bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Pre-Operative Mental Health and Depression on Outcomes after Total Ankle Arthroplasty
Authors: Cunningham Daniel J. , Steele John , Adams Samuel B. 
Published: November 2020

Category: Ankle Introduction/Purpose: Poor pre-operative mental health and depression have been shown to negatively impact patient- reported outcomes (PROMs) after a broad array of orthopaedic procedures involving the spine, hip, knee, shoulder, and hand. However, the relationship of mental health and patient-reported outcomes in foot and ankle surgery is less clear. The purpose of this study is to characterize the impact of pre-operative mental health and depression on patient-reported outcomes after total ankle arthroplasty. The study hypothesis is that depression and decreased SF36 MCS will be significantly associated with diminished improvement in PROMs after total ankle arthroplasty. Methods: All patients undergoing primary TAA between January 2007 and December 2016 who were enrolled into a prospective, observational study and who had at least 1 to 2-year minimum study follow-up were included. Patients were separated into 4 groups based on the presence or absence of SF36 MCS<35 and diagnosis of depression. Pre-operative to post- operative change scores in the SF36 physical and mental component summary scores (PCS and MCS), Short Musculoskeletal Function Assessment (SMFA) function and bother components, and visual analog scale (VAS) pain were calculated in 1 to 2-year follow-up. Multivariable, main effects linear regression models were constructed to evaluate the impact of SF36 and depression status on pre-operative to 1 to 2-year follow-up change scores with adjustment for age, sex, race, body mass index, current smoking, American Society of Anesthesiologist’s score, smoking, and Charlson-Deyo comorbidity score. Results: As in Table 1, adjusted analyses demonstrated that patients with MCS<35 and depression had significantly lower improvements in all change scores including SF36 MCS (-5.1 points) and PCS (-7.6 points), SMFA bother (6 points) and function scores (5.7 points), and VAS pain (7.5 points) compared with patients that had SF36>=35 and no depression. Patients with MCS<35 and no depression had significantly greater improvement in SF36 MCS (5.3 points) compared with patients that had MCS>=35 and no depression. Patients with MCS>=35 and depression had significantly lower improvement in SF36 MCS (-3.2 points) compared with patients that had MCS>=35 and no depression. Adjusted analyses of minimum 5-year outcomes demonstrated significantly increased improvement in MCS and SMFA function for patients with pre-operative MCS<35 and no depression. Conclusion: Presence of depression and decreased SF36 MCS are risk factors for diminished improvement in PROMs. Patients with depression and decreased MCS should be counseled about their risk of diminished improvement in outcomes compared to peers. As PROM’s become part of physician evaluations, it is becoming increasingly important to identify factors for diminished improvement outside of the physician’s control. [Table: see text]
Periprosthetic Fracture of the Talus following Total Ankle Replacement: A Case Series
Authors: Day Jonathan , Kim Jaeyoung , Ellis Scott J. , Deland Jonathan T. , O’Malley Martin J. , Demetracopoulos Constantine A. 
