bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results after Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures
Authors: Grün Wolfram , Molund Marius , Nilsen Fredrik , Stødle Are 
Published: October 2019

Category: Arthroscopy, Trauma Introduction/Purpose: Surgical treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of infection and soft tissue complications. During the last years there was a trend towards less invasive fixation methods. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of good visualization of the posterior facet of the subtalar joint with a minimally invasive approach. We have performed this technique since 2014 in selected Sanders II and III fractures. Methods: We conducted a clinical and radiographic follow-up of 19 patients with 20 calcaneal fractures which had been treated by PACO with a minimum follow-up of 12 months. The follow-up rate was 66% (19 of 29 patients). 18 men and 1 woman with a median age of 44 years (range, 21-65) and a follow-up period of 18 months (12-33) were examined. There were 11 Sanders II and 9 Sanders III fractures. Radiographs of all feet were obtained at final follow-up to evaluate the reduction of the fractures as well as the presence of osteoarthritis of the subtalar joint. Our primary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcomes were the Calcaneus Fracture Scoring System (CFSS), the Manchester- Oxford Foot Questionaire (MOxFQ), the Visual Analog Scale (VAS) for pain and the incidence of complications. Results: The patients were operated on after a median of 4 days after injury (range, 1-12). The operation time was 139.5 minutes (98-234). The patients were discharged 3 days (1-6) postoperatively. Postoperative radiographs showed a Böhler angle of 29.5 degrees (0-40). However, the follow-up radiographs showed subsidence of the fractures and a Böhler angle of 21 degrees (-16-36). 95% of the operated feet showed signs of posttraumatic subtalar osteoarthritis. There were no wound healing complications. Two patients were reoperated with screw removal due to prominent screws. The AOFAS score was 85 (50-100), the CFSS score 85 (26-100), the MOxFQ score 26.6 (0-73.4). The VAS pain score was 0 (0-5.7) at rest and 4 (0-8.2) during activity. Conclusion: Only a few articles have reported the outcome after percutaneous artroscopically assisted calcaneal osteosynthesis. Our results suggest that PACO gives good clinical results and a reduced risk of complications in selected calcaneal fractures. However, since this technique is technically challenging and has a steep learning curve, we expect to be able to further improve our results over time. Prospective longterm studies will be necessary to better document the potential advantages and limitations of this operating technique.
Patient-Reported Outcomes after Exosym Bracing (Intrepid Dynamic Exoskeletal Orthosis (IDEO)) in the Civilian Population
Authors: Hadden Ryan , Meeker James , Weiss Jason , Thompson Austin 
Published: October 2019

Category: Ankle Arthritis, Orthosis Introduction/Purpose: When it comes to ambulation, the dynamic interplay of anatomy at the foot and ankle affords weight acceptance, stability and force production. The outcome is gait efficiency. Various musculoskeletal injuries challenge gait biomechanics. While surgical management may address the fault in kinetic chain, it may not fully address the problem of pain, functional outcome and patient satisfaction. Non-surgical interventions such as bracing using ankle foot orthoses (AFO) aim to assist, restore and redirect weightbearing forces with immobility in mind. As an energy-storing AFO, however, the IDEO was created to improve functional performance in veterans after limb salvage procedures. The goal of the study was to evaluate outcomes following use of Exosym (or IDEO) bracing for foot and ankle pathologies in the civilian population. Methods: Through review of one institution’s electronic medical record, 29 patients ages 18 years or older who were prescribed the Exosym brace by a single foot and ankle surgeon over a 5-year period were identified. A composite questionnaire including patient-reported outcomes of PROMIS SF Physical Function, PROMIS SF Pain Interference, Brace Use, and EQ-5D was obtained over the phone or by email. Results: A total of 29 patients were prescribed the brace over a 5-year period with only 18 patients receiving the brace. Insurance denying coverage was the most common reason (n=7) for patients not receiving the brace. Of the 18 patients that received the brace, 17 of them were willing to answer the questionnaire. The average age of patients with the Exosym brace was 42.3 (sd=13.8) years old with 6 (35%) being female. Patients with the Exosym brace reported an average score of 47.2 (sd=6.0) for the PROMIS Physical Function and 53.6 (sd=8.4) for the PROMIS Pain Interference. The average satisfaction with the Exosym brace was 65.5 (sd=17.6) out of a possible 100. Conclusion: Exosym bracing in various foot and ankle pathologies provides functionality and pain modulation in the civilian population that rivals respective subpopulation norms. One of the acknowledged limitations of the study is that not obtaining pre- bracing patient reported outcomes precluded evaluation of a minimum clinically important difference. However, the study was not designed to provide such data. It did, however, provide impetus to pursue a follow-up study evaluating plantar pressure changes with and without brace use, which is currently ongoing. Such knowledge may help identify which injuries would be best suited for Exosym bracing.
Normal Variation and Instability Values of the Tibiofibular Joint on Weightbearing CT
Authors: Hagemeijer Noortje , Chang Song Ho , Elghazy Mohamed Abdelaziz , Waryasz Gregory , Guss Daniel , DiGiovanni Christopher 
Published: October 2019

