bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Chronic Lateral Ankle Instability with a Sprain Stimulator: A Controlled Study in Physically Active Subjects
Authors: Lalevee Matthieu , Schmidt Eli , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar
Published: December 2023

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

Chronic Lateral Ankle Instability (CLAI) represents a significant socioeconomic burden. Paradoxically, its management has changed little over the years, notably because research is divided into functional and mechanical instability, whereas CLAI encompasses both. Sprain simulators can encompass both functional and mechanical instability by assessing the maximal ankle inversion velocity (MIV) during a simulated inversion trauma. We built a sprain simulator capable of producing a sudden ankle inversion motion during walking. We aimed to differentiate subjects with chronic lateral ankle instability (CLAI) from controls and quantify functional CLAI as well as impairments in activities of daily living and sports using a sprain simulator.

Methods:

Forty-five physically active subjects were included and assigned to a CLAI group, a control group, or excluded according to the International Ankle Consortium selection criteria. Each subject walked on a treadmill with instability boots after completing the Identification of Functional Ankle Instability (IdFAI) and the Foot Ankle Ability Measurement (FAAM) questionnaires. A simulated trauma was unexpectedly triggered by the observer. Maximal inversion velocities (MIV) were measured at this very moment using inertial moment units. We normalized these values by the average MIV of the 5 stance phases of the same foot preceding the simulated trauma (Ratio MIV). Normality of data were assessed with the Shapiro-Wilk test. The groups were compared using Student T test for normal and Mann-Whitney U test for nonnormal variables. Multivariate linear regressions were performed to assess the relation between, the IdFAI, the FAAM Activities of Daily Living Subscale, the FAAM Sports Subscale and the explanatory variables.

Results:

Twenty-six ankles were excluded, 32 composed the CLAI group and 32 the control group. Mean MIV were 213.5+/-54.7°/s and 177+/-64.2°/s (p=0.02), and mean Ratio MIV were 1.22+/-0.13 and 1.08+/-0.08 (p < 0.001) in the CLAI and Control groups respectively. In multivariate analysis, Ratio MIV was associated with higher values of IdFAI (β=42.8 [12.9;72.8],p=0.006), lower values of FAAM Activities of Daily Living Subscale (β=-14.1 [-27.8;-0.5],p=0.04) and lower values of FAAM Sports Subscale (β=-7.2 [-13.7;- 0.6],p=0.03) whereas MIV was not.

Conclusion:

Inversion velocities caused by a sprain simulator clearly differentiated CLAI from controls in our study. Ratio MIV showed good ability to quantify functional CLAI as well as impairments in activities of daily living and sports. This tool should be used in future studies in an attempt to provide a complete picture of CLAI encompassing its functional and mechanical aspects which may lead to improved LAS and CLAI management.
Patient-related Risk Factors Associated with Poorer Outcomes Following Total Ankle Arthroplasty: A Scoping Review of 101552 Cases
Authors: Haq Ibrahim Inzarul , Arshad Zaki , Bhatia Maneesh
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty and ankle arthrodesis are both first line options for end stage arthritis. Both have good outcomes in terms of patient reported outcome measures, complications, and revision rate. Despite efforts to determine a superior option, results are inconsistent. It may be better to take a patient-specific approach in deciding which procedure to use based on risk factors such as BMI, age, and co-morbidities. This scoping review aims to identify and summarise all literature on total ankle arthroplasty and risk factors to guide a patient-specific decision making process, helping clinicians refine selection criteria and identify patients who are likely to respond well to the procedure.

Methods:

A scoping review was performed using the Preferred Reporting Items for Systematic Reviews an Meta-Analyses (PRISMA) guidelines. Computer based literature searching was performed in PubMed, Embase, Cochrane trials and ISI Web of science. Two reviewers independently performed title/abstract and full text screening according to pre-determined selection criteria. English-language original research studies reporting patient related factors associated with a poorer outcome following total ankle arthroplasty were included. Outcomes were defined as patient reported outcome measures (PROMs), peri-operative complications and failure.

Results:

A total of 94 studies reporting 101,552 cases of total ankle arthroplasty in 101,177 patients were included. The most common patient-related risk factor associated with poorer outcomes were younger age (21 studies), rheumatoid arthritis (17 studies) and diabetes (16 studies). Of the studies using multivariate regression specifically, the most frequently described risk factors were younger age (12 studies), rheumatoid arthritis (8 studies) and diabetes (8 studies).

Conclusion:

When controlling for cofounding factors, the most commonly reported risk factors are younger age, rheumatoid arthritis and co-morbidities such as diabetes and smoking. These patient-related risk factors reported may be used to facilitate the refinement of patient selection criteria for total ankle arthroplasty and inform patient expectations.
Proximal Tibial Cortex Transverse Distraction Facilitating Healing and Limb Salvage in Severe and Recalcitrant Diabetic Foot Ulcers
Authors: Hua Qikai
Published: December 2023

Category:

Diabetes; Diabetes

Introduction/Purpose:

The management of severe and recalcitrant diabetic foot ulcers is challenging. Distraction osteogenesis is accompanied by vascularization and regeneration of the surrounding tissues. The longitudinal distraction of the proximal tibia stimulates increased and prolonged blood flow to the distal tibia. However, the effects of the transverse distraction of the proximal tibia cortex on severe and recalcitrant diabetic foot ulcers are largely unknown.

