bluuebunny/crossref_metadata_2025_split huggingface dataset:
Syndesmosis Screw Breakage: An Analysis of Current Literature
Authors: Maten Josh W. Vander , Roebke Logan , Liu Jiayong 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis screw fracture is a common occurrence post syndesmosis screw fixation. The purpose of this study is to analyze all studies that include syndesmosis injury fixed with syndesmosis screws based on patient, screw, and surgical/rehabilitation characteristics. An emphasis will be placed on patients who suffered syndesmosis screw fracture following fixation. To date, no review has examined patient, screw, and surgical/rehabilitation characteristics with an emphasis on screw fractures in this patient population. Methods: Of the 482 articles assessed for eligibility, a total 52 articles were selected for full-text review. Following further inclusion criteria requirement 21 articles were included in the study. Each study was analyzed based on patient, screw, and surgical/rehabilitation characteristics. Patient demographics and comorbidities of gender, age, BMI, smoking, alcohol abuse, diabetes, soft tissue conditions were included. Screw characteristics that were included were screw material, number of screws, screw width, number of cortices, and number of patients with screw fracture (screw fracture rate). Surgical/rehabilitation characteristics included ankle position, screw placement above tibial plafond, screw angle, routine removal, rehabilitation process, and time to full weight bearing. Results: A total of 1,196 patients, 761 men and 440 females, were included in the analysis. The average number of patients in each study was 59.80±39.41(12-161). Comprehensive screw, surgical, and rehabilitation + outcome data can be seen in Table 1, 2, and 3, respectively. Nine studies reported on ankle position during surgery; dorsiflexion was the most common. Fourteen reported on placement of the screw above the tibial plafond, with 2 cm being the most common. Five reported on screw angle. 141 patients had a fractured screw(s). The average fracture rate was 11.41%. Five of the 21 studies reported BMI. Three studies stratified data comparing broken screw versus intact screw patients. Five reported on diabetes, one on alcohol abuse, and one study reported on comorbidities. Conclusion: In conclusion, analysis of syndesmosis screw fracture patients versus those with no fracture was difficult due to lack of differentiation in almost all the studies. Notably, syndesmosis screw fracture studies under report patient characteristics, specifically BMI. Comorbidities, especially BMI, are potential cofounding variables within this patient population and could contribute to screw failure. Future studies should include both BMI and comorbidities when analyzing patients whose syndesmosis fixation resulted in screw breakage.
Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery
Authors: Vasukutty Nijil L. , Mordecai Simon , Subramaniam Murali , Tarik A , Srinivasan Bala 
Published: November 2020

Category: Diabetes Introduction/Purpose: Antibiotic loaded bio composites help in eradication of infection and obliteration of dead space created by debridement in diabetic foot disease. Methods: We present early results of 54 feet in 51 patients from 2 centres in the UK, where we used local antibiotic carrier. Of these 51 had osteomyelitis and in 3 cases we used this agent prophylactically for Charcot reconstruction. All patients were managed by a multidisciplinary team. Our protocol involved, pre op assessment, debridement, culture specific systemic antibiotics and dead space obliteration with antibiotic loaded bio composite (CERAMENT G Bone Support, Lund, Sweden). The wound was managed with negative pressure wound therapy where applicable and all patients were off loaded. Skin cover where required was undertaken by our plastic surgeons. Results: Nine patients were Cierny-Mader type 1, 7 were defined as type 2, 16 were type 3 and 19 were type 4. 26 patients were type B hosts and 25 were type A hosts. 38 patients had forefoot pathology, 7 had midfoot and 9 had hindfoot disease. 6 patients had pre-operative reperfusion procedures. At a mean follow up of 72 weeks (12-136) 44 feet were infection free and 41 patients (80%) were mobilizing full weight bearing with or without surgical footwear. 15 wounds healed by secondary intention, 3 had plastic surgical procedures and 23 had primary closure. 5 patients required revision procedures. 6 patients had below knee amputation, 2 due to significant vascular disease and 2 at patient request. Conclusion: A multidisciplinary approach and a strict protocol including augmented debridement and Cerament G are effective for treatment of chronic osteomyelitis in diabetic foot disease.