Category: Ankle Introduction/Purpose: Prompt management of syndesmotic instability is critical for optimizing clinical outcome, but subtle injuries may be difficult to diagnose. Application of modern imaging modalities such as weight bearing CT (WBCT) may better identify such injuries by virtue of assessing the distal tibiofibular articulation under physiologic load. The aim of this study was to evaluate the distal tibiofibular articulation using WBCT among patients with known syndesmotic instability and compare these findings with their uninjured contralateral sides, and thereafter corroborate such measurement differences with patients devoid of any syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring surgical fixation (n=12) underwent bilateral ankle WBCT that incorporated the entire foot. A separate cohort of patients without ankle injury also underwent bilateral ankle WBCT for assessment of either a Lisfranc injury or forefoot condition (n=24). All WBCT imaging was performed preoperatively. A set of five axial plane tibiofibular joint measurements including one angular measurement were standardly assessed one cm above the tibial plafond. Values were recorded by two independent observers to assess for interobserver reliability scores. Interpretation of the intraclass correlation coefficients was carried out according to the guidelines proposed by Shrout: 0.00-0.10 virtually none, 0.11-0.40 slight, 0.41-0.60 fair, 0.61-0.80 moderate, 0.81 -1.00 substantial. Results: Among the control population without ankle injury, no differences were found between bilateral measurements (p-value range 0.172 - 0.961). Among those with known unilateral syndesmotic instability, values differed between the injured and uninjured side in five of six measurements— including syndesmotic area, direct anterior-, middle-, and posterior- difference, and sagittal translation (p <0.001, <0.001, <0.001, <0.001, 0.039, respectively). Those same measurements also differed when comparing the left-right delta values between uninjured and injured patients (p <0.001, 0.002, <0.001, <0.001, and 0.042, respectively). Fibular rotation differed neither in direct nor delta comparisons (p=0.460 and 0.271 respectively). Substantial agreement was found for all measurements except for sagittal translation, which had only slight agreement. Conclusion: This study highlights the ability of WBCT to effectively differentiate syndesmotic diastasis and fibular translation among patients with surgically-confirmed syndesmotic instability as compared to those without syndesmotic instability. It also underscores the importance of using the contralateral, uninjured side as a valid internal control. Additional studies are necessary to better understand the role of WBCT in prospectively diagnosing more subtle cases of syndesmotic instability among patients for whom the diagnosis remains in question.
Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations
Authors: Heenan G. Matthew , Parikh Kisan , Tarakemeh Armin , Schroeppel J. Paul , Mullen Scott , Vopat Bryan G. 
Published: October 2019