Methods:

Between July 2014 and March 2017, we treated 136 patients with diabetes and severe ulcers (University of Texas Grade 2B to 3D) that had not responded to treatment for at least 6 months. and their ulcers had a mean ± SD area of 44 cm2 ± 10 cm2. All 136 patients underwent tibial cortex transverse distraction. We compared these patients with the last 136 consecutive patients we treated with standard surgical treatment between May 2011 and June 2013; All patients received standard off-loading and wound care. We compared the groups with respect to ulcer healing (complete epithelialization without discharge, maintained for at least 2 weeks) in a 2-year follow-up, the proportion of ulcers that healed by 6 months, major amputation, recurrence, and complications in the 2-year follow-up. Foot arterial status and perfusion were assessed in the TCTD group using CT angiography and perfusion imaging.

Results:

The tibial cortex transverse distraction group had a higher proportion of ulcers that healed in the 2-year follow-up than the control group (96% versus 68% ; p < 0.001). By 6 months, a higher proportion of ulcers healed in the TCTD group than in the control group (93% versus 41% ; p < 0.001). Lower proportions of patients in the TCTD group underwent major amputation (2.9% versus 23%; p < 0.001) or had recurrences 2.9% versus 17%, OR 0.20 [95% CI 0.05 to 0.45]; p < 0.001) than the control group in 2-year follow-up. In the feet of the patients in the TCTD group, there was a higher density of small vessels and higher blood flow and blood volume 12 weeks postoperatively than preoperatively.

Conclusion:

Proximal tibial cortex transverse distraction substantially facilitated healing and limb salvage and decreased the recurrence of severe and recalcitrant diabetic foot ulcers. The surgical techniques were relatively straightforward although the treatment was unorthodox, and the complications were few and minor. These findings suggest that tibial cortex transverse distraction is an effective procedure to treat severe and recalcitrant diabetic foot ulcers compared with standard surgical therapy. Randomized controlled trials are required to confirm these findings.
Radiographic and Clinical Results of 4rd Generation Minimally Invasive Bunion Surgery for Symptomatic Hallux Valgus
Authors: Rodriguez-Materon Solangel , Lopez Kyra E. , Chapman Cary , Chapman Grant , Hodgkins Christopher , Giovanni Thomas P. San
Published: December 2023

Category:

Bunion; Other

Introduction/Purpose:

Minimally invasive techniques for surgical treatment of hallux valgus has gained popularity over the past few years. Most published reports involve combined minimally invasive Chevron and Akin osteotomies (MICA) performed by a single surgeon. This study reports radiographic and clinical results on patients who underwent minimally invasive transverse distal 1st metatarsal and Akin osteotomies by 3 fellowship trained Foot & Ankle orthopedic surgeons. A minimally invasive transverse distal 1st metatarsal osteotomy has advantages over MIS chevron osteotomy as it is less technically demanding and in theory, the surgeon can control 1st metatarsal head rotation to improve sesamoid position.

Methods:

Ninety-five consecutive patients between 2019 and 2021 with symptomatic Hallux valgus without 1st tarsometatarsal or metatarsal phalangeal joint arthritis or TMT joint instability were followed for at least one year. Primary radiographic outcomes include pre and postoperative hallux valgus and 1-2 intermetatarsal angles. Pain relief was measured by VAS scores. Patient Reported Outcomes (PROMS) used were Foot and Ankle Mobility (FAAM) scores in the dimension of activities of daily living (ADL) and sports. PROMS measured at one year follow-up. Radiographic recurrence was defined as a change in HVA >2.6 degrees between any 2 postoperative radiographs and an HVA >15 degrees. Z-Scores were calculated depending on the patient's demographics based on normative values to assess the deviation from a normal population FAAM scores.

Results:

Demographics and preoperative bunion classification of all patients included in this study can be found in table 1. Average pre-op HVA and IMA were 24.9 and 12.2 degrees respectively and improved to 8.43 and 5.86 degrees (p < 0.01) at 3 months. From the 3 months to 12 months, the patients’ HVA and IMA average was 9.39 and 6.85, but this change was not statistically significant (p = 0.35). VAS scores improved from 5.37 preoperatively to 1.9 at final follow up (p < 0.01). The average postoperative FAAM ADL score was (86.34 +/- 17.18) and z-score was (-0.08 +/- 1.16). The average postoperative FAAM sport score was (66.12 +/- 30.93) and z-score was (-0.26 +/- 1.94).

Conclusion:

Overall, the results of the study affirm the literature that third generation MIS hallux valgus surgery remains a good option. This study showed no infections in patients undergoing MIS hallux valgus surgery and the correction of the hallux valgus angles that persisted at 12 months with low recurrence rates. At this time, the results show a trend toward lower FAAM scores postoperatively at one year follow-up that was significant in the sports subscore but the difference from a normal population is not significant in the ADL subscore. Longer follow-up is needed to evaluate the trend further.
Reliability of Cone Bean Weight-Bearing Measurements of the Postoperative Outcome of Total Ankle Arthroplasties and Inter-Method Reliability with Respect to the Weight Bearing x-rays
Authors: Barbero Agustin , Efrima Ben , Maccario Camilla , Indino Cristian , Ovadia Joshua , Usuelli Federico Giuseppe
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Postoperative evaluation of the total ankle arthroplasty (TAA) alignment is a fundamental step in measuring the surgical outcome. The current reference standard, weight-bearing x-ray (WBXR), is subject to technical bias. Weight-bearing cone beam computer tomography (WBCT) allows visualization of the complex three-dimensional (3D) structure of the foot under the influence of its deforming forces. A WBCT-based measurement system to assess postoperative outcomes has yet to be validated. The purpose of this study was (1) to measure the surgical outcome of TAA using semiautomatic generated models, (2) to evaluate the agreement levels between two raters, and (3) to evaluate the inter-method reliability with respect to WBXR.

