedic clinics. Hypothesis: CNNs will accurately predict Lisfranc Injuries on weightbearing and nonweightbearing radiographs.

Methods:

In a retrospective study of 120 patients, 73 with Lisfranc injuries, and 47 without Lisfranc injuries were identified through medical record and imaging review. Radiographs and chart review were utilized to diagnose patients into Lisfranc and Not Lisfranc cohorts. A resnet-50 CNN model was trained, validated, and tested in a ratio (70:20:10) for each imaging view (anteriorposterior, lateral, oblique). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, F score, and area under the curve (AUC) were calculated for each model and compared between weightbearing and nonweightbearing films.

Results:

The best deep learning model for Lisfranc identification has 94.5% sensitivity, 78.7% specificity, 90.2% negative predictive value, 87.3% positive predictive value, 88.3% accuracy, 90.8% F score, and 91.5% AUC. Only 2 out of 48 Lisfranc injuries were missed on nonweightbearing films and 3 out of 25 Lisfranc injuries were missed on weightbearing films.

Conclusion:

CNNs identify Lisfranc injuries on weightbearing and nonweightbearing radiographs with acceptable accuracy. The best model missed fewer Lisfranc injuries than frequently reported numbers for trained radiologists. F score and AUC indicate that this is an excellent test. This provides a method to improve and supplement diagnosis in patients with acute foot injuries, thus limiting long-term sequela from misdiagnosed Lisfranc injuries.
Custom Patient-Specific 3D-Printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements: Classification, Technical Tips and Treatment Algorithm
Authors: Lewis Thomas L. , Walker Roland , Alkhalfan Yousif , Latif Ahmed , Abbasian Ali
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants which offer an alternative salvage option for failed total ankle replacements.

Methods:

A prospective observational study of six cases of failed total ankle replacements which were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification and a treatment algorithm were developed based on our initial experience. All p-values < 0.05 were considered significant.

Results:

Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow up was available for all cases. The mean follow up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (p< 0.05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (p< 0.05) and the EQ-VAS also improved from 53.0 to 63.3 (p=0.36). The mean VAS-Pain score at final follow up was 27.5. There were no cases of non-union.

Conclusion:

Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable alternative treatment option for failed total ankle replacements. MOXFQ Scores Following Custom Patient-Specific 3D-printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements
Development and Validation of Fully Automated Measurement Framework to Quantify 3D Foot and Ankle Alignment Using Weight-Bearing CT
Authors: Van den Borre Ide , Peiffer Matthias , Huysentruyt Roel , Huyghe Manu , Vervelghe Jean , Pizurica Aleksandra , Audenaert Emmanuel , Burssens Arne
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

Traditionally, foot and ankle alignment is quantified on 2D standing radiographs. This imaging method present limitations in capturing the 3D nature of our foot and ankle alignment and the obtained manual measurements are prone to observer error. This study aims to integrate weight-bearing CT (WBCT) imaging and advanced deep learning techniques to automate and enhance quantification our 3D foot and ankle alignment.

Methods:

Thirty-two patients who underwent a WBCT of the foot and ankle were retrospectively included. Training and validation of a 3D nnU-Net model on 45 cases to automate the segmentation into bony models was assessed by Hausdorff distance (measures how far two 3D bone model scans are from each other) and dice coefficient (measures the similarity between 3D bone model scans). Afterwards, 35 clinically relevant 3D measurements were automatically computed using a custom-made tool. Automated measurements were assessed for accuracy against manual measurements, while the latter were analyzed for inter-observer reliability.

Results:

Deep learning segmentation results showed a mean Hausdorff distance of 1.41mm and a mean dice coefficient of 0.95. A good to excellent reliability and mean prediction error of under 2 degrees was found for all angles except the talonavicular coverage angle and distal metatarsal articular angle, which were under 2.5 degrees.

