bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Outcomes of Coalition Resection in Adult Tarsal Coalition
Authors: Bemenderfer Thomas B. , Boersma Jacob B. , Bohay Donald R. , Anderson John G. , Maskill John D. 
Published: November 2020

Category: Hindfoot; Other Introduction/Purpose: Although the diagnosis, treatment, and natural history of tarsal coalitions has been well described in the adolescent population, there remains a paucity of orthopaedic literature on outcomes associated with coalition resection with or without interposition in the adult population. This study is the first to evaluate clinical and radiographic outcomes in adult patients with tarsal coalition resection without interposition. Methods: All patients with symptomatic tarsal coalition (subtalar, calcaneonavicular, or talonavicular) who failed conservative management and underwent coalition resection with concomitant procedures as indicated by their pathology between January 2006 and December 2014 were included in our retrospective case series. Demographics, clinical outcomes, patient comorbidity information, visual analogue scale (VAS) pain scores were collected. Advanced imaging (CT or MRI) was reviewed to determine fibrocartilaginous or osseous coalition. The primary outcome was reoperation. Secondary outcomes were change in visual analog score (VAS), and minor complications (local wound care, use of antibiotics, and skin dehiscence). Results: 68 patients (52.9% males, 47.1% females; average age 35.9 years old, range 18 to 70) met inclusion. Calcaneonavicular, subtalar, and talonavicular coalitions were resected in 45.6% (n=31), 54.4% (n=37), and 0% of patients, respectively. At average final clinical follow up of 36 months, there were a total of 33 reoperations in 33.8% of patients (n=23) most commonly including subsequent fusion (n=11), exostectomy (n=10), and removal of hardware (n=15). There was no significant difference in reoperation (42.3% versus 63.1%, p=0.454) or fusion (19.4% versus 19.2%, p=0.99) following subtalar or calcaneonavicular coalition resection. Average VAS score preoperatively and postoperatively was 5.8 to 3.0. Minor complications were present in 16.2% of patients (n=11; 3 local wound care, 10 use of antibiotics, and 0 skin dehiscence). Conclusion: The present study demonstrates overall improvement in VAS score by an average of 2.8 points following subtalar and calcaneonavicular coalition resection. Although 33.8% of patients may anticipate additional surgery, the majority of patients may expect long-term maintenance of improvement in pain without subsequent fusion.
Outcome of Concomitant First Metatarsophalageal and Tarsometatarsal Arthrodesis for Severe Hallux Valgus
Authors: Bemenderfer Thomas B. , Boersma Jacob B. , Pryor Michael J. , Maskill John D. , Anderson John G. , Bohay Donald R. 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Arthrodesis of the first tarsometatarsal (TMT-1) joint is a widely accepted procedure for treatment of hallux valgus (HV) with medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high intermetatarsal angles (IMA). Similarly, metatarsophalangeal fusion (MTP-1) has been suggested for severe hallux valgus, metatarsophalangeal arthritis, and severe or recurrent deformities. Prior studies have demonstrated early outcomes in a small sample of patients. This study aimed to evaluate clinical and radiographic outcomes in patients with severe HV who underwent concomitant TMT-1 and MTP-1 arthrodesis for severe HV. Methods: All patients with symptomatic severe HV who failed conservative management and underwent concomitant MTP-1 and TMT-1 arthrodesis between January 2006 to December 2018 were included in our retrospective case series. Patients were operated on by one of three senior foot and ankle surgeons at a single tertiary center. Demographics, clinical outcomes, patient comorbidity information, and radiographic outcomes including baseline hallux valgus angle (HVA), IMA 1-2, hallux valgus interphalangeus angle, distal metatarsal articular angle, and sesamoid station were collected. The primary outcome was reoperation. Secondary outcomes were minor complications (local wound care, use of antibiotics, and skin dehiscence), visual analogue scale (VAS) pain scores, and change in radiographic measurements. Results: From 2006 to 2018, 42 patients (21.4% male, 78.6% female) at an average age of 62.6 years (range 48 to 80) met inclusion. At final average clinical follow up of 28 months, there were a total of 23 reoperations in 35.7% of patients at an average 18.5 months from index surgery (n=15; 1 revision TMT, 2 revision MTP, 1 hallux interphalangeal (IP) fusion, and 11 hardware removal). Minor complications were present in 7.1% of patients (n=3; 3 local wound care, 2 use of antibiotics, and 3 skin dehiscence). Average VAS score preoperatively and postoperatively was 5.5 to 1.9, respectively. Average preoperative HVA and IMA 1-2 angles were 35.6 and 15.3 degrees compared to postoperative angles of 9.0 and 9.3 degrees, respectively. Conclusion: The present study demonstrates concomitant MTP-1 and TMT-1 arthrodesis in cases of HV secondary to medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high IMA has a high correction capability and achieved normal HVA as well as normal IMA 1-2 at greater than two years. Concomitant MTP-1 and TMT-1 arthrodesis in patients with severe HV appeared to be safe and clinically successful.