Methods:

Fifty-five consecutive patients were retrospectively viewed. Two raters independently created a 3D model using dedicated software. Each rater measured six different measurements: α angle tibiotalar angle, hind foot angle (HFA), β angle, γ angle, and Φ angle using a semiautomatic 3D model and one measurement, the tibiatalar ratio (TTR) using WBCT on sagittal view. Measurements were repeated two months apart in the same independent fashion. Results were compared to standard weight- bearing x-rays. Consequently, interobserver, intraobserver, and intermethod agreements were calculated.

Results:

All seven measurements showed good to excellent interobserver and interobserver reliability. (ICC 0.85-0.95). The intermethod agreement showed good agreement for the γ angle (0.79) moderate agreement levels for the α angle, TTS angle, β angle, and TTR (ICC 0.68, 0.69, 0.70, 0.69 respectively), a poor agreement for the HFA angle (ICC 0.25), and a negative agreement for the φ angle (ICC -0.2).

Conclusion:

Postoperative analysis of TAA using WBCT demonstrated good to excellent interobserver and intraobserver agreement and can be reliably used. When compared to WBXR, moderate to good agreement was measured for the sagittal and coronal alignment of the components. A poor agreement was measured for the coronal alignment of the hindfoot, and a negative agreement was measured for the axial rotation angle, indicating that the intermethod comparison is unreliable.
Anatomical Features of Patients with Recurrent Dislocation of the Peroneal Tendons
Authors: Nishimura Akinobu , Senga Yoshiyuki , Fujikawa Yuki , Sudo Akihiro
Published: December 2023

Category:

Hindfoot; Sports

Introduction/Purpose:

The occurrence of peroneal tendon dislocation (PTD) may be influenced by anatomical variations in the peroneal muscles and ankle lateral malleolus. One such factor is peroneal groove crowding, which can result from increased muscle and tendons bulk within the peroneal tendon sheath. Another potential factor is the shape of the retromalleolar groove, which determines the inherent stability of the tendons in the groove. This study aims to examine the anatomical variations of the retromalleolar groove and peroneal muscles in patients with and without recurrent PTD (RPTD) using magnetic resonance imaging (MRI) and computed tomography (CT).

Methods:

This study included 30 patients (30 ankles) with recurrent PTD who underwent both MRI and CT before surgery (PD group) and 30 age- and sex-matched patients (control (CN) group) who underwent MRI and CT. The imaging was reviewed at the level of the tibial plafond (TP level) and the center slice between the TP and the fibula tip (CS level). CT images were used to assess the appearance of a malleolar groove (convex, concave, or flat) and the posterior tilting angle of the fibula. MRI images were used to assess the appearance of accessory peroneal muscles, height of the peroneus brevis muscle belly, and volume of the peroneal muscle and tendons. Low-lying muscle belly (LLMB) of the PB was defined as when the musculotendinous junction extended beyond the tip. The Mann-Whitney U test was used to compare continuous variables, and Fisher’s exact test was used to compare nominal variables.

Results:

There were no differences in the appearance of the malleolar groove, posterior tilting angle of the fibula, or accessory peroneal muscles at the TP and CS levels between the PD and CN groups. However, the peroneal muscle ratio was significantly higher in the PD group than in the CN group at both levels (both p< 0.001). The peroneal tendons ratio was not significantly different between the groups at both levels. The height of the peroneus brevis muscle belly was significantly lower in the PD group than in the CN group (p=0.001). LLMB of the PB was identified in 19 patients (63.3%) in the PD group and in eight patients (26.7%) in the CN group (p=0.009).

Conclusion:

The findings of this study suggest that LLMB of the PB and the peroneal muscle ratio are significantly related to RPTD, whereas retromalleolar bony morphology is not. Therefore, maintaining proper volume in the peroneal tunnel is more important than the groove shape. Reduction of the muscle belly of the peroneus brevis during RPTD surgery may help prevent peroneal tendon dislocation.
Comparison Total Joint Replacement with Arthrodesis of the 1st Metatarsophalangeal Joint
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiological, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1).

Methods:

All consecutive patients with A and RG from January 23, 2011 until September 18, 2019 at the authors’ institution were considered for inclusion in the study. Preoperatively and at FU, radiographs and/or weight-bearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual-Analogue-Scale Foot and Ankle (VAS FA), European Foot and Ankle Society Score (EFAS Score), MTP1 range of motion for dorsi-/plantarflexion (DF/PF) were registered and compared pre- operatively and FU.