Category: Ankle, Arthroscopy Introduction/Purpose: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,428) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,236) or lateral ankle ligament reconstruction (n=1,211). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=314), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=473), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Cost was higher for arthroscopy groups: repair with arthroscopy ($5,991.32) versus repair without arthroscopy ($3,677.11; p<0.001); reconstruction with arthroscopy ($5,744.83) versus reconstruction without arthroscopy ($4,601.13; p=0.001). Proportionately more patients had complications in the repair without arthroscopy group than in the repair with arthroscopy group (9.87%, 5.41%; p=0.013). Proportionately more patients had newly-diagnosed intra-articular defects in arthroscopy groups: repair with arthroscopy (57.0%) versus repair without arthroscopy (35.6%; p<0.001); reconstruction with arthroscopy (63.0%) versus reconstruction without arthroscopy (39.8%; p<0.001). Proportionately more patients underwent reoperation for intra-articular defects in the combined arthroscopy group (6.89%) than in the combined non-arthroscopy group (4.18%; p=0.006). The average time until reoperation for intra-articular defects was shorter in the combined arthroscopy group (302.536 days) than in the combined non-arthroscopy group (473.886 days; p=0.045). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was over 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.
Treatment Options for Osteoarthritis of the Ankle: Appropriate Distinction Between Brace Treatment and Arthrodesis
Authors: Hirano Takaaki , Akiyama Yui , Karube Tomoko , Haraguchi Naoki , Niki Hisateru , Mitsui Hiroyuki 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis (fusion) for the treatment of osteoarthritis of the ankle (OA) was reported to have good therapeutic results; however, this has not been compared with conservative treatment. At this conference last year, brace treatment using an ankle-foot orthosis, Hiflex Foot Gear (HFG), was also reported to have good therapeutic results, which allows for slight mobility in the ankle joint while providing appropriate level of support for the ankle joint. On this occasion, the therapeutic results of brace treatment and fusion were compared, and treatment options for OA were examined. Methods: Subjects included nine cases and ten feet in a group that was diagnosed with stage IIIb OA or worse according to the Takakura Classification and were treated with HFG (mean age of 70.6 years, mean course observation period of 8.4 months) and nine cases and ten feet in a group that was treated with fusion for the same diagnosis (mean age of 58.1 years, mean course observation period of 25.5 months). The pre-treatment and post-treatment physician-initiated objective evaluation by the Japanese Society for Surgery of the Foot scale (JSSF scale) and patient-reported subjective evaluation by the Japanese Orthopaedic Association/ the Japanese Society for Surgery of the Foot, and subscales of Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were examined, and improvements in each score in two groups were compared (post-treatment vs pre-treatment) by an unpaired t-test. The validity and reliability of JSSF scale and SAFE-Q have been established by psychometric verification Results: The improvement after the treatment for the HFG group and the fusion group was observed. JSSF scores were 16.1 (p < 0.001) and 35.5 (p < 0.001), respectively, and pain and pain-related scores in the SAFE-Q were 20.8 (p = 0.021) and 35.4 (p < 0.001), respectively. Physical function and daily living were 12.8 (p < 0.001) and 18.6 (p = 0.007), respectively, while social functioning scores were 18.0 (p = 0.001) and 32.8 (p = 0.001), respectively. The JSSF score for both groups was significantly improved. In SAFE-Q, physical function and daily living improved significantly in the HFG group, while pain and pain-related improved significantly in the fusion group.
Outcomes of Bridge Plating Versus Standard Fixation in Geriatric Ankle Fractures
Authors: Holzgrefe Russell E , Erwood Amalie , Maidman Samuel , Runge William , Gottschalk Michael , Bariteau Jason 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures represent one of the most common injuries encountered by foot and ankle specialists. Internal fixation of the lateral malleolus can be achieved by several different techniques, most commonly by lag screw and neutralization plating. However, ankle fractures in older patients often present technical challenges as osteoporotic bone is more commonly encountered which may require bridge plating techniques. This study compares outcomes in patients over age 50 years who underwent ORIF of the lateral malleolus with either a bridge plate or lag screw and neutralization plate technique. Methods: This retrospective study evaluated 56 patients with closed ankle fractures, aged over 50 years who underwent open reduction internal fixation of the lateral malleolus. These were divided into two groups: 36 patients had fixation with one or more lag screws and a neutralization plate, and 20 patients had fixation with a bridge plate technique. Fractures were stabilized with lag screw fixation when feasible, while bridge plating was utilized in patients where lag screw fixation was not possible. SF-36 scores were attained at a minimum one-year post-op. Final radiographs and complications were recorded. Results: The lag group had a mean age of 63 years, 17% men, 61% with syndesmotic screw fixation, and 56% with medial malleolus fixation. The bridge group had a mean age of 65 years, 15% men, 60% with syndesmotic screw fixation, and 70% with medial malleolus fixation. At minimum one-year, SF-36 physical component summary score was 74.2 ± 19.4 in the lag group vs 63.2 ± 24.8 in the bridge plate group (p=0.049). The SF-36 mental component summary score was 89.2 ± 12 in the lag group vs 75.5 ± 22.7 in the bridge plate group (p=0.009). One patient in each group required return to the OR for irrigation and debridement for infection. No patients experienced fixation failure and all fractures demonstrated union on final radiograph. Conclusion: In the present study of patients over age 50 years who underwent ORIF of an ankle fracture, as compared with bridge plating, lag screw and neutralization plating is associated with superior one-year SF-36 physical and mental summary scores with similar rates of complications. However, additional research is needed to determine to what degree this difference is causative or correlative with confounding variables as fixation technique was not found to be an independent predictor of SF-36 outcomes in this small cohort.
Analysis of Independent Predictors of Poor Outcomes of Chevron Osteotomy for Hallux Valgus: Focus on Generalized Ligamentous Laxity and Foot Width Changes
Authors: Hwang Yeok Gu , Ahn Jungtae , Kim Tae Yong , Jeong Bi O 
Published: October 2019