Conclusion:

In summary, this study introduces a fully automated framework (Fig. 1) to quantify foot and ankle alignment and showcases reliability comparable to current clinical practice measurements. This operator-friendly and time-efficient tool holds promise for implementation in a clinical setting, benefitting both radiologists and surgeons. Future studies are encouraged to assess the tool's impact on streamlining image assessment workflows in clinical practice.
Direct Anterior Approach for AO43B/43C Pilon Fracture Fixation Demonstrates No Difference in Rate of Reoperation Compared to Other Surgical Approaches
Authors: Sokil Laura , Wong Liam H. , Roti Elizabeth , DeKeyser Graham , Working Zachary , Friess Darin , Meeker James
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

The direct anterior (DA) approach is commonly used for reconstructive procedures to treat posttraumatic ankle osteoarthritis (PTOA), however, literature investigating utilization of the DA approach (defined as the interval between the tibialis anterior tendon and extensor hallucis longus tendon) for initial fixation of pilon fractures is lacking. This retrospective study of patients undergoing fixation of pilon fractures hypothesizes that there is no difference in reoperation rate for patients whose pilon fractures were treated with DA approach.

Methods:

A retrospective radiographic and chart review of patients undergoing surgical fixation of tibial plafond fractures over a nine year period (2013-2022) at an urban, level 1 trauma center was undertaken. Review of operative notes for reoperation for infection, PTOA, nonunion and symptomatic hardware was utilized to determine reoperation rates. Injuries were radiographically stratified by AO/OTA classification, and quality of fracture reduction was assessed via measurement of the lateral distal tibial angle (LDTA) and lateral talar station (LTS) at the first postoperative radiograph. Likelihood of reoperation within one year of index surgery was analyzed using Kaplan-Meier estimations. Reoperation risk factors were determined with multivariable logistic regression analyses created using a backwards stepwise process.

Results:

135 fractures in 130 patients met inclusion criteria; 44 fractures were treated via a DA approach, 91 treated via all other approaches, many in combination. Between groups, AO/OTA classification, demographics, injury characteristics and operative time were no different. Overall reoperation rate was 40.7%. There was no significant difference between DA and all other approaches in rate of reoperation for infection (2.3% vs. 10%, p=0.21), nonunion (15.9% vs. 16.5%, p=1), PTOA (9.1% vs. 7.8%, p=1) and removal of symptomatic hardware (25% vs. 36.3%, P=0.27). Multivariable regression showed DA approach was associated with lower risk of reoperation within one year (OR 0.25, 95% CI 0.07-0.71, P=0.02). The DA group lateral talar station (LTS) was significantly greater (more anterior) by 0.9mm (2.75mm DA vs. 1.85mm all others, P=0.01).

Conclusion:

Utilization of the direct anterior approach to the ankle for initial fixation of pilon fractures has no difference in overall reoperation rates and a lower likelihood of reoperation within one year compared to all other combinations of approaches to the tibial plafond. Radiographic outcomes were different between groups, but the clinical significance of this is unclear. The DA approach should be considered for fracture patterns amenable to its use and may offer benefit should reconstructive procedures become necessary.
Distance Mapping of the Ankle to Assess Changes after Isolated Arthroscopic Anterolateral Subtalar Arthrodesis in Progressive Collapsing Foot Deformity
Authors: Bernasconi Alessio , Izzo Antonio , Fernando Céline , Lintz François
Published: December 2024

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

End-stage subtalar osteoarthritis in the context of Progressive Collapsing Foot Deformity (PCFD) is usually treated through subtalar joint (SJ) arthrodesis. In this study we set out to assess the changes occurring at the ankle joint after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA).

Methods:

In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Hindfoot alignment was assessed using multiple measurements. Distance Mapping (DM) at the ankle joint (divided in 9 regions) allowed to assess changes in terms of joint interaction between pre and postoperative images.

Results:

Out of 94 PCFD treated, thirtythree feet (33 patients, median age 62) were included in the study. Hindfoot alignment significantly improved, with a median Foot and Ankle Offset significantly decreased from 9.3 to 4 points (p< 0.001). We found a significant increase in mean distances occurring posterolaterally at the ankle (from 4.5 mm (SD 1.2) to 5.4 mm (SD 1.5), p< 0.001) along with a significant decrease occurring anteromedially (from 9.1 mm (SD 1.2) to 8.3 mm (SD 1.4), p< 0.001). In the three anterior regions there was a significant reduction of the mean distance between surfaces (all p= or < 0.01) while in two of the three posterior regions the distance between the tibia and talus significantly increased (p< 0.01).

