bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exposure of the Calcaneus via the Sinus Tarsi Approach versus the Lateral Extensile Approach: A Cadaveric Study
Authors: Prather John C. , Wilson John , Abyar Eildar , Young Sean , McGwin Gerald , Johnson Michael D. 
Published: November 2020

Category: Hindfoot; Trauma Introduction/Purpose: The lateral extensile approach (LEA) to the calcaneus has long been a popular surgical approach to treat calcaneal fractures. However, high rates of wound complications have led surgeons to investigate alternative approaches. As a result, the sinus tarsi approach has grown in popularity. The lateral extensile approach affords substantial visualization of the calcaneus. However, this visualization has never been compared in a quantitative manner to the sinus tarsi approach (STA). The objective of this cadaveric study is to compare calcaneal visualization afforded by a sinus tarsi approach and a lateral extensile approach. Methods: Seven pair-matched, fresh-frozen, below-knee cadaver specimens were obtained. For each pair, one side received an LEA and the other side received a STA. To identify areas of the calcaneus accessible by instrument, a curette was used to mark the visualized calcaneal surfaces. The calcaneus was then disarticulated and cleared of all soft tissue. The curette markings were then identified and marked with blue surgical marker. Photos were taken of each calcaneus, and visualized surface areas were calculated using Image J software. Results: There were no statistically significant differences in the articular surfaces accessible between the two approaches (831.99 mm2 for LEA vs. 903.41 mm2 for STA, p=0.53) including the anterior, middle, and posterior facets. The total calcaneal surface area accessible was 3107.08 mm2 for LEA and 1444.19 mm2 for STA (p=0.02). The LEA allowed better exposure to the lateral wall (p<0.01) and superior greater tuberosity of the calcaneus (p=0.05). Conclusion: In comparison to the LEA, the STA allows for equivalent exposure to articular surfaces. While the LEA allows for greater exposure of the lateral wall and posterior tuberosity, direct visualization of these structures may not warrant the higher risk of wound complications. Surgeons should be mindful of these differences when choosing a surgical approach in the treatment of calcaneal fractures.
Combined Suspensory and Aperture Fixation of Posterior Tibialis Tendon Anterior Transfer for Dropfoot
Authors: Ray Robbie , Navratil Richard , Ogilvie Andrew , Lewis Thomas L. 
Published: November 2020

Category: Other; Trauma Introduction/Purpose: Anterior transfer of the tibialis posterior tendon (TPT) can restore ankle dorsiflexion in patients with foot drop. A limitation of this procedure is the need for postoperative ankle immobilisation. We present the results of a novel dual method of TPT docking which infers immediate stability, allowing early weightbearing. Methods: 8 patients underwent 9 tendon transfers,age range of 28-52 years. 3 patients had dropfoot from common peroneal nerve injury, 6 cases were part of a complex cavovarus or spastic equinovarus correction. The TPT is passed to the dorsum of the foot through the interosseous membrane. The docking site is prepared with a bicortical pilot hole followed by unicortical overreaming. The TPT is whipstitched and an Arthrex biceps button is threaded to the sutures. The button is passed bicortical and flipped using a tension slide technique give stable suspensory fixation. Additional stability is conferred by overpassing an Arthrex biotenodesis screw giving aperture fixation. Patients are immobilised in a boot and allowed to weightbear immediately. Results: Follow up was 6 months. There was difficulty in docking of suspensory fixation in two of the early cases. These patients had aperture fixation and were immobilised non weightbearing in a cast for 6 weeks. With technical modifications, all subsequent patients had dual fixation. At 6 months there were no radiological or clinical failures of fixation. Patients without other underlying issues were able to mobilise splint free at 6 months. All patients were satisfied with their procedure. Conclusion: Aperture fixation with an interference screw has become the gold standard for TPT transfer, however, patients still need a prolonged period of immobilisation. Combined suspensory and aperture fixation is technically straightforward and seems to give more initial stability allowing early weightbearing. Further prospective studies and biomechanical studies are needed to validate this technique.
Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx
Authors: Ray Robbie , Robinson Peter W. , Dearden Paul M. , Goff Thomas A. , Lam Peter , Lewis Thomas L. 
Published: November 2020

Category: Lesser Toes; Bunion Introduction/Purpose: Deformities of the lesser toes are usually described in the sagittal plane. Coronal plane deviation is also common, yet there is a paucity of literature on the management of these challenging deformities. Traditional soft tissue procedures and translational Weil osteotomies are unpredictable and can lead to post-operative stiffness. We present the results of a novel percutaneous osteotomy of the proximal phalanx to treat valgus deformity of the 2nd toe. Methods: 29 patients underwent 38 osteotomies at a mean age of 59+/-9 years. Through a 2mm dorsomedial incision, a percutaneous proximal metaphyseal medial closing wedge osteotomy is performed using a low speed, high torque 2x8mm burr. The toe is then taped for 2 weeks. Mean follow up was 29+/-18 months. Post-operative weight bearing radiographs were performed at a mean of 27+/-18 months. Dichotomous variables were assessed using a Chi square test. After confirming normality using a Kolomgrov-Smirnov test, continuous variables were measured using paired and independent t-tests. Results: 90% (n=26) patients responded. 88% (n=23) patients were satisfied or extremely satisfied with the procedure. 24% reported a partial (n=4) or complete recurrence (n=2) of deformity. Patients who perceived recurrence were significantly more likely to be dissatisfied (p=0.001). Radiographs were available for 27/38 osteotomies. Mean valgus angle decreased from 21+/-10° to 9+/-8° (p=0.001). All osteotomies united with no delayed union. There were no wound complications or infections. 2 patients reported long term numbness in the toe and 1 patient complained of a floating toe. Conclusion: Percutaneous closing wedge osteotomies to correct (valgus)coronal plane deformity is technically straight forward with a low complication rate and high patient satisfaction. Future studies should assess the role of this technique to correct medial crossover deformities and compare outcomes with other techniques.
Long-Term Follow up of Correction of Moderate to Severe Deformity with the STAR Ankle Prosthesis
Authors: Reddy Sudheer C. , Mann Roger A. , Zemeir Kyle , Reddy Sudheer C. 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Addressing coronal plane deformity when performing a total ankle arthroplasty (TAA) remains a topic of controversy. While surgeons have become bolder in correcting deformity, long-term follow-up is sparse regarding maintenance of correction and viability of the prosthesis. The purpose of this study is to assess the long-term follow up of the correction of moderate to severe coronal plane deformity with the use of a mobile bearing prosthesis. Methods: Out of a consecutive series of 130 patients who underwent TAA between 2000 and 2009, 43 patients (44 ankles) had at least 100 of tibiotalar coronal plane deformity, with 25 having between 100 and 200 of deformity and 18 having greater than 200. Average age at time of the index surgery was 66 yrs (range 41-79). Initial deformity was 17.90 (range 10-290) in the entire cohort. All patients underwent intraarticular deformity correction with intraoperative soft-tissue balancing as indicated utilizing the STAR prosthesis. Patients requiring realignment osteotomies were performed in a staged fashion prior to undergoing TAA. Results: Seven patients (16%) were available for long-term follow up (avg 13 yrs; range 9-16 yrs) with retention of the original prosthesis, two of which had greater than 200 of initial deformity. Average final tibiotalar deformity was 4.90, with a mean correction of 130(p=0.0001). No additional procedures related to the prosthesis were performed. Eleven patients (12 ankles) were deceased at the time of the study due to unrelated conditions. Of the original cohort, five were deemed failures (2 converted to arthrodesis; 2 underwent component revision; 1 polyethylene fracture) and excluded from long-term follow up. The remaining 20 patients were lost to follow-up, had declined or were unable to participate due to health status. Conclusion: While the low follow-up rate limits the overall generalizability of the results, enduring correction of moderate and severe coronal plane deformity with a mobile bearing prosthesis can be achieved in a cohort of patients traditionally regarded as high-risk. One must be cautious when discussing with patients the utilization of TAA in the setting of moderate and severe coronal plane deformity given the risk of failure. However, provided a well-balanced ankle can be achieved intraoperatively, long-term mobile bearing prosthesis survivorship is achievable.
