bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Suture-Button Fixation for Treatment of Maisonneuve Injuries
Authors: Fox Rabun S. , Rogero Ryan G. , Corr Daniel , Raikin Steven M. , Pedowitz David I. , Larwa Joseph , O’Neil Joseph T. , Fuchs Daniel J. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: The purpose of this study was to evaluate the radiographic and functional outcomes of suture-button devices for treatment of Maisonneuve injuries, which present unique considerations due to the proximal one-third fibular fracture, through which the distal fibular segment can potentially shorten. Methods: Patients undergoing operative management of Maisonneuve injuries from 2014-2018 utilizing suture-button devices with 2 fellowship-trained foot and ankle orthopedic surgeons were included. Exclusion criteria included use of a transosseous syndesmotic screw, fixation of the proximal fibular fracture, or less than 12 months follow-up. Medial clear space, tibiofibular clear space, tibiofibular overlap, talocrural angle, and distal fibular congruency on the injured and non-injured ankles were measured. Patients also completed the Foot & Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports subscales and Visual Analog Scale (VAS) for pain (n/100). Thirty-three patients were included. Results: Three (9.1%) patients experienced a postoperative complication, including 1 wound dehiscence and 2 requiring hardware removal. No significant differences were demonstrated in radiographic parameters measured between 6-week and final radiographs on the injured ankle, as well between final radiographs taken of the injured and uninjured ankles (Table 1). At mean follow-up of 34.7 (range, 12-58) months, patients had a mean FAAM-ADL of 91.1, FAAM-Sports of 81.7, and VAS pain of 14.3. Conclusion: This study demonstrates that isolated use of suture-button devices for syndesmotic fixation in Maisonneuve injury patterns is effective at maintaining fibular length and reduction of the syndesmosis, as well as achieving satisfactory patient outcomes. [Table: see text]
2.4mm Non-Cannulated Screws are Non-Inferior to 4.0mm Cannulated Screws for Medial Malleolar Fixation in Unstable Ankle Fractures
Authors: Fram Brianna R. , Schmitz Joseph L. , Rogero Ryan G. , Chang Gerard , Krieg James 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Ankles fractures are the third most common adult fractures, representing significant cost to society. This makes the effectiveness of ankle open reduction internal fixation (ORIF) an important area for study. The majority of existing literature on medial malleolus fracture fixation involves biomechanical testing in synthetic bone or cadaveric models. We sought to compare the clinical efficacy of medial malleolar fixation with 2.4mm non-cannulated screws to 4.0mm cannulated screws by evaluating rates of loss of reduction and hardware failure. Methods: We performed a propensity-score-matched retrospective cohort study on patients who underwent ORIF of an unstable ankle fracture with fixation of the medial malleolus with either 2.4mm non-cannulated (N=51 ankles in 51 patients) or 4.0mm cannulated (N=60 ankles in 60 patients) screws. Vertically oriented medial malleolus fractures or those in which additional fixation was used were excluded. We identified post-operative complications and compared follow-up radiographs with immediate post-operative radiographs for signs of hardware failure or loss of reduction. Mean age was 50.2 years (SD 13.9). There was no significant difference between groups in age, BMI, Charleston Comorbidity Index (CCI), smoking or diabetes status. The 2.4mm patients were more likely to require syndesmosis fixation (56.9% 2.4mm, 30.0% 4.0mm, p=0.007) but not posterior malleolus fixation (25.5% 2.4mm, 28.3% 4.0mm, p=0.831). Most medial malleoli were fixed with 2 screws (1 screw 9.8%, 2 screws 90.2% 2.4mm, 1 screw 7.0%, 2 screws 93.0% 4.0mm, p=0.60). Results: There was no significant difference in total complications (7.8% 2.4mm, 15.0% 4.0mm, p=0.375), operative complications (5.9% 2.4mm, 5.0% 4.0mm, p=1.00), loss of medial reduction (3.9% 2.4mm, 6.7% 4.0mm, p=0.69), or medial hardware breakage (2.0% 2.4mm, 0% 4.0mm, p=0.45). The two patients in the 2.4mm screw group with loss of medial malleolus fixation were noncompliant with non-weight bearing restrictions and failed by screw backing out, while the 4 patients in the 4.0mm group failed by medial fracture fragment displacement around stable screws. The 4.0mm group had more nonoperative complications (0% 2.4mm, 10.0% 4.0mm, p=0.031); one of these was delayed union of the medial malleolus, while the remainder were delayed lateral wound healing or sural or superficial peroneal distribution paresthesias, which appeared unrelated to medial fixation type. Conclusion: When used for medial malleolus fixation in unstable ankle fractures, 2.4mm non-cannulated screws do not have higher rates of loss of reduction or hardware failure compared to 4.0mm cannulated screws. Given their decreased cost and equivalent ease of insertion, surgeons should consider their use when fixing unstable ankle fractures.