Conclusion:

In patients diagnosed with PCFD undergone ALAPSTA, we observed significant changes in terms of interaction between the articular surfaces at the ankle joint, demonstrating a an external rotation and dorsiflexion on the talus in keeping with a ‘re-saddling’ effect over the calcaneus achieved through the procedure.
Does Timing of Hindfoot Reconstruction Before or after Primary Total Knee Arthroplasty Impact Reoperation Rates?
Authors: Larwa Joseph , Dohse Nicolas , Moses Alexander , Ledford Cameron , Haupt Edward T.
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

Total knee arthroplasty (TKA), ankle arthrodesis/arthroplasty, and hindfoot arthrodesis are effective procedures in treating end-stage osteoarthritis and deformity of the knee and hindfoot, respectively. Risk of reoperation remains a significant complication associated with these major lower extremity surgeries. Our study aimed to evaluate revision/reoperation rates and etiologies in patients undergoing staged ipsilateral TKA and hindfoot reconstruction (HFR).

Methods:

A retrospective review identified 162 patients undergoing ipsilateral TKA and HFR procedures between 2000 and 2022. Groups were stratified according to their index surgery: TKA first (n=81) versus HFR first (n=81). Reoperations rates, complications, and indications were compared via descriptive statistics. Mean follow-up was 4 years from the second surgery.

Results:

For the TKA first cohort, the overall rate of any reoperation was 28% (23/81), including a significantly higher rate of HFR than TKA reoperations (22% vs. 7%, respectively, p< 0.01). The most common etiology for HFR reoperation was arthrodesis nonunion (8/18, 44%) whereas for reoperation indication for TKA was evenly divided between instability, aseptic loosening, and patellar dysfunction. For the HFR first cohort, the overall rate of any reoperation was 16% (13/81), including similar rates of HFR and TKA reoperations (9% and 10%, respectively, p=0.4). The most common etiologies of HFR and TKA reoperations after F&A surgery first were adjacent joint disease (6/7, 86%) and patellar-related complications (4/8, 50%), respectively.

Conclusion:

Reoperation after a HFR appears to be higher when an ipsilateral TKA is performed first, primarily due to arthrodesis nonunion. Our series represents a first report of the temporal relationship between TKA and ankle/hindfoot reconstruction.
Early Clinical Outcomes and Complications of Transfibular Total Ankle Arthroplasty: The Australian Experience
Authors: Wines Andrew , Mittal Rajat , Symes Michael , Clugston Ellery , Scholes Corey , Wilton Alex
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

We report the short-term outcomes of a retrospective cohort of Trabecular Metal total ankle arthroplasties (TAAs) via a transfibular approach from a single, nondesigner surgeon in Australia.

Methods:

This was a retrospective cohort study. Demographic, clinical, and patient-reported outcome measures (PROMs) were collected. The primary outcome was the Foot and Ankle Outcome Score (FAOS), and secondary outcomes included patient satisfaction, the EuroQol-5 Dimension (EQ5D), and complications including revision rates.

Results:

Between 2016 and 2019, 84 trabecular metal prostheses were implanted in 84 patients. Mean age (SD) at time of surgery was 68 (7.8) years, and 46 (55%) were male. Mean follow-up (SD) was 26.1 (13) months. There were significant improvements in the FAOS (Pain (47.9 to 79.1), activities of daily living (59.5 to 83.7), and quality of life (25.5 to 60.2)) and EQ-5D (0.55 to 0.75) (P < .001), and overall satisfaction was 69.6%. Complications included wound infection/breakdown (11.9%), fibular nonunion (3.5%), plate irritation (3.5%), and tibial nerve neuropathy (3.5%). There were no thromboembolic complications. Implant survivorship was 100%, with Trabecular Metal components retained in all patients. Two patients developed deep infection, with 1 requiring debridement and polyethylene exchange. No patients experienced implant loosening.

Conclusion:

Our results demonstrate that the trabecular metal survival rates are comparable with other total ankle implants in the Australian Orthopaedic Association National Joint Replacement Registry and as published in other international literature. Overall patient satisfaction was high, as were PROMs. However, the data highlight potential complications uniquely associated with this implant. The authors believe that these figures support TAA via a transfibular approach as a viable option in the treatment of ankle arthritis.
Early Outcomes of the 3-Component Salto Total Ankle Arthroplasty and Management of Major Complications
Authors: Lim Jung-Won , Im Je-Min , Jung Hong-Geun
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

The popularity of total ankle arthroplasty (TAA) increased. Despite the favorable outcomes reported after TAA, there are many complications and subsequent reoperations after surgery. In this study, we evaluate the early clinical and radiologic outcomes of the Salto mobile bearing 3-component total ankle prosthesis, especially in terms of complications and reoperations.