A Prospective Assessment of Great Toe Fusion Outcomes: The Effect of Concomitant Procedures
Authors: Berkowitz Mark J. , Miniaci Sara-Lyn , Davis Alan , Ramanathan Deepak , Hasan Khalid , Strnad Greg , Coombs Jeffrey , Jin Yuxuan , Spindler Kurt P. , Pinney Stephen J. 
Published: November 2020

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Great toe fusion is the standard of care for severe hallux rigidus and other great toe pathology requiring definitive surgical management. Great toe fusion has proven an effective surgical treatment when correctly performed on appropriate patients. This study aimed to prospectively assess the clinical results of great toe fusion surgery in isolation compared to great toe fusion surgery combined with concomitant procedures. Methods: All patients undergoing a 1st metatarsophalangeal joint fusion from January 1st 2017 through June 30th 2018 were prospectively studied. Patients completed the Foot and Ankle Outcome Score (FAOS) and Veterans RAND 12 (VR-12) patient- reported outcome measures (PROMs) on the day of surgery (T0) and 12 months post-surgery (T1). Surgeons were surveyed regarding surgical details and patient characteristics. 204 patients underwent a great toe fusion during the study period. There were 67 enrollment failures (2 patient refusals, 63 incomplete T0 patient surveys, 2 incomplete surgeon surveys). Of the 137 patients completing the initial PROMs at T0, 100 patients (73%) also completed the PROMs at T1. Within this study group, 54 patients underwent an isolated great toe fusion and 46 underwent one or more concomitant procedures including hammertoe correction (30); MTP joint capsulotomy (22); Weil osteotomy (19); bunionette (2); metatarsal head resection (3); and other (12). Results: The study group consisted of 80 females and 20 males with age = 63.3 +/-8.5 and BMI = 28.3 +/-6.0. Indications for surgery included: hallux rigidus (26%), hallux valgus (35%), hallux varus (7%), arthritic bunions (30%) and other (2%). Fixation constructs included: a plate and a lag screw (82%), a plate alone (15%), and lag screws alone (3%). Patients undergoing isolated great toe fusions and those undergoing concomitant procedures both improved at one year (Table 1). Multivariable analysis demonstrated that after controlling for confounding variables, patients undergoing an isolated great toe fusion when compared to those also undergoing a concomitant procedure had higher odds for improvement in: FAOS pain (odds Ratio = 0.34, p=0.011); FAOS QoL (Odds Ratio=0.38, p=0.022); and VR-12 PCS (Odds Ratio=0.58, p=0.162). Conclusion: A great toe fusion can lead to substantial improvement in pain, quality of life, and overall physical function. However, this study demonstrates that the addition of a concomitant procedure such as a claw toe correction or a Weil osteotomy leads to an inferior outcome with respect to pain and quality of life when compared to an isolated great toe fusion. [Table: see text]
Salvage Tibiotalocalcaneal Arthrodesis Augmented with Fibular Columns and Iliac Crest Autograft: A Technical Note
Authors: Bernasconi Alessio , Patel Shelain , Malhotra Karan , Singh Dishan B. , Welck Matthew J. , Cullen Nicholas 
Published: November 2020

Category: Ankle; Ankle Arthritis Introduction/Purpose: End-stage ankle arthritis may be managed with ankle arthrodesis or total ankle replacement (TAR). Failure of these procedures results in a challenging clinical situation. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required. Bone grafting may be necessary to maintain length and reduce disability, and fibular strut grafting in form of ‘pillars’ or ‘columns’ may be used in association with intramedullary TTC nailing. In our experience, fibular column autograft may be supplemented with tricortical and cancellous iliac crest graft and stabilised with cannulated screws and either an intramedullary nail or a lateral plate. In this technical note, we review the history of this technique and report indications, surgical approach, results and complications. Methods: A distal J-shaped lateral approach is performed over the posterior edge of the distal fibula. An oblique fibular cut is made with a saw at 8- 12 cm from the fibular tip. Careful removal of the implant, previous cement spacer or metalwork is performed then articular surfaces are prepared. After assessment of the articular gap, the autograft is prepared by removing the tip of the fibula from the fibular block, then sectioning it in to either three or four columns which are positioned into the gap and stabilised either in a