Published: November 2020

Category: Ankle; Ankle Arthritis; Trauma Introduction/Purpose: Although total ankle replacement (TAR) for the treatment of end-stage ankle arthritis has been shown to have excellent radiographic and clinical outcomes, there is a risk for complications such as periprosthetic fractures. While periprosthetic fractures of the tibia are well described in the literature, little is known about such fractures involving the talus. The purpose of this case series is to describe the radiographic findings and surgical management of talar fractures sustained after placement of total ankle prostheses. Methods: We retrospectively reviewed 489 patients who underwent total ankle replacement from June 2015 to March 2019, and identified five cases (2 males, 3 females, average age 45.7 years) in which patients sustained a periprosthetic fracture of the talus. All patients presented symptomatically with ankle pain during postoperative follow-up, and fractures of the talus were confirmed on computed tomography (CT) imaging. One patient had psoriatic arthritis and four patients had primary osteoarthritis of the ankle. CTs were reviewed to confirm location and pattern of the fracture, as well as related pathology such as osteolysis and subsidence. Hospital charts and operative reports were reviewed to record patient demographics and postoperative management including reoperations. Results: Overall the incidence of talar fractures was 1% (5/489) and all occurred in implants with a talar stem (4 INBONE II, 1 Salto Talaris). All fractures extended from the stem of the talar component into the subtalar joint, with one case of a non- displaced fracture. Osteolysis surrounding the talar stem was observed in all cases, with subsidence of the talar component observed in four out of five patients on CT. All five patients presented symptomatically and underwent reoperation (1 revision of talar component with ORIF, 3 subtalar fusions, 1 tibiotalar fusion). Conclusion: The findings in this case series suggest that periprosthetic fractures of the talus following total ankle replacement is a possible complication of stemmed implants and is associated with poor clinical outcomes requiring reoperation. Therefore, a periprosthetic fracture of the talus should be considered in a patient with unexplained pain and evidence of radiographic osteolysis around the stemmed component. [Table: see text]
Severe Ankle Varus Malalignment Management with a Fix-Bearing Total Ankle Replacement Implant
Authors: Silvestri Claudia A. Di , D’Ambrosi Riccardo , Maccario Camilla , Indino Cristian , Usuelli Federico Giuseppe 
Published: November 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: Despite Total ankle replacement (TAR) is currently considered a safe procedure and an optimal alternative to ankle fusion in end-stage ankle arthritis, still the precise indications and the limits of TAR are a highly controversial topic. Coronal malalignment correction with TAR is also a widely debated point. Purpose of this work was to confront two patient groups undergoing Total Ankle Replacement (a group of patients with a pre-operative ankle varus misalignment on coronal plane, versus a group of patients with neutral pre-operative ankle alignment) comparing clinical and radiographic results, complications and survival rate of the implant. Methods: 171 patients, all affected by end-stage ankle arthritis and all treated with total ankle replacement with fix-bearing Trabecular Metal Total Ankle System (Zimmer-Biomet, Warsaw IN, USA), were divided in two groups. Group ‘A’ included 159 patients having a normal alignment or a slight valgus or valgus misalignment within 10°. Group ‘B’ included 12 patients with a pre- operative varus malalignment >10°. Each patient of the study was evaluated, clinically and radiologically, before and after surgery, and subsequently at 6 and 12 months follow-up, then once every year. Clinical evaluation comprised some score: visual analogue scale (VAS); American Foot and Ankle Society Score (AOFAS); and the Short Form (SF)-12 Quality of Life, in both of its ‘physical’ (PCS) and ‘mental’ (MCS) components. Radiological evaluated parameters were: tibio-talar surface angle (TTS), lateral distal tibial angle (LDTA-α), and anterior distal tibial angle (ADTA-β). Complications and implant survival rate were evaluated for both groups. Results: At a mean follow up of 2,75 years (range 2.09-5.66 years), improvement was found in all clinical and radiological evaluated parameters of two groups, without statistically significant differences between two groups at last follow-up. In group A most frequent reported complication was the presence of a fibular symptomatic hardware. Major complication were a deep arthroplasty infection and a 3 months post-operative ankle fracture-dislocation/periprostethic fracture. In group B there were 2 delayed wound healing, and one case of loosening of correction. No significant difference in complication and revision rate comparison between two groups was founded. Conclusion: Mid-term results reported in the present show that in patients with varus greater than 10 ° it is possible to obtain a post-operative alignment similar to pre-operative neutral ankles and that the complication rate is not greater. Despite this, is Authors opinion that major and complex misalignment should be approached by skilled surgeons, with an adequate learning curve experience, with a wide range of cases and in highly specialized centers.
Are Locked Plates Necessary to Maintain Reduction in the Treatment of Geriatric Ankle Fractures?