Results:

Seventy RG and 72 A were included. Preoperative VASFA/EFAS Score did not differ between RG and A (Average scores, VASFA, RG/A, 50.6/45,6; EFAS Score, RG/A, 10,7/10,6; each p>0.05). Wound healing delays without further operative measures were registered in 4 (6%) patients for RG and 5 (7%) for A (p=0.67), and 5 revisions in 5 (7%) for RG and 12 in 8 (11%) for A (p=0.05). The longest available FU was higher in RG than in A (RG/A, 47/37 months on average, p< 0.001). VASFA/EFAS Score at FU was higher in RG than in A (Average scores, VASFA, RG/A, 72,6/63,6; EFAS Score, RG/A, 16.1/14.1; each p< 0.05). DF/PF was only possible in RG (Average values DF/PF RG, 36.1/14.0)

Conclusion:

We found marginally lower revision rates and higher PROMs, joint motion (DF/PF) and more physiologic force distribution at slightly longer FU for the RG subgroup than the A subgroup. Longer follow-up and broader clinical reporting are needed to identify potential deficits of RG.
Effect of Plate and Screw Fixation on Stability of Weber B/Supination-External Rotation Fractures with Partial Deltoid Ligament Injury (SER4a): Robotic-Based Joint Testing
Authors: Gregersen Martin Greger , Dalen Andreas Fagerhaug , Nilsen Fredrik , Molund Marius
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

Fibular fractures with signs of concomitant deltoid ligament injury have been operated on with plate and screw fixation of the fibula for decades. More recently, clinical studies have suggested that some fibular fractures have only partial deltoid ligament injury and that the deep posterior tibiotalar ligament may be intact (SER4a), allowing for nonoperative treatment. The purpose was to determine whether fibula fracture fixation using plate and screws improves stability and restores normal joint kinematics in such fractures. It was hypothesised that fixation of the fibula fracture does not add significantly to the stability of SER4a models or restore normal joint kinematics.

Methods:

Fifteen cadaveric foot and ankle specimens underwent biomechanical testing using a six-degrees-of-freedom force- movement robotic arm in three states: intact joint, SER4a model (anterior inferior tibiofibular ligament sectioned + oblique trans syndesmotic fibular osteotomy + superficial layer of deltoid ligament sectioned + deep anterior tibiotalar ligament sectioned) and SER4a model + plate and screw fixation of the fibula. Joint stability was measured in lateral translation, valgus, and talar internal- and external rotation in three talocrural joint positions: 20° plantarflexion, neutral, and 10° dorsiflexion. Fluoroscopy was used to measure isolated talar lateralisation and talar tilt. The foot was rigidly fixed to a custom pedestal, while the tibia was rigidly fixed to the robot arm through a load cell. Talar lateral translation at neutral ankle position was the primary outcome.

Results:

Fixation of the fibular fracture reduced lateral translation by 0.16 millimetres (P = .101) at neutral ankle position (See Figure 1). In general, the tests for lateral translation and valgus showed no differences between the SER4a models and the SER4a models with fibular fracture fixation. As for talar internal rotation, the fixation only slightly increased stability. But, when the talus was externally rotated, the fixation provided stability. Although the fixation improved stability during rotations, it did not fully restore the native ankle kinematics.

Conclusion:

The results suggest that plate and screw fixation of the fibular fracture does not significantly reduce instability or restore intact joint stability in SER4a models. These results support the nonoperative treatment of these fractures, as suggested by previous clinical studies.
Efficacy of Collagenase Clostridium Histolyticum Injection, a Potential Nonsurgical Intralesional Treatment Option for Plantar Fibromatosis: A Randomized, Open-Label, Dose-Ranging Study
Authors: Caporusso Joseph , Pollak Richard , Hernandez David , Dalton Shannon , Xiang Qinfang , Vijayan Saji , Anderson C. James
Published: December 2023

Category:

Midfoot/Forefoot; Basic Sciences/Biologics

Introduction/Purpose:

Plantar fibromatosis (PFi) is characterized by collagen-containing nodules on the foot along the plantar fascia that can cause pain and functional disability. Current treatments focus on symptom relief, which may become ineffective, or surgery, which can have lengthy recovery times. Collagenase clostridium histolyticum (CCH) is approved for Dupuytren’s and Peyronie’s disease treatment, which are both fibroproliferative disorders that may coexist in patients with PFi. This dose-ranging study assessed the efficacy and safety of CCH treatment of PFi.

Methods:

In this Phase 1, multicenter study, participants were randomly allocated (1:1:1) to receive 0.6, 1.2, or 2.25 mg/mL CCH. All participants underwent the initial treatment period (ITP) and received 1–2 intralesional injections per nodule on Day 1 with 5 follow-up assessments. Participants with palpable treated nodules could receive additional CCH doses (at 2.25 mg/mL; retreatment period, RP), with follow-up at specified intervals. Assessments included a 5-scale measure of nodule hardness (0 [nonpalpable] to 4 [hard]), and the Foot Function Index-Short Form23 (FFI-SF23) reported as a composite score (0 – 100) of 3 subscale scores (disability, difficulty, and pain subscales).