Immediate Weight Bearing and Range of Motion After Internal Fixation of Unstable Ankle Fractures: A Retrospective Controlled Study
Authors: Fram Brianna R. , Rogero Ryan G. , Corr Daniel , Chang Gerard , Krieg James , Raikin Steven M. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are the third most common adult fractures. Further, they are the second most common fracture type to require inpatient admission, behind only hip fractures, despite occurring in a population on average nearly 30 years younger. There is evidence that early or immediate weight bearing and range of motion may be safe following ankle fracture fixation, but existing studies are small and largely exclude patients with syndesmotic or posterior malleolar fixation. We therefore studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of unstable ankle fractures in a diverse cohort and attempted to identify risk factors for complications. Methods: We performed a retrospective case-control study. Out of 268 patients who underwent primary ORIF of an unstable ankle fracture from 2013-18, we identified 133 (49.6%) who were IWBAT and IROM. The treating surgeon excluded patients from IWBAT if they had an ipsilateral leg injury requiring non-weight bearing, a large displaced posterior malleolus fragment, or Maisonneuve injury with fracture of the proximal fibula. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-op. We reviewed medical records and radiographs for demographic, injury and treatment characteristics. Our primary outcome was complications. We compared demographics, injury characteristics, treatment episode, and complications between the IWBAT and NWB groups and performed within group analysis to identify risk factors for complications. A p-value <0.05 was considered significant. Results: The groups did not differ significantly in age, BMI, Charleston Comorbidity Index (CCI), smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB, p=0.11), posterior malleolus (24.1% IWBAT, 26.7% NWB, p=0.59), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, p=0.85). There was no significant difference in total complications (9.8% IWBAT vs. 12.8% NWB, p=0.41), nonoperative complications (6.8% IWBAT vs. 8.7% NWB, p=0.53), or operative complications (3.8% IWBAT vs. 4.1% NWB, p=0.89). We did not identify any factors associated with increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, CCI or pre-injury assisted ambulation. Conclusion: IWBAT and IROM may be safe following ankle fracture ORIF in a broader patient population than previously believed. We did not identify specific risk factors for post-operative complications. Further study on patient selection may allow for more extensive use of this protocol to reduce the morbidity associated with unstable ankle fractures. [Table: see text]
Can Reducing Implant Costs Increase Revenue for Surgically Treated Ankle Fractures: Time Driven Activity Based Costing for 1 year Episode of Care
Authors: Freking Will , Okelana Bandele , McMillan Logan J. , Kibble Kendra , Parikh Harsh R. , Cunningham Brian P. 
Published: November 2020

Category: Ankle; Trauma; Other Introduction/Purpose: Implant selection may provide an opportunity to reduce costs and improve value in healthcare, but most orthopaedic surgeons are unfamiliar with the cost of surgical implants. Large variation has been reported in the overall cost of the surgical treatment of ankle fractures, largely due to variations in implant selection. The purpose of this study is to evaluate the relationship between implant selection and the Reimbursed Cost of Care (RCC) over the total cost-of-care over the entire care episode. Methods: A single payer database was queried for isolated ankle fractures from 2010-2017. Patient characteristics, implant cost, RCC and total cost of care for one-year episodes were collected. Total cost of care was determined via Time Driven Activity Based Costing (TDABC). Analysis consisted of multivariable linear regression and goodness-of-fit tests. The relative proportion of the implant cost to the RCC was defined as Ic/RCC. Results: Construct costs (Inpatient: $1563.30 vs Outpatient: $1143.00; p<0.01)TDABC cost of care (Inpatient: $3670.90 vs Outpatient: $2941.90; p<0.01)RCC (Inpatient: $17350.00 vs Outpatient: $10895.80; p<0.01) were all significantly lower for the outpatient setting. Construct costs constituted an estimated 38.8% of the total TDABC cost and 14.5% of the RCC. The difference between RCC and implant costs presented a significant negative trend with the total construct costs for outpatient procedures (B=-$1.54; p=0.03), but non-significant for inpatient (B=-$0.37;p=0.79). Conclusion: This study investigated the effect of implant cost on the total cost of care in surgically treated ankle fractures. We found an overall higher reimbursed cost of care (RCC) in the outpatient setting and a higher TDABC cost of care in the inpatient setting, reinforcing the trend towards outpatient surgical management. Implant selection proved not only a significant portion of the overall cost of care, but a driver of overall revenue.