Authors: Dib Aseel G. , Crocker Caitlin Curtis , Prather John C. , Johnson Michael D. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Treatment of geriatric fractures are unique in their perioperative and postsurgical complications. Increased age, increased number of comorbidities, and decreased bone quality present a significant challenge when treating geriatric fractures, including ankle fractures. Recent studies have hypothesized using locking plates will lead to better outcomes compared to non-locking plates in geriatric ankle fractures. Conventional non-locking plates depend on the bone quality and screw-plate friction in order to achieve proper fixation and stability whereas locking plates do not. Locking plates are common in this patient population due to greater rigidity and biomechanical stability while not relying on bone quality to maintain fixation. This study aims to determine if locking plates are necessary to maintain reduction in geriatric ankle fractures. Methods: After approval from the Institutional Review Board, a retrospective chart review was performed on all patients 60 years or older sustaining an ankle fracture between 2012-2018. Patients with less than 3 months follow-up at the time of injury were excluded. Each patient underwent surgical fixation at the discretion of the attending surgeon for bimalleolar or trimalleolar ankle fractures. The following patient information was collected from the charts: age, mechanism of injury, and comorbidities. Radiographic review was performed to determine open or closed fracture status, the type of fracture pattern and presence or absence of a syndesmotic injury. Patient radiographs from the most recent follow-up were analyzed for maintenance of reduction and use of a locking or non-locking plate. Statistical analysis was performed using the Chi Square Test for significance and the Fisher’s Exact Test when necessary. Results: Out of 218 patients, 143 received locking plates (L) and 75 received non-locking plates (NL). There were 99 bimalleolar fractures (69.2%) and 44 trimalleolar fractures (30.8%) in the L group. The NL group had a higher percentage of trimalleolar fractures, 50.7% (38), with 37 bimalleolar fractures (49.3%) (p=0.004). The two groups did not differ in terms of mechanism of injury (p=0.906), high energy (39.2% in L and 41.3% in NL, p=0.773), and open fractures (24.5% in L and 17.3% in NL, p=0.227). Upon radiographic review, 142 patients in the L group (0.7%) and 72 patients in the NL group (4.0%) maintained reduction (p=0.119). Loss of reduction in the L group was a trimalleolar fracture whereas 2 bimalleolar and 1 trimalleolar fractures in the NL group. Conclusion: Our study demonstrates that there is not a greater loss of reduction when utilizing locking plates. Surgeons should keep this in mind when choosing constructs for fixation of geriatric ankle fractures.
Impact of Socioeconomic Status on Return to Work after Acute Ankle Fracture
Authors: Falk Alessandra L. , Hanstein Regina , Kulsakdinun Chaiyaporn 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Socioeconomic status has been recognized throughout the medical literature, both within orthopedics and beyond, as a factor that influences outcomes after surgery, and can result in substandard care. Within the foot and ankle subspecialty, there is limited data regarding socioeconomic status and post-operative outcomes, with the current literature focusing on outcomes for diabetic feet. However, ankle fractures are among the most common fractures encountered by orthopedic surgeons. While a few studies have explored the impact of ankle fractures on employment and disability status, the effect of socioeconomic status on return to work post operatively has not yet been investigated. The purpose of this study was to determine the impact of low socioeconomic status on return to work. Methods: We retrospectively reviewed 592 medical charts of patients with CPT code 27766, 27792, 27814, 27822, 27823, 27827, 27829, 27826, 27828 from 2015-2018. Included were patients >18 yrs of age who sustained an acute ankle fracture, were employed prior to the injury, and with information on return to work after ankle surgery, zip code, race, ethnicity and insurance status. Excluded were patients who were not employed prior to their injury. Socioeconomic status was either defined by insurance status - Medicaid/Medicare, commercial, or workman’s compensation -, or by assessing socioeconomic status (SES) using medial household per capita income by zip code as generated and reported by the US National Census Bureau’s 2013-2017 American Community Survey 5-Year Estimates. The national dataset was divided into quartiles with the lowest quartile defined as low SES. Patients who had income that fell within this income category were classified as low SES. Results: 174 patients were included with an average follow-up of 10.2months. 22/174 (12.6%) patients didn’t return to work post-operatively. Univariate analysis identified non-sedentary work to decrease the likelihood of return to work (HR:0.637; p=0.03). Patients with a low SES were more prevalent in the no return group compared to the return to work group (86% vs 60%; p=0.028). 95% of patients with low SES were a minority compared to 56% with average/high SES (p<0.005). Patients with low SES had a higher BMI (p=0.026), a longer hospitalization (p=0.04) and more wound complications (p=0.032). Insurance type didn’t affect return to work (p=0.158). Patients with workman’s compensation had a longer follow-up time and a longer time to return to work compared to other insurances (p<0.005 for each comparison). Conclusion: Low socioeconomic status based on income, not insurance type, affected return to work after an ankle fracture ORIF. Patients with workman’s compensation took a longer time to return to work compared to other insurance types. These findings warrants the need to consider socioeconomic status when allocating resources to treat these patients.