Impact of Preoperative Metatarsus Adductus on Surgical Correction after Triplanar Tarsometatarsal Arthrodesis
Authors: Reside Joshua M. , Ray Justin J. , Shackleford Taylor L. , Koay Jennifer , Dayton Paul , Hatch Daniel J. , Smith W. Bret , Santrock Robert D. 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Early radiographic outcomes of hallux valgus correction focusing on multiplanar deformity have shown promising results. Surgical correction for patients with preexisting metatarsus adductus is considered more challenging and results in higher recurrence rates following hallux valgus surgery. The purpose of this study was to evaluate the impact of preoperative metatarsus adductus on surgical correction following triplanar first tarsometatarsal (TMT) arthrodesis with early weightbearing for hallux valgus. Methods: A retrospective review was performed of 57 patients (62 feet) aged 39.7 +- 18.9 years who underwent triplanar first TMT arthrodesis between 2015 and 2017 at four institutions. After the operation, patients were allowed early full weightbearing in a walking boot. Patients were grouped based on preoperative metatarsus adductus angles for comparison. Preoperative imaging was reviewed and compared to radiographic imaging at 12 months postoperative. Hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), lateral round sign, and sesamoid subluxation (axial) were evaluated. For statistical analysis, one-way analysis of variance (ANOVA) and chi-square tests were performed using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Patients with a preoperative metatarsus adductus angle greater than 20 degrees had significantly higher HVA at 12 months (p = 0.0165). There were no differences in IMA or TSP at 12 months based on preoperative metatarsus adductus (p = 0.7687 and p = 0.8703, respectively). Overall recurrence rate for hallux valgus was 3.2% (2/62 patients), and both of these patients had a preoperative metatarsus adductus greater than 20 degrees. There was significantly more sesamoid axial subluxation at 12 months for patients with preoperative metatarsus adductus greater than 20 degrees (p = 0.0092). Overall, the symptomatic non- union rate was 1.7% (1/62 patients). Conclusion: Preoperative metatarsus adductus greater than 20 degrees resulted in higher HVA and recurrence rates at 12 months after triplanar tarsometatarsal arthrodesis. For patients with preexisting metatarsus adductus, additional consideration should be given to ensure the sesamoids are properly reduced under the crista. Future studies should compare the long-term impact of metatarsus adductus on surgical correction, recurrence, and complications after triplanar tarsometatarsal arthrodesis.
Early Failures of Polyvinyl Alcohol Hydrogel Implant for the Treatment of Hallux Rigidus
Authors: Rosas Kevin , Hurley Eoghan T. , Kennedy John G. 
Published: November 2020

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: A polyvinyl alcohol hydrogel implant (Cartiva Synthetic Cartilage Implant) has recently been developed, which has a water content comparable to healthy cartilage and a compressive modulus and tensile strength similar to human articular cartilage. These biomechanical features have been thought to be an ideal material for use in hemiarthroplasty of the first MTP joint. The purpose of this study is to evaluate the clinical, functional and radiological outcomes following a polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus. Methods: A retrospective cohort study investigating patients treated with polyvinyl alcohol hydrogel implant for hallux rigidus was performed. Patients who had grade 2, 3 or 4 hallux rigidus based on Coughlin classification were indicated. Clinical outcomes were evaluated with the Foot and Ankle Outcomes Score (FAOS) and Visual Analog Score (VAS) preoperatively and at final follow-up. Plain radiographs were assessed postoperatively at 2, 4, 8 weeks and final follow-up. Results: Fifteen patients (15 feet) with mean follow-up of 19.0 months (12-26 months) were included. The mean age was 61.1 years. FAOS-reported symptoms, pain, daily activities, sports activities, and quality of life were 62.3, 69.8, 74.5, 49.7, and 36,3 post-operatively, respectively. Of 14 patients who had taken adequate postoperative plain radiographs, implant subsidence was observed in 9 patients (64%) at 4 weeks after surgery and 11 patients (79%) at final follow-up. . Eight patients (57%) showed radiologic lucency around the implant. Six patients (40%) had erosion of the proximal phalanx of great toe. Six patients(43%) reported no improvement following surgery at final follow up. Three patients required additional surgery, including debridement and fixation of implant using fibrin glue for loosening. Conclusion: Our current study revealed a high failure rate with the polyvinyl alcohol hydrogel implant in patients with Hallux Rigidus. Significant radiologic subsidence with lysis around the implant, erosion of the proximal phalynx countersurface as well as recorded implant wear are harbingers for concern in the long term.