Novel Hallux Valgus Cadaveric Model: Role of Ligament Damage and Tendon Pull in Recreating the Deformity
Authors: Wagner Emilio , Wagner Pablo , Pacheco Florencia J. , Villarroel Carlos , Palma Felipe H. , Venegas Rodrigo Guzman- 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is of uncertain origin, which explains the plethora of treatment options available. In the last few years it has been shown that it is not a one plane deformity, but a multiplanar one. It is the authors belief that Hallux Valgus originates from instabilities located at medial ray joints. To be able to further understand this frequent pathology, a cadaveric model should be developed. Through specific and limited medial column ligament damage, a model was developed trying to obtain similar deformities to the ones observed in real life, i.e. first ray varus and pronation. Methods: 7 fresh frozen lower leg specimens were used without evident foot and ankle pathology. Tibio-talar and talo-navicular joints were fixed. Luminous markers were attached to the medial and middle foot ray bones, including talus. A constant tibial axial load of 25 kg was used. Cyclic tibial rotation (to simulate gait phases) and 5 kg pull on the extensor and flexor hallucis tendons (EHL and FHL) were applied to every specimen. Limited and sequential medial and middle column ligamentous sectioning were performed, including the naviculocuneiform, intercuneiform, metatarsocuneiform, metatarsophalangeal medial capsule and intermetatarsal ligaments. After each ligament damage, 3D bony alignment was registered using high speed high definition infrared cameras. Results: After ligament sectioning, an increase in intermetatarsal angle was observed of 2.5 degrees (range 0.8-5) (p=0.001), with 1 degree (0-3) (p=0.02) of further increase when Hallucis tendons pull was applied. Intercuneiform angle increased 2.3 degrees (0- 6) (p=0.01), with no change with tendons pull. Regarding bone rotation, the metatarsal pronated in relation to the navicular (metatarso-navicular angle) 6.3 degrees (3-20) (p=0.015) and the cuneiform pronated in relation to the navicular (naviculo- cuneiform angle) 3.3 degrees (0.5-6) (p=0.005). At the metatarso-cuneiform joint, a non-significant rotation was identified (1 degree (p=0.39). Hallucis tendons pull did not significantly affect any rotation angle. An evident hallux valgus deformity could be created, which further deformed with hallucis tendons pull. Conclusion: After sequential medial and middle ray ligament sectioning, a progressive and simultaneous increase in medial column varus and pronation were observed. Hallucis tendons pull, increased the medial column varus, but appeared not to play a role in bone rotation. Bone rotation occurs along the medial column joints, not isolated to the tarsometatarsal joint. Progressive medial ray ligamentous sectioning was able to recreate a Hallux valgus deformity, including medial ray varus and pronation.
Low Risk of Wound Complications with Sinus Tarsi Approach for Treatment of Calcaneus Fractures
Authors: Wallace S. Blake , O’Neill David , Narayanan Anish , Liu George T. , Chhabra Avneesh , Wukich Dane K. , Lalli Trapper 
Published: November 2020

Category: Trauma; Hindfoot Introduction/Purpose: Fractures of the calcaneus are life-changing events with a major socioeconomic impact from lost productivity. Traditional operative treatment with the extensile lateral approach has shown relatively high rates of wound complications. Less invasive approaches can improve fracture alignment and decrease wound healing complications. The purpose of this study is to report our experience with the sinus tarsi approach in treating calcaneus fractures. Methods: We retrospectively identified patients at our institution treated with a limited sinus tarsi approach for calcaneus fractures from 2009-2018. Demographic and radiographic data were collected including: age, sex, mechanism of injury, occupation, presence of diabetes, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements. Results: Our analysis included 105 fractures in 100 patients: 86% males, 42% smokers, 4% diabetics, with an average body mass index of 26.5. The fractures were: Sanders type 2 (32%), type 3 (48%), type 4 (18%), and 2% were a tongue-type variant. Preoperatively 38% of fractures displayed a negative angle, 50% had an angle 0-20 degrees, and 12% over 20 degrees; postoperatively 13% had an angle 0-20 degrees, and 87% had an angle over 20 degrees. Of patients working prior to the injury, 72% had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 12% (12/100), with only 2% (2/100) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p=0.55). Conclusion: The limited sinus tarsi approach for depressed calcaneus fractures allows radiographic restoration of calcaneal height with a low rate of wound complications, even amongst active smokers. To the authors’ best knowledge, this is the largest published case series of calcaneus fractures treated with the sinus tarsi approach. Further follow up is needed to determine the success of this approach in mitigating long term complications.