Methods:

TAA was performed in 120 consecutive ankles (115 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to May 2021 with at least 2-year follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Radiographic outcomes were also evaluated with standing manner. Reoperation is defined as non-revisional secondary surgery involving the ankle not the prosthesis.

Results:

VAS pain score decreased from 6.7 (range, 2–10) pre-operatively to 1.5 (range, 0–8) at last follow-up (p < 0.05). AOFAS score increased from 36.2 (range 3–85) to 86.0 (range 15–100) at last follow-up (p < 0.05). Overall satisfaction rate was 88%. Even with such good clinical outcomes, complications were also identified. There were 22 cases with osteolysis, and 14 cases among them required additional bone graft or cementation. One ankle with talar component subsidence underwent revision procedure. Three ankles with surgical site infection also needed reoperation procedure, and 1 case among them was converted to tibio-talo-calcaneal arthrodesis at 3 months postoperatively. Post-operative varus tilted ankle were observed in 5 ankles that underwent reoperation procedures such as lateral ligament reconstruction.

Conclusion:

The TAA using single Salto 3-componenet implant showed favorable early outcomes. Nevertheless, there were many complications that needed reoperation procedures during the 2-year follow-up, so periodic close observation is necessary. In reoperation, proper diagnosis of problems and skilled procedures are required.
Epidemiology of Pickleball-Related Foot and Ankle Injuries (2015 – 2023)
Authors: Kingston Kiera , Parker Emily Belle , Higgins Alexander , Smith Jeremy T.
Published: December 2024

Category:

Sports; Ankle

Introduction/Purpose:

Pickleball, a paddle sport that combines elements of tennis, badminton, and ping-pong, is the fastest-growing sport in the United States. The surge in pickleball’s popularity is largely attributed to a growing population of older adults in search of a relatively low-impact yet engaging physical activity. While pickleball is great for promoting both physical fitness and social interaction, it is not without risk of injury. This study seeks to describe the epidemiology of pickleball-related foot and ankle injuries with a goal of providing insight into injury demographics, injury types, and injury patterns.

Methods:

For this cross-sectional retrospective study, we queried our institutional database for patients with documentation including “pickleball” or “pickle ball” who were seen by a foot and ankle provider between 1/2015 – 12/2023. Sites included two large academic medical centers and two community hospitals. Clinical notes were reviewed and only patients with foot and ankle injuries directly associated with playing pickleball were included. Patient demographics (age, sex, BMI), date of injury, laterality, diagnosis, treatment, and mechanism of injury (when available) were collected. We calculated the annual incidence of injuries over the study period and conducted descriptive analyses on patient demographics, diagnoses, and treatment approaches.

Results:

We identified 198 patients with pickleball-related foot and ankle injuries. The annual injury incidence rose rapidly over the study period, increasing 6.5-fold from 2019 to 2023 (Figure 1). The mean age at time of injury was 58.3 years (SD=12.2) and mean BMI was 26.7kg/m2 (SD=4.1). The majority of patients (58.6%) were male and reported a traumatic injury (77.8%) versus exacerbation of a chronic injury. The most common diagnoses were Achilles tendon rupture (39.4%), gastrocnemius injury (16%), and Achilles tendinopathy (12.1%). Of patients with documentation of the mechanism of injury (n=101), the most common causes were running or lunging forward (29.7%), inverting the foot/ankle (14.8%), and moving backward (8.0%). While the majority of injuries (72.7%) were treated non-operatively, 60% of Achilles tendon ruptures were treated surgically.

Conclusion:

The incidence of pickleball-related foot and ankle injuries has increased dramatically over recent years. Most injuries identified in our cohort were traumatic, with Achilles tendon rupture being the most common diagnosis. Injuries occurred more often in men and players older than 50-years-old while running or lunging for the ball. As the popularity of pickleball increases, there is a corresponding need for expanded education regarding strategies to help prevent foot and ankle injuries among pickleball players, with particular attention towards preventing Achilles tendon rupture. Further research is needed examining functional outcomes and return to sport after pickleball-related foot and ankle injuries.
From extraction to contamination: Illegal refineries, polluted waters and environmental activism in Iraqi Kurdistan
Authors: Wiktor-Mach Dobrosława , Zangana Goran
Published: December 2024