Total Ankle Arthroplasty (TAR) vs. Ankle Arthrodesis (AA) for Primary Ankle Osteoarthritis: A Nationwide Analysis
Authors: Ross Bailey J. , Savage-Elliott Ian , Wu Victor , Rodriguez Ramon F. 
Published: November 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: Ankle arthrodesis (AA) has historically been the gold standard for operative management of end-stage ankle osteoarthritis (OA). Recent increases in utilization of total ankle arthroplasty (TAR) have been observed secondary to new implant designs, improved surgical technique, and favorable functional outcomes. However, there is minimal data comparing clinical complications between the two procedures. The purpose of this study was to compare incidences of postoperative joint and systemic complications for patients that received primary AA vs. TAR for primary ankle osteoarthritis between 2007-2017 using a comprehensive Medicare database. Methods: A retrospective review of patients that received primary AA or TAR was performed using the PearlDiver database (Fort Wayne, IN). All patients and associated complications were identified using ICD-9/ICD-10 and CPT codes. Patients with a history of ankle fracture, prior AA/TAR, or active ankle infection during the index procedure were excluded. Demographic data and overall joint complication rates were compared at 90-days, 1-year, and 2-years postoperatively using a Chi-Square test. Postoperative rates of subtalar fusion, prosthetic joint infection, hardware removal, periprosthetic fracture, and systemic complications were compared using logistic regression. Statistical significance was set at p < 0.05. Results: A total of 1,580 patients received operative management of primary ankle OA: 1,100 (70%) patients received AA and 480 (30%) patients received TAR. The overall joint complication rate was higher in the AA group at 90-days (30% vs. 17%, p < 0.001), 1-year (36% vs. 21%, p < 0.001), and 2-years (38% vs. 22%, p < 0.001) post-discharge. AA patients were more likely to have a subsequent subtalar fusion at 90-days (OR 4.49), 1-year (OR 5.10), and 2-years (OR 5.36) post-discharge, as well as periprosthetic fracture at 1-year (OR 1.69) and 2-years (OR 1.77). Hardware removal was less likely for AA patients at 90-days (OR 0.43), 1-year (OR 0.41), and 2-years (OR 0.43). Neither group was more likely to develop systemic complications postoperatively. Conclusion: The present study found that AA patients have higher incidences of major joint complications in both the short- term and mid-term. Patients that received AA were more likely to have a subsequent subtalar fusion and sustain a periprosthetic fracture. Relative to TAR patients, a greater proportion of these patients were under the age of 65, obese, had diabetes, and used tobacco. TAR patients were more likely to have hardware removal post-discharge. Further study is warranted to better quantify patient selection for AA vs. TAR and trend the long-term complications of these procedures.