Patient Perceptions of Patient Reported Outcome Measures in Orthopedic Surgery (PROMOS): A Snapshot of Data for Foot and Ankle Patients
Authors: Walley Kempland C. , Vannatta Emily , Stauch Chris M. , Fritsche Madelaine W. , Dunleavy Mark , Juliano Paul J. , Aynardi Michael C. 
Published: November 2020

Category: Other Introduction/Purpose: Used intimately to qualify the use of new surgical devices, advance new surgical techniques and evaluate faculty performance with regard to patient satisfaction and outcomes, patient reported outcome measures (PROMs) are commonplace across all sub-specialties in orthopaedics. Despite their theorized utility, these interactive tools are burdensome in clinic and their true utility is anecdotally in question. No prior study to the best of our knowledge has investigated the degree at which patients find them useful or even appropriate measures to objectify their injuries or state of recovery. The purpose of this study is to ascertain patient perceptions of the utility of commonly used patient reported outcome measures (PROMs) in foot and ankle surgery. Methods: After IRB approval, consecutive patients visiting a foot and ankle surgery outpatient clinic (either new or return) will be asked to complete a survey assessing their attitudes toward commonly used PROMs relevant to foot and ankle surgery. Upon verbal consent, patients will be asked a short series of demographic questions including: age, whether they are a new patient, sex, education level, disability status, current region of residence, and history of opiate use. After completion, patients will be shown the Visual Analog Scale (VAS) tool to quantify pain and asked two questions: 1) concerning effectiveness and 2) concerning their personal perceptions. Next, patients will be shown a single PROM used pertaining to their injury (eg, Foot & Ankle Disability Index (FADI)). All patient will comment on their perceptions of the VAS and one additional PROM specific to the sub-specialty in which there are seeking treatment. Results: We report a total of 39 patients in this preliminary data set (49% males, 51% females) with a mean age of 51 (range, 19 - 83). A majority of patients reported that both VAS and FADI are effective PROMs in foot and ankle surgery. Additionally, patients reported that there is no benefit to artificially inflating their PROMs to receive better/more-prompt patient care. These findings were independent of history of opiate use, disability, gender, or age cohort (Figure 1). Conclusion: The results of this study show that the majority of patients visiting a foot and ankle surgeon in the outpatient setting perceive both VAS and FADI are effective tools to describe their respective foot/ankle condition. Patients report, in this preliminary sample, do not ‘game’ these PROMs to receive better care though these study findings are subject to the Hawthorne Effect.