press-fit fashion or using 1.6mm K-wires. Six patients (4M, 2F; mean age: 69.8 years (range, 51 to 83)) were treated between December 2018 and March 2019 (5 failed TAR and 1 was symptomatic tibiotalar non-union) at our institution. Fixation was achieved in 5 cases with a locked intramedullary nail and in 1 case with a lateral locking plate. Results: At a mean follow up of 10 months (range, 6 to 11 months), 4 patients had clinically and radiologically united and were satisfied with the outcome of surgery. Two patients remained dissatisfied having not united: one patient with a background of chronic kidney disease had raised inflammatory blood markers at 10 months and is undergoing investigation to exclude infection whilst one other patient with no obvious risk factors for non-union has started low intensity pulsed ultrasound treatment at 6 months. No other complications were observed. Conclusion: Tibiotalocalcaneal fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and the subtalar joint pathologies with significant talar bone loss. However larger studies with longer follow-up are required to define the rates of success and failure with future research directed to better understand which factors may predict the outcome.
Fractures of the Tibial Plafond: Does the Presence or Absence of a Fibular Fracture Predict Future Morbidity?
Authors: Boateng Henry , Walley Kempland C. , Nwachuku Chinenye , Lands Vince , Walker Justin W. , Mirza Muhammad Z. , MacNeille Rhett , Tornetta Paul , Reid Spence 
Published: November 2020

Category: Trauma; Ankle Introduction/Purpose: Surgical management pilon fractures continue to be a challenge for orthopedic surgeons. Despite a staged protocol, anatomic reduction, and stable fixation, many patients will require secondary procedures including ankle arthrodesis to treat painful post-traumatic arthritis. Some investigators have correlated the absorbed energy at the time of the injury with the natural history of the pilon fracture despite the quality of the surgical reconstruction. We hypothesize that the presence of an intact fibula in association with an OTA Type C pilon fracture may be a marker for a strict axial compression mechanism resulting in more severe cartilage compression and a poor late outcome. No studies to date have correlated the presence of an intact fibula to pilon fracture outcomes. Methods: An IRB approved 7-year retrospective study was performed at three Level I Trauma Centers. Inclusion criteria included all adult patients (>=18) with isolated OTA type B or C pilon fractures from 2008 through 2014. All patients were treated in a staged fashion with initial external fixation by fellowship-trained orthopedic traumatologists. The primary outcome measurement was ankle arthrodesis. Secondary measurements included infection. Binary logistic regression models were used to evaluate the prognostic factors of arthrodesis and infection. Results: A total of 239 patients met inclusion criteria for analysis: 33-patients (13.81%) had open injuries, 155 (64.85%) had a C type pilon fracture and 157 fractures (65.69%) presented with an associated fibula fracture. Only 12 patients (5.02%) progressed to ankle arthrodesis. The incidence of fusion in the intact fibula group was 5 (6.10%) similar to that of 7 (4.46%) of patients with an associated fibula fracture. It was found that OTA Type C pilon fractures (OR (95% CI): 6.34 (0.80, 49.98), p=0.08), intact fibulas (OR (95% CI): 1.39 (0.43, 4.53), p=0.58), and open injuries (OR (95% CI): 2.19 (0.56, 8.55), p=0.26) were more likely to result in eventual arthrodesis compared to OTA Type B pilon fractures, fractured fibulas, and closed injuries, respectively. Conclusion: The results of this study suggest an adverse relationship for closed complex pilon fractures with an intact fibula. This was especially pronounced in C type injuries in comparison to type B injuries with a 6.34 odds ratio of subsequent fusion. The data approached statistical significance and may have clinical relevance in the decision making and patient counselling for managing these fractures. Pilon fractures historically have had poor outcomes and a higher rate of secondary surgeries which was surprisingly low in our current study. Further study needs to determine if this observation correlates with improved patient outcomes. [Table: see text]
Postoperative Opioid Dependence following Orthopaedic Foot and Ankle Surgery: A Cohort Study of 448 Patients
Authors: Bohl Daniel D. , Hejna Emily , Mehraban Nasima , Lin Johnny L. , Holmes George B. , Lee Simon , Hamid Kamran S. 