Results:

After ITP (n=24), 100% (8/8) of participants receiving 2.25 mg/mL CCH showed improvement in nodule hardness, compared with 87.5% (7/8) and 75% (6/8) of participants receiving 1.2 and 0.6 mg/mL, respectively. FFI-SF23 also showed a negative change from baseline across treatment groups, indicating improvement. Participants that received 2.25 mg/mL reported the largest percent improvement (-83.7%). After RP (n=11), 81.8% (9/11) of participants showed improvement in nodular hardness and an FFI-SF23 score change of -9.3%, indicating further improvement from baseline after ITP. CCH had a consistent safety profile in ITP/RP.

Conclusion:

CCH caused dose-dependent improvement of nodule hardness after treatment, with 2.25 mg/mL utilized for nodule retreatment; FFI-SF23 scores correlated with this finding, indicating CCH may be a potential nonsurgical intralesional option for PFi treatment.
Opposing Flanks vs Parallel Flanks – the Influence of Headless Screw Design on Compression and Pull- Out Resistance
Authors: Tan Rachel , Patterson Alba Morillo , Taylor Stephen JG , Patel Shelain , Bernasconi Alessio , Malhotra Karan
Published: December 2023

Category:

Basic Sciences/Biologics; Basic Sciences/Biologics

Introduction/Purpose:

Screws generate and maintain compression against distracting forces when performing osteotomy or fusion surgery. Headless screws with opposing flank angles (OFA) between the threads of the head and shaft are purported to achieve better compression. The purpose of this study was to compare OFA designs against traditional parallel flank angle (PFA) headless screws and headed screws to determine differences in compression and pull-out resistance (POR).

Methods:

In this biomechanical in-vitro study, four screw designs were compared: headless screws with OFA (Screw_A and Screw_B), headless screws with PFA (Screw_C), and headed screws (Screw_D). All screws were 4.0x50mm partially threaded cannulated screws. Screw_B had a 1.4mm shorter head length and 0.5mm narrower head thread diameter than Screw_A and Screw_C, which were similar. A custom apparatus was designed for measuring compression and POR. Osteotomies were created on synthetic bone blocks (density 0.32g/cm3) simulating cancellous bone. Screws were inserted perpendicular to osteotomies in accordance with manufacturer guidance and maximum compression recorded. Increasing distracting forces were then applied to the blocks until the screws pulled out. For each screw type, five screws were tested.

Results:

There was no significant difference in maximum compression between screw designs: Screw_A=38.7N±14.2N, Screw_B=48.7N±15.6N, Screw_C=51.9N±36.4N, Screw_D=32.0N±9.2N; p=0.921. When assessing POR, all screws failed at the head-bone interface (screw heads subsided into block). Pull-out forces significantly differed between all groups: Screw_A=466N±29.0N, Screw_B=310N±22.0N, Screw_C=399N±46.0N, Screw_D=183N±12.9N; p< 0.001 (ANOVA). Screw_Ahad the highest POR but the other OFA design (Screw_B) had significantly lower POR.

Conclusion:

Screw design, whether headless (OFA or PFA) or headed did not appear to influence compression generated. However, headed screws had significantly lower POR than headless designs. Within headless designs, OFA may increase POR, but other screw head features (number / diameter of threads) had an apparently greater influence than flank angle.
Prevalence of Heterotopic Ossification following Total Ankle Arthroplasty: A Systematic Review
Authors: Healy Hazel , Butler James J. , Anil Utkarsh , Randall Grace W. , Walls Raymond J. , Kennedy John G.
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

End-stage ankle osteoarthritis is a debilitating pathology and is most commonly preceded by trauma. Surgical intervention via ankle arthrodesis or ankle arthroplasty is the mainstay management option. Heterotopic ossification (HO) is a common finding following joint arthroplasty. However, no consensus regarding the impact of heterotopic ossification on clinical outcomes following total ankle arthroplasty has been reached to date. The purpose of this systematic review and meta- analysis was to evaluate the prevalence and clinical outcomes of heterotopic ossification following total ankle arthroplasty.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting heterotopic ossification following TAA. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed.

Results:

Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 45% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (120 patients, 33.9%). Random effects models of standardized mean differences found no difference in AOFAS, VAS and ROM between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 10.5%.

Conclusion:

This systematic review and meta-analysis found that HO is a common finding following TAA that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-severe, symptomatic HO following TAA. This study is limited by the significant heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAA.
Primary Care Physicians’ Preferences Regarding Communication from Orthopaedic Providers
Authors: Chiodo Christopher P. , Striano Brendan M. , Parker Emily Belle , Bluman Eric M. , Smith Jeremy , Martin Elizabeth A. , Greco Julia M. , Healey Michael J.
Published: December 2023

Category:

Other

Introduction/Purpose:

Musculoskeletal consultations constitute a growing portion of primary care physician (PCP) referrals. Optimization of communication between PCPs and orthopaedists can potentially reduce the time PCPs spend in the electronic medical record (EMR). This, in turn, may help reduce burnout. However, little is known about the preferences of PCPs regarding communication from orthopaedic specialists. The current study therefore investigated the preferences of PCPs across a large health network regarding communication from orthopaedists.

Methods:

One hundred and seventy-five PCPs across 15 practices within our health network were surveyed. These providers universally used the Epic Systems EMR. PCPs were asked to report their years in practice, panel size, typical number of electronic clinical messages received each day, time spent in the EMR after normal clinical hours, and burnout level. Likert scales and top-box scores were used to assess the PCPs’ perceived importance of communication from orthopedists in specific clinical scenarios. PCPs were further asked to report their preferred method of communication in each scenario and overall interest in communication from orthopaedists. Regression analyses were performed to determine if any PCP characteristics are associated with communication preferences and overall PCP interest in communication from orthopaedists.