Pediatric Calcaneus Fractures and Associated Injuries
Authors: Ward Norman H. , Roper Brennan P. , Munz John W. , McGarvey William C. , Mansour Alfred 
Published: November 2020

Category: Trauma; Hindfoot Introduction/Purpose: The objective of the study was to determine the injuries associated with calcaneus fractures in pediatric patients and to determine if the skeletally immature sustain different injury patterns than the skeletally mature. In the adult population, these concurrent injuries are well-defined and consistent with a large axial load; however in the pediatric population, we anticipate that the differences in the mechanism of injury and developmental anatomy will alter the types of injuries observed with calcaneus fractures. Additionally, given the plasticity of immature bone, the skeletally immature patients may sustain different fracture patterns than the skeletally mature. Methods: A retrospective chart review was performed of pediatric patients presenting with a calcaneus fracture from 2008 to 2017. Patients under the age of 18 with an ICD code consistent with a calcaneus fracture were included. Patients who sustained penetrating trauma were excluded along with medical records with incomplete data. Demographics, injury information, associated injuries, skeletal maturity, fracture characteristics, and treatment were recorded. As defined by calcaneal apophyseal closure, the cohort was divided into the skeletally mature and immature for analysis. Student’s t-test and Fisher’s exact tests were used to determine significance. Results: 199 records were reviewed resulting in a sample of 81 pediatric patients with 91 calcaneus fractures. 37(40.7%) patients were immature at the time of injury. The most common mechanism witnessed was a fall in 52(64.2%) patients, with an average age of 12.8 years-old (range 0-17). There were 50(54.9%) intra-articular fractures and 15(16.5%) who underwent reduction and fixation. In the immature, open reduction internal fixation was performed on 6(14.3%) fractures which demonstrated a significantly decreased average Bohler’s angle than the conservatively treated, 14 degrees(p= 0.048). Fractures of the spine were the most commonly associated injury in 10(12.3%) pediatric patients however tibia fractures were the most commonly observed injury in the skeletally immature cohort, 7(18.9%). There were no associated injuries significantly unique to the skeletally immature. Conclusion: The present study provides one of the largest published cohorts to date of pediatric calcaneus fractures. They were most commonly associated with fractures of the spine however in the skeletally immature group as defined by apophyseal staging, tibia fractures were most often observed. No injuries were found to be significantly associated with immature patients. The skeletally immature calcanei produce fracture patterns which may be difficult to observe on radiographs and often require advanced imaging to delineate. While the majority may be treated with conservative therapy, there are no current concrete operative indications for the closed skeletally immature calcaneus fracture.
Functional Analysis of Distraction Arthroplasty in the Treatment of Ankle Osteoarthritis
Authors: Xiaojun Liang , Hong-Mou Zhao 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Ankle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis. However, the benefit of this procedure and failure relative factors are still in debate. The purpose of current study was to evaluate the functional outcomes of AJDA in treatment of moderate to severe ankle OA; and to evaluate the relative factors correlated with treatment failure. Methods: Forty-six van Dijk stage II and III ankle osteoarthritis patients were included. Fifteen males and 31 females with a mean age of 54.8 (range, 42-71) years were followed with a mean of 42.8 (range, 24-68) months. The Ankle Osteoarthritis Scale (AOS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were used for functional outcomes evaluation. The talar tilt (TT) angle and ankle joint space distance (AJSD) were evaluated. The risk ratio (RR) was calculated for each potential failure relative factor. Results: The AOS and AOFAS scores were significantly improved at the last followup time (P＜0.01). The AJSD was improved in 61% of patients, and with a significant improvement compared with the preoperative conditions (P＜0.01). The TT angle and range of motion reached no significant difference. The failure rate was 21.7%. Patients with large TT (>=5°) angle (RR=3.81, 95%CI: 1.28-11.33, P=0.02) and obesity (RR=3.58, 95%CI: 1.30-9.89, P=0.01) were found have positive correlation with failure. No correlation was found between failure and gender, or overweight, or side, or age, or type and stage of OA, or pin infection. Conclusion: Current study confirmed the early functional outcomes of ankle distraction arthroplasty. However, this procedure still has a relatively high failure rate, especially for those obesity patients and the patients with large TT angles.
Short-Term Effect of the INBONE II Total Ankle Arthroplasty in the Treatment of End-Stage Ankle Arthritis
Authors: Xiaojun Liang , Hong-Mou Zhao 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: To study the short-term effect of the INBONE II total ankle arthroplasty in the treatment of end-stage ankle arthritis, and to analyze the main operation points and complications. Methods: A total of 10 patients who used INBONE II for total ankle replacement in my Center from March 2016 to June 2017 were retrospective analyzed, including 2 patients who have a subtalar joint fusion at the same time. The VAS pain score and the American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate the clinical efficacy. Results: All the patients were followed up, the average follow-up time was (12.80+-4.11) months (5-15 months), The AOFAS of preoperation was significantly higher (44.00+-4.06) vs (82.50+-3.17) score than that of the final follow-up, and VAS score was lower (6.80+-0.63) vs (1.60+-0.70) than that of the final follow-up (all P<0.01). There were 1 medial malleolus fracture, 1 lateral malleolus fracture intraoperation, 1 with symptomatic lateral malleolus osteophytes and lateral instability, which needs debridement, no superficial or deep infection was found,no prosthesis subsidence or malalignment and other complications was found. Conclusion: The short-term effect of total ankle arthroplasty using INBONE II prostheses for ankle end-stage arthritis is satisfactory, and further analysis was needed for its long-term efficacy and prosthetic survival rate.