Union Rates and Deformity Correction Using the Hintermann Osteotomy in Type IIb Flatfoot Deformity
Authors: Gallagher Brian P. , Hembree Walter C. , Schon Lew C. 
Published: November 2020

Category: Ankle; Hindfoot Introduction/Purpose: Multiple Lateral column lengthening procedures have been described for the correction of the abduction component of stage II flatfoot deformity. The Hintermann osteotomy, although technically difficult, offers powerful lengthening of the lateral column with low risk of violating the articular cartilage of the subtalar joint as compared to the more widely performed Evans osteotomy. This study reports on the radiographic and clinical outcomes of the Hintermann osteotomy performed by a single surgeon. Methods: Patients who underwent reconstruction for stage II flatfoot deformity with a Hintermann lateral column lengthening were restrospectively identified. The talus-1st metatarsal angle, percent talus uncoverage, calcaneal pitch, lateral column length, CC joint subluxation, and distance from CC joint to the osteotomy were measured on pre and postop radiographs. Radiographic union was also assessed. The Kellgren-Lawrence scale was used to assess degenerative changes at the ST, CC, and TN joints. Charts were reviewed for comorbidities, clinical evidence of union, time to protected weightbearing, time to unrestricted weightbearing, signs of peroneal irritation, clinical signs of osteoarthritis progression, and complications. A paired students t test was used to identify differences in radiographic parameters. Results: Twenty-six patients (30 feet) met inclusion criteria. All osteotomies achieved union with only 1 (1/30) instance of delayed union. Average duration before clinical and radiographic union was 12.6 weeks (9-37). The AP Talus-1st metatarsal angle decreased on average of 12.3 degrees (STD 9.1) (p<0.0001). Percent talus uncoverage decreased on average 17.7 percent (STD 11.5%) (p<0.0001). Subluxation at the CC joint was found to increase on average 1.63mm (STD 1.99) (p<0.01). Only 3 patients (10%) had radiographic progression of osteoarthritis at either the CC or ST joint. No patients showed clinical signs of osteoarthritis and none went on to fusion. One patient had lateral hardware pain necessitating plate removal. Conclusion: The Hintermann osteotomy is a powerful tool for lateral column lengthening. In this series there was significant correction of the preoperative abduction deformity with no nonunions. Degenerative changes in the surrounding hindfoot joints were rare. One benefit of the Hintermann osteotomy is its ability to preserve the articular cartilage of the anterior and middle facets.
Cerclage Fixation of Navicular Fractures
Authors: Gallivan Robert E. , Kupcha Paul C. 
Published: November 2020

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Navicular fractures are commonly seen midfoot fractures that can be easily missed and difficult to treat. More severe fractures result from forces that compress the talar head into the navicular causing the navicular to displace radially like staves of a barrel. In a case report from Foot and Ankle International, Naidu and Singh (2005) showed a displaced comminuted intra-articular navicular fracture that was treated innovatively with a cerclage wiring technique. To our knowledge, this is the only published report of a navicular fracture treated with this approach. Since that time the senior author has treated over 25 of these severe fractures with a similar cerclage wiring technique. Over time this technique has evolved and now preferentially involves use of an Arthrex FiberTape cerclage system. Methods: The surgical technique is described as follows. First a small incision is made over the medial pole of the navicular. A lead suture is then passed after subperiosteal dissection along the plantar surface of the navicular and received at a similar incision at the lateral pole. The original technique we employed involved the use of a Dall-Miles cable and cable passer but has been supplanted by the lead suture technique or by using the needle of an Arthrex FiberTape. Once control of the plantar surface is accomplished, subperiosteal dissection is made along the dorsal surface with a Kelly clamp or small periosteal elevator. The lead suture is then delivered to the medial pole which then allows for circumferential control of the fracture fragments. The FiberTape is then passed by pulling the lead suture which delivers the FiberTape circumferentially. This provides indirect reduction by radial compression as it is sequentially tightened. Results: We have performed over 25 cases in a similar manner and in our experience have found this to be the best fixation and reduction technique available (Image 1 & 2). Conclusion: This approach demonstrates a safe, expedient, minimal incision surgical approach that provides optimal fixation of these difficult navicular fractures.
Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty
Authors: Ghobrial Philip G. , Schmitt Daniel , Brown Nicholas M. , Pinzur Michael S. , Schiff Adam P. 