The Efficacy of Unfocused Extracorporeal Shock Waves for the Treatment of Achilles Tendinopathy
Authors: Fansa Ashraf M. , O’Malley Martin J. , Hurley Eoghan T. , Kennedy John G. 
Published: November 2020

Category: Sports Introduction/Purpose: Extracorporeal shock wave therapy (ESWT) may be a viable non-invasive treatment modality for patients suffering from Achilles Tendinopathy. There seems to be a relationship between the ESWT protocol and patient outcomes. Data suggest that higher energy levels of shock waves together with adequate treatment delivery to the affected area is necessary to achieve favorable outcomes. The aim of this study is present our experience with the use of electrohydraulically produced unfocused extracorporeal shock waves for the treatment of Achilles Tendinopathy. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had received ESWT for plantar fasciitis heel pain between January 2013 and September 2018. The primary outcomes included change in pain intensity on the visual analog pain scale and patient satisfaction at final follow-up. Pre and post-procedure Foot and Ankle Outcome Scores were also assessed for change. Results: A total of 158 patients (179 heels) were followed-up for a mean duration of 17 +- 6.8 months post ESWT. The mean pre-ESWT pain VAS improved from 7.2 +- 1.4 to 2.3 +- 2.1 (p< 0.001) at final follow-up. The FAOS Symptoms, Pain, Function of Daily Living, Function of Sports and Recreational activities and Quality of Life domains improved from 57.7 +- 12.7 to 79.7 +- 13.6 (p< 0.001), from 35 +- 15.8 to 72.6 +- 22 (p< 0.001), from 43.8 +- 15.3 to 81.4 +- 11 (p< 0.001), from 41.2 +- 21.3 to 66.4 +- 18.3 (p< 0.001) and from 33.9 +- 17.4 to 78 +- 24.4 (p< 0.001), respectively. Overall, 85.4% were satisfied with the procedure at final follow-up. Conclusion: For patients with Achilles tendinopathy, unfocussed extracorporeal shock wave therapy appears to be a safe and viable non-invasive treatment option with a patient satisfaction rate of 85.4% and a 68% reduction in patient reported pain intensity.