Analysis of Short-Term Outcome of Osteotomy Combining with Soft Tissue Surgery in the Treatment of Symptomatic Children with Flexible Flatfoot
Authors: Yi Li , Xiaojun Liang , Hong-Mou Zhao 
Published: November 2020

Category: Hindfoot; Other Introduction/Purpose: To evaluate the short-term curative effect of clinical results and imaging of osteotomy and soft tissue surgery for the treatment of children with flexible flatfoot. Methods: From July 2014 to October 2016, 28 patients (47 feet) with flexible flatfoot were treated with osteotomy combining with soft tissue surgery, included 16 males (26 feet) and 12 females (21 feet) with the average age of (11.7+-2.1) years old ranging from 9 to 14 years old. The VAS score, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, Maryland score were evaluated before and after the operation to study the clinical effect. Patient satisfaction was also investigated at the end of the follow-up. The talo-navicular coverage angle (TNCA), the talo-1st metatarsal angle (T1MA), the talo-2nd metatarsal angle (T2MA) in the weight-bearing anteroposterior view and the calcaneal inclination angle (Pitch angle), the talo-1st metatarsal angle (Meary’s angle), the talo-calcaneal angle (Kite angle) and final follow-up time to study the imaging data. Results: Superficial tissue infection occurred in 2 cases (3 feet) after surgery, wound healing was achieved through debridement and short-term oral antibiotics. The average VAS score of the final follow-up was significantly lower than that before surgery (P < 0.01). The average AOFAS score and the average Maryland score were significantly higher than pre-operation (P < 0.01). Patient satisfaction at the last follow-up: very satisfaction 20 (71.43%), satisfaction 7 (25%), general 1 (3.57%). The the talo-navicular coverage angle (TCA) ,the talo-1st metatarsal angle (T1MA), the talo-2nd metatarsal angle (T2MA) in the weight-bearing anteroposterior view of the final follow-up were significantly improved compared with preoperation (P＜0.01), the Pitch Angle, Meary’s Angle and Kite Angle in the weight-bearing lateral view ere significantly improved compared with preoperation (P＜0.05). Conclusion: Osteotomy combined with soft tissue surgery has good short-term effect on children’s flexible flatfoot, and the effect of correction of malformation is obvious, but the medium-term and long-term effects need to be further studied.
Pneumatic Vitreolysis With Intravitreal Air for Focal Vitreomacular Traction
Authors: Seamone Mark E. , Rubin Uriel , Grewal Parampal S. , Greve Mark 
Published: November 2020

Purpose: To determine whether pneumatic vitreolysis with intravitreal air is effective for focal vitreomacular traction (VMT). Methods: We conducted a retrospective consecutive case series of 20 eyes from 19 individuals with focal VMT who underwent pneumatic vitreolysis with intravitreal air (January 2017 to November 2018). We analyzed patients via spectral-domain optical coherence tomography before intravitreal air injection and at 1 month. The primary outcome measure was release of VMT. Results: We observed release of VMT in 55% of individuals. An analysis limited to phakic eyes demonstrated release of VMT in 69%, and 65% developed improved best-corrected visual acuity. Individuals with persistent VMT and visual improvement had a significant reduction in angle of vitreoretinal insertion ( P < .01), area under VMT ( P < .05), and subfoveal cyst area ( P < .05). Conclusions: Intravitreal air is an effective treatment for focal VMT. In individuals with persistent VMT, visual-acuity improvement was associated with a reduction in overall VMT.