Published: November 2020

Category: Ankle; Other Introduction/Purpose: Tranexamic acid (TXA) has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty (TAA). In light of expanding indications for TAA and its growing utilization, there is a need for more data regarding interventions such as TXA that may reduce perioperative complications and improve patient outcomes for this procedure. The purpose of the current study was to determine if the use of TXA in patients undergoing total ankle arthroplasty impacts the blood loss or overall complication rate. Methods: A retrospective chart review was conducted for 34 patients who underwent TAA with (n=17) and without (n=17) intraoperative TXA from 2016 to 2019 at a single academic medical center. Inclusion criteria were patients who underwent TAA for any clinical indication and had quantified intraoperative blood loss. Patients were excluded if they had a contraindication to TXA (ie. impaired renal function), a history of coagulopathy, no recorded intraoperative blood loss, or intraoperative complications that resulted in excessive bleeding. Estimated blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss and complication rates were recorded and compared between groups. Statistical analysis was performed using SPSS 21.0. Results: There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference or hidden blood loss between the groups (all, p>0.05). A lower rate of wound complications was observed in the TXA group. The difference between the overall complications rates observed for each group was not statistically significant (p>0.05). Conclusion: Intravenous tranexamic acid did not result in decreased blood loss during TAA, as measured in our study. However, tranexamic acid was not associated with any increase in overall complications while a lower rate of wound complications was seen in patients in which TXA was utilized. Based on our findings, further studies are needed to better elucidate the impact of TXA on blood loss and wound healing in TAA. [Table: see text]
Humanitarian Medical Trips after COVID-19: Perspectives from Volunteers
Authors: Gokcen Eric C. , Vosseller J. Turner 
Published: November 2020

Category: Other Introduction/Purpose: The COVID-19 pandemic has caused major disruption in all areas of life around the world. Volunteers that are involved in providing international humanitarian medical trips may have reservations about resuming these trips. The purpose of this study was to determine the perspectives of previous international humanitarian medical trip applicants regarding resuming these trips. Methods: A ten-question survey was given to 27 physicians that had previously applied to go on a humanitarian trip to Vietnam in 2020 with the American Orthopaedic Foot & Ankle Society. Recipients were given 3 weeks to complete the survey, with three reminders sent. 19 completed the survey for a 79% response rate. Results: 47% of the respondents were ages 36-49, with 47% from the USA. 47% had been on 1-5 previous medical trips. All of the respondents are still considering going on a future trip. The majority (79%) anticipate being able to resume travel by June 2021. 74% will determine when to go based upon government clearance for travel and 79% will take into consideration the COVID-19 status at the host site. Only 2 respondents (11%) would wait for their practice to stabilize economically. Conclusion: Although the COVID-19 pandemic has severely limited the ability to travel for international humanitarian medical trips, previous volunteers and applicants are still anticipating resuming these trips within a year. Most are monitoring government restrictions and the COVID-19 status at the host site as the main determinants for going. Once these factors are favorable, humanitarian medical trips will be able to resume. Those that are planning these trips should continue their preparations.
Influence of Interventions on the Sural Complex like the Gastrocnemius Recession on the Calf Strength
Authors: Gottlieb Tonio , Klaue Kaj 
Published: November 2020

Category: Ankle; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Increasing evidence has shown that gastrocnemius tightness is related to various types of foot and ankle pathology. The recession and lengthening of the gastrocnemius has become an important ancillary procedure in many reconstructive operations, such as hallux valgus, pes plano-valgus and total ankle arthroplasty surgery. Additionally, isolated Gastrocnemius Recession is also performed alone to treat plantarfasciitis, achillestendinosis, metatarsalgia and diabetic forefoot ulceration. The reports about the clinical results are encouraging, but evident data about the resulting strength of the treated muscle is lacking. Methods: This study was designed to measure calf-strength of every patient before and after Gastrocnemius Tenotomy, Gastrocnemius Recession, Achillestendon lengthening. The data was taken before surgery and one year post-op. A Leonardo Mechanograph GRFP was used to measure calf-strength with bended and extended knee on both sites. 85 patients were measured before surgery. 58 of these patients underwent a intervention on the sural complex. The interventions included Gastrocnemius Tenotomy, Gastrocnemius Recession, Achillestendon lengthening combined with different types of foot and ankle reconstruction. Results: The results show that the calf strength decreased overall significantly. The force on the operated site decreases significantly with bended and extended knee. However, contralatrel forces diminish in the same dimension. The decrease in force was mainly related to the force during knee extension. There was no significant force difference postoperatively between ipsi- and contralateral. Conclusion: Apparently, a surgical intervention on the foot seems to cause a weakening of the flexor muscles on both lower legs. Not surprisingly, the greater reduction in strength is during knee extension. Apparently, however, the loss of strength on the operated foot is compensated, so that ultimately there is the same strength on both side.