Published: November 2020

Category: Other Introduction/Purpose: Surgeon prescription of narcotic medications has been identified as a contributor to the nation’s devastating opioid epidemic. The purpose of this study is to identify risk factors for postoperative opioid dependence following orthopaedic foot and ankle surgery. Methods: Four hundred and forty-eight patients undergoing orthopaedic foot and ankle surgery at a single institution over a 6- month period were identified. The Illinois Prescription Monitoring Program was used to track opioid prescriptions filled in the preoperative, perioperative, and postoperative periods. Preoperative use was defined as the filling of a prescription during the six months prior to the procedure, excluding the 30 days prior to the procedure. Postoperative dependence was defined as the filling of opioid prescriptions beyond the initial postoperative prescription. Baseline characteristics, including preoperative opioid use, were tested for association with opioid dependence. Results: The rate of preoperative opioid use was 20.5%. The rate of postoperative opioid dependence was 31.3%. Patients who used opioids during the preoperative period had the highest risk for postoperative opioid dependence, at 59.6% (RR=2.5, 95% confidence interval = 1.9-3.2, p<0.001; Table 1). Other baseline characteristics associated with postoperative opioid dependence included antiepileptic use (RR=1.8, p=0.001), recreational drug use (RR=1.7, p=0.022), Charlson comorbidity index >= 2 (RR=1.6, p=0.002), benzodiazepine use (RR=1.5, p=0.010), current smoker status (RR=1.5, p<0.001), age >=60 years (RR=1.4, p=0.022), body mass index >= 30 kg/m2 (RR=1.4, p=0.027), antidepressant use (RR=1.4, p=0.050), and <1 drink per week (RR=1.3 p=0.045). Conclusion: The single strongest predictor of postoperative opioid dependence was preoperative opioid use, which was associated with more than a doubling in risk. Of note, the chronicity of the foot or ankle condition did not predict postoperative opioid dependence. Preoperative discussion of opiate treatment duration, multimodal pain management strategies and judicious prescription of narcotics should be considered in patients with the above-noted risk factors in an effort to avoid dependence on this potentially addictive and harmful class of medications. [Table: see text]
Routine Fixation of Weber B Fibula Fractures with a Lateral Locking Plate and No Lag Screw
Authors: Bohl Daniel D. , Mehraban Nasima , Foran Ian , Hamid Kamran S. 