Results:

A total of 107 (61%) PCPs completed the survey. PCPs most commonly rated communication from orthopaedists as highly important when the orthopaedist needed information from the PCP. In this scenario, PCPs preferred to receive an Epic Staff Message. Other scenarios rated as important included: the decision for surgery, hospitalization, and a major clinical change. In these scenarios, a CC’d Chart rather than Staff Message was preferred. Increased EMR use after-hours was associated with diminished odds of having high interest in communication from orthopaedists (odds ratio=0.65, 95% confidence interval: 0.48-0.88, P=0.005). Ninety-three PCPs (86.9%) reported spending at least 1 hour a day in Epic after normal clinical hours. Twenty-seven (25.2%) spent more than 3 hours. Forty-six PCPs (42.9%) reported experiencing at least one symptom of burnout.

Conclusion:

In the current study, there were distinct preferences among PCPs regarding clinical communication from orthopaedic surgeons. In addition, there was evidence of substantial burnout and after-hours work effort by PCPs. Our results may be helpful in optimizing communication between PCPs and orthopaedists, while also reducing time spent in the EMR by PCPs.
Retrospective Review of Double vs Triple Hindfoot Arthrodesis: Clinical and Radiographic Comparison
Authors: Walsh Devin F. , Graham George Dillon , Haynes William B. , Ellington Kent , Shawen Scott B. , Davis Hodges , Cohen Bruce , Irwin Todd A. , Jones Carroll
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

Triple arthrodesis of the subtalar, talonavicular, and calcaneocuboid joints is a commonly performed procedure to treat hindfoot deformity. Debate exists regarding the need to include the calcaneocuboid joint in the arthrodesis, leading some surgeons to perform double arthrodesis of the subtalar and talonavicular joints to treat similar pathology. Differences in clinical, radiographic and patient reported outcomes between the two procedures have not been thoroughly reported. The purpose of this study is to evaluate the clinical and radiographic outcomes of double versus triple arthrodesis for the correction of symptomatic hindfoot deformity.

Methods:

A retrospective cohort study reviewed all patients who underwent double or triple arthrodesis to correct hindfoot pathology between January 2016 and April 2019 at our institution. Patients were identified using CPT codes. Inclusion criteria included patients greater than 18 years old who underwent hindfoot correction by a primary double or triple arthrodesis with a minimum 3 month clinical and radiographic follow up. Exclusion criteria included prior hindfoot arthrodesis and peripheral neuropathy. The primary outcome was union at each arthrodesis site. Secondary outcomes included deformity correction, operative times, re-operation rates, complications, and patient reported outcomes. Chi-squared or Fisher’s Exact tests were used as appropriate to compare categorical variables and t-tests were used to compare numerical variables.

Results:

One hundred fourteen procedures met inclusion criteria. There were 86 double (75%) and 28 triple arthrodeses (25%). Eleven talonavicular non-unions were identified in the double arthrodesis group (12.7%) compared to 5 in the triple arthrodesis group (17.9%, p =0.54). There were 2 (7.1%) calcaneocuboid non-unions in the triple group. Subtalar arthrodesis was achieved 100% in both groups. Operative time was shorter for doubles compared to triples, but this did not reach statistical significance (104 min vs 117 min, p = 0.089). The only deformity correction parameter to reach significance was post operative cuboid height being higher in the double group (19.1mm vs 16.7mm, p = 0.012). Pre-operative deformity, overall union rates, reoperation rate, and post operative complications were not statistically different between the two procedures.

Conclusion:

In this study double arthrodesis was shown to result in shorter operative times with similar deformity correction, union rates, and post operative complications when compared to triple arthrodesis. The double arthrodesis is a viable alternative to treat hindfoot pathology. More research is warranted to further compare the long term outcomes between the two procedures.
Statistical Shape Modeling Enables Identification of Subtalar Contact Stress Differences Following Tibiotalar Arthrodesis and Total Ankle Replacement
Authors: Lisonbee Rich , Dibbern Kevin , Anderson Andrew E. , Kruger Karen , Lenz Amy
Published: December 2023

Category:

Hindfoot; Ankle Arthritis

Introduction/Purpose:

Clinical studies have shown 32% of patients with a TAR progress to subtalar OA within 5 years, whereas 78% of patients with a tibiotalar arthrodesis presented with subtalar OA by 7.5 years. Higher rates of subtalar OA after arthrodesis may be explained by a transfer of ankle forces and stress through the adjacent subtalar joint while TAR may mitigate these changes. The objective of this study was to compare subtalar joint contact stresses between patients treated with tibiotalar arthrodesis and total ankle replacement (TAR) during an overground walking activity using correspondence particles to enable regional analysis.