All-Inside Arthroscopic Cancellous Allograft for the Large Cystic Osteochondral Defect of the Talus
Authors: Feng Shi-Ming 
Published: November 2020

Category: Arthroscopy; Sports; Trauma Introduction/Purpose: The purpose of this study was to evaluate the surgical technique and long-term clinical outcomes of all- inside arthroscopic treatment for large cystic osteochondral defect of the talus with the use of cancellous allograft. Methods: Eight patients admitted from January 2016 to October 2018 by our hospital for large cystic osteochondral defect of the talus was retrospectively analyzed with their complete follow-up data. The subjects consisted of 5 males and 3 females, aged between 27 to 50 years, and with an average age of 34.2 years. All of these cystic osteochondral defects were larger than 15 mm in diameter, sized 1.3cm3 to 5.2cm3. The visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Karlsson Ankle Functional Score (KAFS) and subjective satisfaction survey rating were obtained. CT scan and magnetic resonance imaging of the ankle were obtained before and after surgery. Results: All incisions were healed in the first stage, and no complications such as nerve, blood vessel and tendon injuries occurred. All patients were available for follow-up at a mean of 26.2 months (range, 18 to 48 months). By the last follow-up, the postoperatively AOFAS 、 KAFS scores were 86.5 and 84.2 compared with 60.8 and 59.3 preoperatively, respectively. And the mean VAS score decreased from 6.4 preoperatively to 1.1. The range of motion of the ankle joint was normal and returned to the pre-pain state for these patients. Six patients rated their result as excellent, 2 as good and none as fair. Conclusion: All-inside arthroscopic cancellous allograft was an effective option for the treatment of large cystic talus osteochondral defects.
Chronic Lateral Ankle Instability with Subtalar Instability: Does Lateral Ligaments Reconstruction Reliable?
Authors: Feng Shi-Ming 
Published: November 2020

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: To evaluate the functional outcomes of arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability with subtalar instability during short term follow-up Methods: We retrospectively analyzed data in 8 patients (5 males, 3 females; 2 left ankles, 6 right ankles) aged between 21 and 49 years, with an average age of 31.74 +- 8.48 years presenting with CLAI with subtalar instability from Auguse 2015 to October 2018. The duration of the symptoms lasted for 12 to 43 months, with an average of 24.26 +- 10.17 months. All patients underwent arthroscopic anatomical reconstruction of ATFL and CFL. Pre- and postoperative visual analogue scales (VAS), the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS) and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation Results: After surgery, all incisions healed in stage I and there were no complications. All patients were followed for 12 to 36 months, averaging 26.15 +- 9.34 months. At the final follow-up, the ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and subtalar, and all patients returned to normal gait. The mean VAS score decreased to 1.06 +- 0.27, the AOFAS score increased to 93.16 +- 5.26 and the KAFS score increased to 92.01 +- 6.73. All the follow-up indexes were significantly different from those before surgery Conclusion: Arthroscopic anatomical reconstruction of ATFL and CFL in the treatment of chronic lateral ankle instability with subtalar instability is reliable in short term
Hindfoot Arthrodesis using the Medial Approach to Correct Adult Acquired Valgus Flat Feet: A Series of Cases
Authors: Ferraz Gabriel F. , Filho Miguel V. Pereira , Oksman Daniel 
Published: November 2020

Category: Hindfoot Introduction/Purpose: Hindfoot arthrodesis is used in patients with flat feet acquired in advanced stages, usually associated with degenerative joint disease. The objective of the study is to evaluate the clinical and radiographic results of hindfoot arthrodesis using the medial approach. Methods: A prospective cohort of 23 consecutive patients who underwent surgical correction between the years 2012 and 2018 through the hindfoot modeling arthrodesis was evaluated. Clinical assessment was performed using the visual analogue pain scale (VAS), AOFAS score for the hindfoot, SF-36 and FFI (Foot Function Index). Radiographic images were also analyzed, as well as satisfaction criteria. Results: In six procedures, calcanecuboid arthrodesis was included, with a small lateral access route. The average pain score decreased by 6.04 points (p <0.001), with an average final AOFAS of 75.63. Two cases presented talus necrosis, in three there was no consolidation of talonavicular arthrodesis, and in three others, synthesis material was removed. No case presented wound dehiscence and only one needed to treat superficial infection with antibiotics. Conclusion: Arthrodesis to correct adult acquired valgus flat feet can be performed using the medial approach with good clinical results and low rates of healing complications. However, about 25% of the patients had other complications that led to the need for a surgical approach.