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The identification of factors associated with poor outcomes in patients who have undergone chevron metatarsal osteotomy is helpful for predicting postoperative outcomes. The purpose of this study was to evaluate the impact of generalized ligamentous laxity and various clinical risk factors on the radiological and clinical outcomes of chevron osteotomy for hallux valgus. Methods: A total of 135 patients (137 feet) who underwent chevron metatarsal osteotomy for hallux valgus deformity were included in this study. The mean follow-up duration was 5.6 years (range, 2–10.4 years). Generalized ligamentous laxity was assessed in all patients. After assessing the clinical outcome after chevron osteotomy for hallux valgus using the American Orthopedic Foot and Ankle Society scores - Hallux Metatarsophalangeal-Interphalangeal scale (AOFAS score), the clinical and radiological risk factors that affect postoperative outcomes were analyzed with bivariate and logistic regression analyses. Results: The average AOFAS score improved on surgical treatment from 51.4 ± 13.5 preoperatively to 86.0 ± 12.1 at the last follow-up (P < 0.001). Patients with generalized ligamentous laxity showed no significant difference in radiological and clinical parameters compared to non-laxity patients. According to bivariate and multivariate logistic regression analyses, second plantar callosity on the metatarsophalangeal joint before surgery and the ratio of foot width difference after surgery were significantly associated with clinical outcome after surgery. Conclusion: In the surgical treatment of hallux valgus, more careful surgical technique is required for patients with second plantar callus on the metatarsophalangeal joint before surgery, and efforts are needed to reduce foot width through surgical treatment.
Arthroscopically Assisted Bone Pegs Fixation Without Malleolar Osteotomy for Osteochondral Lesion of Talus
Authors: Park Chul Hyun 
Published: October 2019

Category: Ankle, Arthroscopy Introduction/Purpose: Several surgical treatments have been suggested for osteochondral lesions of talus (OLT). Fixation of osteochondral fragment using bone pegs is physiologic and does not require removal of implants and has no risk of foreign body reaction. However, this procedure commonly requires osteotomy of malleolus to obtain sufficient surgical field. Therefore, it has longer rehabilitation and a risk of malunion of osteotomy site. We have performed bone pegs fixation without malleolar osteotomy through arthroscopic assistant. The purpose of this study was to introduce our technique and to evaluate clinical and radiographic outcomes of bone pegs fixation for OLT. Methods: Ten patients (10 ankles) with osteochondral lesions of talus were treated by arthroscopically assisted autogenous bone pegs fixation without malleolar osteotomy. Intraoperative assessments were evaluated site of lesion, size of fragment, and number of pegs. Clinical assessments were evaluated using VAS and AOFAS score preoperatively and at last follow-up. And SF-36 and ROM of ankle (comparing with uninvolved ankle (%)) was evaluated at last follow-up. Radiographic assessments were evaluated according to criteria as described by Kumai et al. Results: The lesion was on posteromedial side in 8 patients and anterolateral side in 2 patients. Mean fragment size was 9.6*13.5 mm. And mean number of used pegs were 2.6. VAS and AOFAS score significantly improved from 6.1 and 74.8 preoperatively to 1 and 93.7 at last follow-up. SF-36 was 80.5 at last follow-up. ROM of ankle joints revealed 97% of uninvolved ankle joints at the last follow-up. Radiographic results were good in 4 patients, fair in 5 patients, and poor in 1 patient. Conclusion: Arthroscopically assisted bone pegs fixation without malleolar osteotomy could be a treatment option for OTL with large fragment.
Talus Fractures and Concomitant Injuries Patterns
Authors: Ibrahim Ishaq , Ye Michael , Smith Jeremy , Kwon John Y. , Miller Christopher P. 
Published: October 2019

Category: Trauma Introduction/Purpose: Fractures of the talus are rare, but serious injuries to the hindfoot associated with high-energy mechanisms in often polytraumatized patients. The collective knowledge regarding talus injuries is lacking in many regards. Limited effort has been previously made to identify and characterize associated injuries ordinarily occurring in conjunction with fractures of the talus. The purpose of the current study was to [1] determine what associated injuries occur in high incidence in patients presenting with major fractures of the talus, and to [2] identify clinical injury patterns that warrant special attention in patients presenting with talus fractures. Methods: A retrospective review was conducted for patients with talar body or neck fractures at three level-1 academic trauma centers in Boston, MA between June 1, 2004 and June 30, 2018. Patient charts were reviewed for demographic details, injury mechanism, open versus closed injury status, and all associated orthopaedic and non-orthopaedic injuries identified during the initial patient encounter and hospitalization. Results: 253 patients met criteria for inclusion. The final study population included 158 (61%) talar neck fractures, 82 (32%) body fractures, and 18 (7%) head fractures. Falls from height, MVC/MCC, low energy falls and sports injuries were the most common mechanisms of injury in declining order. 64% of patients presenting with a talus fracture had at least one other concomitant injury. The table demonstrates the breakdown of associated injuries rates by body area. Conclusion: Talus fractures are commonly associated with injuries to different anatomic sites and systems. Trauma to the ipsilateral foot is most common necessitating complete imaging of the foot and ankle in all patients presenting with talus fractures. Trauma to the chest, abdomen, and pelvis occurred most commonly following motor vehicle trauma. Talar fractures and lumbar spine injuries was also observed frequently and underscores the importance of lumbar spine evaluation in patients presenting with major talus fractures, particularly those occurring after falls from height. This study presents valuable information to surgeons when evaluating and assessing injured patients to optimize care for patients.