This research explores the interplay between extractivism, river pollution, and the proliferation of illegal oil refineries in the Kurdistan Region of Iraq. Positioned within the framework of the Capitalocene, the study highlights how systemic socio-ecological harm is not merely a by-product of economic activity but a fundamental component of the capitalist systems encouraged locally by power constellations and social dialectics. The paper examines the transformation of the Tanjero River, which became a symbol of ecological disaster, driven by the proliferation of illegal oil refineries and the region's deregulated extractive practices. Through fieldwork conducted in 2021 and 2022, including interviews with environmentalists, governmental officials, and community members, this paper argues that the ecological disaster in the Kurdistan Region of Iraq is fundamentally driven by the dynamics of the Capitalocene and extractivism, which find fertile grounds in new frontiers marked by non-governance, fragility of the state and regulatory failures. Recently, however, environmental activists have mobilised to combat pollution and reclaim natural landscapes, highlighting both the destructive impacts of unchecked extractivism and the potential for community-driven resistance and restoration.
Association between serum uric acid levels and chronic tension-type headache: A case–control study
Authors: Algul Fatma Ebru , Kablan Yuksel
Published: December 2024

Background

Tension-type headache (TTH) is the most common type of primary headache. Its etiology has not been clearly elucidated, and conflicting results have been reported in studies on oxidative stress. Uric acid is a molecule with antioxidant properties and is the end product of purine catabolism. Total oxidant-antioxidant status may potentially play an important role in the pathophysiology of chronic TTH. In this study, we investigated whether there was a difference in uric acid levels, an oxidative stress marker, between patients with tension-type headache and healthy controls.

Methods

The study was designed retrospective observational case–control study. The diagnosis of chronic TTH was made according to the diagnostic criteria established by the International Classification of Headache Disorders. A total of 164 people, including 94 patients with chronic tension-type headache and 70 healthy controls were included in the study. Hemoglobin, blood urea nitrogen (BUN), creatinine, albumin, and serum uric acid levels were studied from the serum of the participants. The Kolmogorov Smirnov Normality test, Mann–Whitney U test, and binary logistic regression test were used for statistical analysis.

Results

There was no statistically significant difference between our control and patient groups in terms of age and BUN ( p = 0.069 and p = 0.547). The serum albumin ( p = 0.000), creatinine ( p = 0.047), and hemoglobin levels ( p = 0.000) in our patient group were found to be significantly low compared to the healthy control group. The serum uric acid levels in the TTH and control groups were 4.28 ± 1.16 and 5.32 ± 1.31 mg/dL, respectively ( p = 0.000). Lower uric acid levels correlate with an increased likelihood of TTH presence in both males and females.

Conclusion

We demonstrated that serum uric acid levels in TTH patients were lower than in controls. Further studies with larger populations are needed to determine whether uric acid plays a protective role in the etiology of TTH by reducing oxidative stress.
Deep brain stimulation versus nonsurgical treatment for severe Alzheimer's disease: A long-term retrospective cohort study
Authors: Xu Junpeng , Liu Bin , Feng Zhebin , Yu Xinguang , Shang Guosong , Liu Yang , Sun Yuxiang , Yang Haonan , Chen Yuhan , Zhang Yanyang , Mao Zhiqi
Published: December 2024

Background

Severe Alzheimer's disease (AD) is characterized by significant neuropsychiatric symptoms and sleep disorders, with limited effectiveness of conservative drug treatments. Deep brain stimulation (DBS) offers a potential alternative.

Objective

To evaluate the efficacy, safety, and long-term outcomes of DBS versus conservative treatment in patients with severe AD.

Methods

We retrospectively analyzed 40 patients with severe AD diagnosed at the People's Liberation Army General Hospital from 2015 to 2022. Twenty patients received DBS, and twenty received conservative treatment. Treatment effects were assessed using standardized scales at three- and twelve-months post-treatment. Primary outcomes included changes in cognitive function [Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Alzheimer's Disease Rating Scale-Cognitive subscale, Clinical Dementia Rating). Secondary outcomes included quality of life, sleep quality, neuropsychiatric symptoms, and caregiver burden (Barthel Index, Functional Activity Questionnaire, Functional Independence Measure (FIM), Neuropsychiatric Inventory (NPI), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PDQI), Zarit Burden Interview (ZBI)].