Methods:

With IRB approval, ten individuals with unilateral tibiotalar arthrodesis and six individuals with unilateral TAR were imaged with biplane fluoroscopy during overground walking. Discrete element analysis (DEA) was performed to estimate subtalar joint contact stress using the tracked bone models. Cartilage was modeled using linear-elastic material properties (E=12 MPa, v=0.42) and uniformly extruded compressible surfaces from rigid subchondral bone (0.98 mm talar side, 0.75 mm calcaneal side1). A calcaneal statistical shape model (SSM) was created and resulting correspondence particles served as registered locations for comparison of cumulative stress across three phases of normalized stance (loading-response 0-24%, mid 25-54%, and terminal 55- 87%). Two-sample t-tests or Wilcoxon rank-sum tests were used to evaluate differences (p < 0.05) in cumulative contact stresses at each correspondence particle within the 3 phases based upon Shapiro-Wilk findings of normality.

Results:

There were significant differences in contact stress exposure across all three phases of gait. Differences were identified along the superior-medial aspect of the posterior facet and within the anterior facet (Figure 1). Higher cumulative stresses were observed along the border of the posterior facet and in the medial facet. This model is limited by a lack of validation, uniform cartilage thickness assumptions applied across groups, and that DEA only estimates contact stress without consideration of shear.

Conclusion:

This study was the first to localize regional differences in subtalar joint stress for patients having undergone TAR and tibiotalar arthrodesis. Interestingly, TAR patients experienced higher stress in this study compared to those with arthrodeses. These ostensibly counterintuitive findings of higher TAR stress may relate to the pre-existence of subtalar OA which is a common indication of TAR versus fusion.
Tibial Cortex Transverse Transport: A Novel Treatment of Large Area of Deep Wounds in the Patient's Lower Extremities
Authors: Hou Jun , Nie Xinyu , Su HongJie , Hua Qikai , Ding Yi
Published: December 2023

Category:

Trauma; Other

Introduction/Purpose:

Large area of deep wounds (LADW) usually undergoes flap grafting, in this study, we propose an innovative treatment for LADW. The objective of our study was to evaluate the efficacy of TTT for the treatment of LADW in the lower extremities and provide indications for the TTT.

Methods:

A retrospective review of consecutive patients with Large Area of Deep Wounds in the lower extremities who underwent reconstruction using the TTT procedure from 2018.1 to 2021.6 was conducted. Inpatient follow-up was performed at 1 month after surgery and outpatient follow-up at 3, 6, and 12 months after surgery. Ulcer healing and healing time, recurrence rate, major amputation rate, and complications were assessed during this 1-year follow-up. All patients were evaluated by computed tomography angiography (CTA) 1 month after surgery for changes in the small blood vessels of the lower extremities.

Results:

A total of 36 patients, including 21 males and 15 females, with a mean age of 62.5 years, were in this study. These included infected skin defects (20 cases), traumatic skin defects (9 cases), tumor resection skin defects (6 cases), and burns (1 case). Among them, the healing rate was 94.4% and the average healing time was 6 months without recurrence, nail tract infection, osteomyelitis, incisional infection, and related complications.

Conclusion:

The results showed that TTT can safely and effectively treat total skin defects of the lower extremity. TTT is relatively simple to perform without grafting, making it an effective method for treating total skin defects of the lower extremity.
Evaluation of Leg-foot Range of Motion: Which Measurement Method is Most Reliable?
Authors: Costa Marco Tulio , Tejerina Javier Felipe Salinas , Silva Cesar Augusto Lima , Rego Itallo , Bergamasco Jordanna , De Marchi Neto Noé
Published: December 2023

Category:

Ankle

Introduction/Purpose:

The measurement of the ankle's range of motion is now considered of great importance for the diagnosis, therapeutic choice, and follow-up of the evolution of the treatment in patients with pathologies, both of the ankle and the whole hindfoot. However, there is no established method of choice for the safety assessment of talocrural mobility. Therefore, to evaluate the methods of measuring leg-foot movement in normal ankles and feet by comparing the results of clinical measurements with those of radiographic measurement and to determine the range of leg-foot movement considered normal.

Methods:

The leg-foot movement was measured in 44 patients (60 feet) using a traditional goniometer, digital goniometer, inclinometer, smartphone application, and radiographic measurement (considered gold standard). Maximum dorsiﬂexion was achieved by asking the patient to take a step forward with the contralateral foot and perform as much dorsiﬂexion as possible in the ankle studied without removing the heel from the ground. For maximum plantar ﬂexion, the patient was asked to take a step back with the contralateral foot and make as much plantar ﬂexion as possible without removing the studied forefoot from the ground.

Results:

The values obtained in radiographic measurement were higher than those obtained with clinical measurement. When we compared only the results of clinical measurement, the traditional goniometer was inaccurate. According to the radiographic method, the mean leg-foot range of motion was 65.6 degrees. The mean maximum plantar ﬂexion was 34.9 degrees, and the mean maximum dorsiﬂexion was 30.7 degrees.