Published: November 2020

Category: Ankle Introduction/Purpose: The current standard of care for management of an unstable ankle fracture that includes an oblique Weber B fibula fracture is open reduction and internal fixation (ORIF) using a plate and screws to anatomically reduce and compress the fractured fibula. The most popular first-line techniques include either a lag screw with neutralization plate or an anti- glide plate with or without a lag screw through the plate. However, these techniques can be technically challenging in osteoporotic bone or within fibulas of smaller diameter, and in some cases can result in fragmentation at the fracture site. The purpose of this study is to examine an alternative first-line method for routine treatment of Weber B fibula fractures. Methods: Fifty-two patients undergoing ORIF of a Weber B fibula fracture by a single surgeon were included in this retrospective study. In every case, reduction and clamping of the fracture was attempted. If successful, a lateral locking plate was slid underneath the clamp(s) and applied with cortical screws proximally and locking screws distally. If clamping was unsuccessful, length/alignment/rotation was achieved by alternative methods (i.e. push-pull technique, use of plate to reduce fracture, etc.), and a lateral locking plate was ultimately applied in a similar manner. No screw crossed the fracture in any case. Per published precedent, nonunion was defined as either a gap of >3mm between fracture surfaces >6 months postoperatively or a fracture line >2-3 mm wide and sclerosing of the fracture surfaces >6 months postoperatively. Similarly, malunion was defined as >=1 of the following: talar tilt >2 degrees, talar subluxation >2 mm, or tibiofibular clear space >=5 mm. Results: The mean (+- standard deviation) age of the 52 included patients was 44.2 +- 16.2 years, the mean body mass index was 27.7 +- 6.6 kg/m2, and 63.5% of patients identified themselves as female. The mean follow-up was 6.2 +- 4.4 months. In addition to undergoing fixation of the lateral malleolus, 21 patients also underwent fixation of the posterior malleolus, 27 underwent fixation of the medial malleolus, 29 underwent fixation across the syndesmosis, and seven underwent repair of the deltoid. In all patients, bony anatomic union of the fibula and congruence of the mortise were achieved, with no cases of malunion or nonunion. Conclusion: Routine fixation of Weber B fibula fractures with a lateral locking plate and no lag screw is an alternative method to treat Weber B fibula fractures with excellent radiographic results.
Headless vs. Headed Screws Fixation for Calcaneal Osteotomy and Subtalar Arthrodesis: What’s the Cost?
Authors: Boren Morgan , Steginsky Brian D. , Vora Anand M. , Suhling Mallory 
Published: November 2020

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Screw prominence in the heel following calcaneal fixation has resulted in unacceptably high rates of symptomatic hardware and subsequent screw removal. The hardware removal rate following calcaneal screw fixation ranges from 11-50%. We are unaware of any cost analysis comparing headed screw fixation vs. headless screw fixation in the foot and ankle literature. Furthermore, there is no literature comparing the rate of subtalar arthrodesis following headed screw fixation vs. headless screw fixation. Methods: CPT codes were used to identify all patients that had a subtalar arthrodesis or displacement calcaneal osteotomy (with screw fixation) performed by a single orthopedic foot and ankle surgeon between 2010 and 2016. The cohort was divided into two groups by the type of screw fixation, 7.0 mm headless screw or 6.7 mm headed screw. Exclusion criteria included <2 years from the index surgery and AVN of the calcaneus or talus. Retrospective chart review was performed to collect demographic data, complications, and cause for screw removal. The primary outcome measure was the rate of symptomatic screw removal. Secondary outcome measure included subtalar arthrodesis as determined by CT or radiographic review. The expense associated with symptomatic hardware removal was determined and cost analysis was performed for the two groups. Results: Seventy-six patients underwent headless screw fixation for calcaneal osteotomy or subtalar arthrodesis, and only two patients (2.6%) required symptomatic screw removal. Fifty-four patients underwent headed calcaneal screw fixation, and twelve patients (22.2%) required symptomatic screw removal. Symptomatic hardware removal was performed more frequently in the headed screw group (p< 0.001). There was no difference in the rate of nonunion after subtalar arthrodesis between the two groups (p = 0.363). The calcaneal osteotomy healed in 100% of patients in both groups. The cost associated with isolated screw removal was compared for private insurance and Medicare at an outpatient surgery center. There was a $51,755 cost savings per 100 cases using headless screw fixation compared to headed screw fixation. Conclusion: The rate of symptomatic screw removal following calcaneal osteotomy or subtalar arthrodesis is lower with headless screw fixation compared to headed screw fixation. There was no difference in the rate of subtalar union between the two groups as a secondary outcome, but the study was underpowered. Although the headless screw implant is more expensive, cost analysis demonstrates a significant benefit when the expense of hardware removal is considered.