Results

DBS patients showed significantly greater improvements in MMSE, MoCA, FIM, and ZBI scores than controls, suggesting improved cognitive function and quality of life, and reduced caregiver burden (p < 0.05). Notably, DBS significantly reduced HAM-A, HAM-D, and PSQI scores, and improved NPI scores more than controls, indicating significant amelioration of neuropsychiatric symptoms and sleep disorders (p < 0.05).

Conclusions

DBS is a safe and reversible treatment that potentially enhances cognitive function and quality of life in severe AD patients and alleviates caregiver burden. For the first time, we report that DBS also improves neuropsychiatric symptoms and sleep disorders, highlighting its clinical potential in AD.
Synergistic activity of nootropic herbs as potent therapeutics for Alzheimer's disease: A cheminformatics, pharmacokinetics, and system pharmacology approach
Authors: Don Bosco Reiya Bosco , Selvan Christyraj Johnson Retnaraj Samuel , Yesudhason Beryl Vedha
Published: December 2024

Background

Alzheimer's disease (AD) is a progressive neurodegenerative disorder, which subdues over 55 million people and finding a cure, still remains disenchanting. Indian medicinal herbs notably, Withania somnifera, Bacopa monnieri, Curcuma longa, and Clitoria ternatea are traditionally utilized for their memory-enhancing properties.

Objective

We computationally investigated the therapeutic potential of four nootropic herbs by uncovering the molecular mechanisms underlying their treatment for AD.

Methods

Cheminformatics, pharmacokinetics, and system pharmacology studies were carried out to predict the phytocompounds drug-like properties, protein targets, targets functional association and enrichment analysis. A comparative study was performed with phytocompounds and FDA-approved drugs. Investigation on the expression of protein targets in the hippocampus and entorhinal cortex of the AD brain was performed. Network was constructed to depict the interaction between phytocompounds, drugs, and molecular targets.

Results

Through comparative analysis, we found that the phytocompounds shared common targets with both FDA drugs and drugs under clinical trials. We identified potential active compounds notably, Withaferin A, Withanolide-D, Withanolide-E, Withanolide-G, and Humulene epoxide II, that can combat AD. Interestingly, the enzyme inhibition scores of the identified drugs were much higher than FDA-approved drugs. In addition, regulatory proteins such as AβPP, acetylcholinesterase, BACE1, and PTPN1 were the targets of 8, 16, 9, and 22 phytocompounds, respectively. Nonetheless, AR and CYP19A, were the primary targets of most phytocompounds.

Conclusions

Herbal medicines can synergistically stimulate multiple protein targets, rendering a holistic and integrative treatment, encouraging a promising avenue to treat AD.
Gut microbiome synthesizes important core metabolites to prevent cognitive decline and mitigate onset and progression of Alzheimer's disease
Authors: Al-Abbas Nouf S , Shaer Nehad A
Published: December 2024

Background

This study explores how gut metabolites, produced through bacterial metabolism in the gut, influence neurological conditions like Alzheimer's disease (AD). Key metabolites such as succinate and short-chain fatty acids signal through the autonomic nervous system and can cross the blood-brain barrier, impacting central nervous system functions.

Objective

The aim is to examine the role of the gut microbiota in compensating for metabolic deficiencies in AD. By analyzing wild-type (WT) and APP/PS1 mice, the study investigates how the microbiome affects key metabolic processes and whether it can slow AD progression.

Methods

High-throughput sequencing data from the gut microbiomes of APP/PS1 transgenic AD model mice and age-matched WT C57BL/6 male mice were analyzed for microbial and metabolite profiles.

Results

Alpha and beta diversity analyses showed differences in microbial composition between groups. Partial least squares discriminant analysis and Anosim confirmed distinct microbiome profiles in WT and APP/PS1 mice. At the genus level, Vescimonas was more abundant in WT mice, while Odoribacter, Lacrimispora, Helicobacter, Bacteroides, and Alloprevotella were more prevalent in APP/PS1 mice.

Conclusions

While taxonomic differences did not directly link specific microorganisms to AD, functional analysis identified key metabolites—acetyl-CoA, glucose, succinate, lipids, choline, and acetylcholine—that may alleviate energy deficits and synaptic dysfunction. This study suggests that the microbiome may help compensate for AD-related impairments, opening avenues for microbiome-based therapies.