Comparative Outcomes and Complications of Open versus Endoscopic Gastrocnemius Recession: A Prospective Randomized Control Trial
Authors: Rungprai Chamnanni , Sripanich Yantarat , Pongpinyopap Warongporn 
Published: November 2020

Category: Other Introduction/Purpose: Both open and endoscopic gastrocnemius recession are commonly used for treatment of gastrosoleus contracture, however; there was a paucity of evidence in literatures to compare post-operative outcomes between the two techniques. The purpose of this study is to compare outcomes and complications between open and endoscopic techniques. Methods: A prospective, randomized collected data of 53 consecutive patients who were diagnosed with gastrosoleus contracture and underwent either open (26 patients) or endoscopic (27 patients) gastrocnemius recession between 2016 and 2018. The primary outcome was ankle dorsiflexion and secondary outcomes were visual analogue scale (VAS), Short Form-36 (SF- 36), FAAM, plantarflexion weakness, operative times, and complications. Results: There were 53 patients with mean age of 49.1 years, mean BMI of 26.5 kg/m2, and mean follow-up of 11.5 months. Both techniques demonstrated significant improvement of ankle dorsiflexion (12.1 vs 11.3 degrees, p<0.001) and all functional outcomes (FAAM, SF-36, and VAS (p<0.001 all)); however, there was no significant difference between the two groups, (p>0.05 all). In addition, there were significant shorter operative times in endoscopic technique (7.3 vs 18.7 minutes, p<0.01). Complications included wound complications (3.8 vs 0%), painful scar (7.7 vs 0%), sural nerve injury (3.8 vs 0%), and plantarflexion weakness (3.8 vs 3.8%) for open and endoscopic techniques respectively. Conclusion: Both open and endoscopic techniques were demonstrated significant improvement of post-operative outcomes as measured with ankle dorsiflexion, FAAM, SF-36, and VAS. Although the post-operative outcomes were not significantly different between the two groups, the endoscopic technique demonstrated lesser complications and shorter operative times.
Comparison of Syndesmotic Malreduction Rate following Trans-Syndesmotic Screw Fixation in SER versus PER Type Ankle Fracture: A Prospective Analytic Study
Authors: Rungprai Chamnanni , Sripanich Yantarat 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic injury frequently presents in severe rotational ankle fracture and a trans-syndesmotic screws fixation is commonly used technique. Bases on previous literatures, syndesmotic malreduction rate can occur between 20- 70 percent following traditional trans-syndesmotic screw fixation in all type of ankle fracture. However, there is a little evidence regarding the malreduction rate in each type of ankle fractures. The purpose of this study is to demonstrate malreduction rate of syndesmosis using simultaneously bilateral post-operative CT measurement after trans-syndesmotic screw fixation between supination external rotation and pronation external rotation type ankle fracture. Methods: A prospective comparative study of patients who had acute ankle fracture with syndesmotic injury between January 2015 and December 2017 were enrolled. Lague-Hansen classification was used to classify all patient into 2 groups: SER and PER based on mechanism of injury. Syndesmotic injury was confirmed by ankle arthroscopic examination in all patients and they were treated with ORIF distal fibula using either 1/3 tubular plate or anatomical locking plate under direct visualization of syndesmosis. Syndesmosis was fixed by one or two of 3.5-mm cortical screw with three or four cortices. The accuracy of syndesmotic reduction was evaluated by simultaneously bilateral post-operative CT scan. Syndesmotic reduction was measured using anterior to posterior distance (AP) and medial to lateral distance (ML). A widening of distance between anterior tibia and fibula at 1-cm above the ankle joint more than 2 mm compared to uninjured sides considered a malreduction of syndesmosis. Results: There were 67 patients were enrolled in this study (SER=48 and PER=15). The syndesmotic injury was present 60% (48/70) in SER and 100% (15/15) in PER group respectively. The malreduction was significant higher in PER than SER (2.1% in SER vs 20% in PER). Operative time was 58.2 and 79.2 minutes in SER and PER. The tibiofibular clear space was 4.0mm versus 4.8mm in SER and PER. The AP distance was -0.33mm and -0.51mm and ML distance was 1.91 mm and 1.59mm for SER compared to normal side and 0.19 mm and -0.21 and ML distance was 2.59mm and 1.63mm for PER compared to normal side. There were significant improvements of functional outcomes (FAAM, SF-36, and VAS) but no significant different between the two groups. Conclusion: The incidence of concomitant syndesmotic injury and syndesmotic malreduction rate following trans-syndesmotic screw fixation was significantly higher in PER type compared SER type ankle fracture. The malposition of distal fibula was displaced anteriorly and laterally (undercompression) compared to uninjured side.