Conclusion:

The most appropriate method for evaluating the leg-foot range of motion is the radiographic one. The traditional goniometer proved to be the most imprecise clinical method. The mean leg-foot range of motion in healthy young adults was 65 degrees.
Outcomes of Scleral Buckling After Failed Pneumatic Retinopexy
Authors: Tran Tuan , Chen Henry , He Bonnie , Albiani David , Kirker Andrew , Merkur Andrew , Maberley David , Mammo Zaid
Published: December 2023

Purpose: To assess the visual and anatomic outcomes of eyes that had secondary scleral buckle (SB) surgery after unsuccessful pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RRD). Methods: A retrospective study, performed over a 12-year period, comprised patients who had secondary SB procedures after failed primary PR. Clinical parameters (eg, best-corrected visual acuity [BCVA], lens status, macula status, details of RRD and subretinal fluid) were assessed at presentation, before additional procedures, and at follow-up (6 months, 1 year, and last visit). Statistical comparisons were made using Brown-Forsythe and Welch analysis-of-variance tests, with significance levels set at P < .05. Results: Fifty-four eyes with adequate follow-up were included. Forty-four (81.5%) of 54 eyes had successful retinal reattachment with secondary SB alone. The remaining eyes had subsequent pars plana vitrectomy (PPV). Patients presenting with macula-on RRD who had successful secondary SB had no statistically significant change in BCVA from baseline (mean final, 0.23 ± 0.25 logMAR [Snellen 20/34]; P = .999). There was a statistically significant improvement in BCVA in patients presenting with macula-off RRD who had successful secondary SB (mean final, 0.32 ± 0.36 logMAR [20/42]; P < .001 and mean change, −1.06 ± 0.85 logMAR). Ten patients presenting with macula-off RRD who had failed secondary SB had a significant improvement in the final BCVA (mean final, 0.22 ± 0.28 logMAR [20/33]; P = .044), despite the need for an additional PPV to achieve reattachment. Conclusions: Secondary SB remains a good option for RRD repair after unsuccessful PR and may avoid the need for PPV.
The Global Impact of COVID-19: Historical Development, Molecular Characterization, Drug Discovery and Future Directions
Authors: Dofuor Aboagye Kwarteng , Quartey Naa Kwarley-Aba , Osabutey Angelina Fathia , Boateng Belinda Obenewa , Lutuf Hanif , Osei Joseph Harold Nyarko , Ayivi-Tosuh Selina Mawunyo , Aiduenu Albert Fynn , Ekloh William , Loh Seyram Kofi , Opoku Maxwell Jnr , Aidoo Owusu Fordjour
Published: December 2023

In December 2019, an outbreak of a respiratory disease called the coronavirus disease 2019 (COVID-19) caused by a new coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China. The SARS-CoV-2, an encapsulated positive-stranded RNA virus, spread worldwide with disastrous consequences for people’s health, economies, and quality of life. The disease has had far-reaching impacts on society, including economic disruption, school closures, and increased stress and anxiety. It has also highlighted disparities in healthcare access and outcomes, with marginalized communities disproportionately affected by the SARS-CoV-2. The symptoms of COVID-19 range from mild to severe. There is presently no effective cure. Nevertheless, significant progress has been made in developing COVID-19 vaccine for different therapeutic targets. For instance, scientists developed multifold vaccine candidates shortly after the COVID-19 outbreak after Pfizer and AstraZeneca discovered the initial COVID-19 vaccines. These vaccines reduce disease spread, severity, and mortality. The addition of rapid diagnostics to microscopy for COVID-19 diagnosis has proven crucial. Our review provides a thorough overview of the historical development of COVID-19 and molecular and biochemical characterization of the SARS-CoV-2. We highlight the potential contributions from insect and plant sources as anti-SARS-CoV-2 and present directions for future research.
Elevated Serum Macrophage Migration Inhibitory Factor Levels are Associated With Major Depressive Disorder
Authors: Supti Kaniz Farzana , Asaduzzaman Md. , Suhee Farhana Islam , Shahriar Mohammad , Islam Sardar Mohammad Ashraful , Bhuiyan Mohiuddin Ahmed , Qusar MMA Shalahuddin , Islam Md. Rabiul
Published: December 2023

Background:

Previous studies have suggested the involvement of an activated inflammatory process in major depressive disorder (MDD), as altered expression of inflammatory cytokines is observed in depression. This alteration can be the cause or a consequence of MDD. However, acknowledging inflammatory cytokines as prospective biomarkers would aid in diagnosing or guiding better therapeutic options. Therefore, we designed this study to assess the macrophage migration inhibitory factor (MIF) in depression.

Method:

We collected blood samples from 115 MDD patients and 113 healthy controls (HCs) matched by age and sex. MDD patients were diagnosed by a qualified psychiatrist based on the symptoms mentioned in the diagnostic and statistical manual of mental disorders (DSM-5). We applied the Hamilton depression (Ham-D) rating scale to assess the severity of depression. We assessed serum levels of MIF using ELISA kit (Boster Bio, USA).

Result:

We detected increased serum MIF levels in MDD patients compared to HCs (6.15 ± 0.23 ng/mL vs 3.95 ± 0.21 ng/mL, P < 0.001). Moreover, this increase is more among female patients than female controls. Also, we noticed a positive correlation between altered MIF levels and the Ham-D scores ( r = 0.233; P = 0.012), where we found that patients who scored higher on the Ham-D scale had higher MIF levels in serum. Moreover, the area under the curve (AUC) of receiver operating characteristic (ROC) curve represented the good diagnostic performance of altered serum MIF.

Conclusion:

Our study findings indicate the association of pro-inflammatory cytokine MIF in the pathophysiology of depression as we identified elevated serum MIF levels in depressive patients compared to HCs. However, more researches are required to confirm whether this alteration of cytokine is the causative factor or a consequence of depression. We recommend conducting further studies to understand the pattern of this alteration of MIF levels in MDD patients.