bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ten-Year Retrospective Study of Symptomatic Naviculo-Medial Cuneiform Coalition in 18 Young Adults: Hidden Features Observed on Computed Tomography
Authors: Choi Jun Young , Suh Jin Soo 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: To the best of our knowledge, there are no previous reports comparing the radiographic findings to CT findings for symptomatic naviculo-medial cuneiform (NC) coalition. The purpose of this study was to demonstrate and compare the features of symptomatic naviculo-medial cuneiform coalition between radiography and computed tomography (CT). Methods: We retrospectively reviewed the radiographic and CT findings of 25 symptomatic naviculo-medial cuneiform coalition cases in 18 patients. The existence of a large pit (depth >3 mm), irregular articular surface, joint space narrowing, dorsal bony spur, subchondral sclerosis, multiple subchondral bony cysts, and intra-articular loose bodies were evaluated on radiograph or CT. The size of the largest subchondral bony cyst was also measured using CT. Results: The proportion of large pit observed on radiograph (52.0%) was significantly different (P = .001) from that on CT (72.0%). Similarly, intra-articular loose bodies were observed more frequently on CT (P = .001). The mean size of the largest subchondral bony cyst on CT was 4.25 mm. Conclusion: While evaluating CT in patients with naviculo-medial cuneiform coalition, physicians should focus on detecting a large pit and intra-articular loose bodies since differences in these features were frequently observed between radiograph and CT, with these findings being more evident on CT. We believe that a large subchondral bony cyst could also be related to the symptoms of naviculo-medial cuneiform coalition.
Two-Year Outcomes of Total Ankle Replacement with the Cadence Total Ankle Replacement System
Authors: Daniels Timothy R. , Kayum Shahin , Khan Ryan M. , Sanjevic Anastasia 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Over the last few decades, total ankle replacement (TAR) emerged as a reliable treatment option in end-stage ankle osteoarthritis (OA) while preserving motion and physiological load. The Cadence™ prosthesis, manufactured by Integra LifeSciences, is a two-component, fixed-bearing implant with minimal tibial and talar resection and has been in clinical use since June 2016. The purpose of this study is to assess the two-year validated clinical outcome scores and radiological parameters of the Cadence™ prosthesis at our hospital. Methods: Thirty-one consecutive patients who received the Cadence™ prosthesis between June 2016 and December 31st, 2016 were enrolled. All patients who underwent a primary TAR with the Cadence™ prosthesis and who had at least two years follow- up were included. All surgeries were performed by a single surgeon with experience in total ankle arthroplasty. At the yearly clinical evaluation, patients were administered the Ankle Osteoarthritis Scale (AOS) and the Short Form Health Survey (SF-36), and their radiological outcomes pre and post-surgery were assessed. Results: Thirty-one patients fulfilled the inclusion criteria. Forty ancillary procedures were performed on twenty-four TAR’s. Radiological analyses showed preoperative talar sagittal translation with 25 anterior, 2 posterior, and 4 neutral. Sagittal translation decreased from an average 3.11 mm to 1.0 mm. Eleven ankles had a perioperative talar Varus and Valgus deformity that was corrected, with neutral alignment in all. At the two-year clinic visit, x-rays showed no lucencies or stress fractures and none of the ankles required revision of metal components. The pre and post-operative pain and disability scores displayed major improvement wherein AOS pain scores decreased -20.28 ± 14.34 points from an average of 47.86 points while AOS disability scores decreased -32.11 ± 22.70 from an average of 57.15 points. Conclusion: The overall outcome of the total ankle arthroplasty with the Cadence™ prosthesis showed excellent clinical and radiological outcomes. Compelling clinical evidence shows that the quality of life, functional measures, and pain in patients suffering from end-stage arthritis significantly improved following surgery with the Cadence™ total ankle replacement system. The semi- constrained design of this two-component implant and utilization of biased polyethylene inserts allowed for correction of the talus in both the sagittal (talar anterior / posterior translation) and coronal planes (talar varus / valgus).
Initial Evaluation by a Nonoperative Provider Does Not Delay the Surgical Care of Operative Ankle Fractures in a Walk-in Orthopaedic Clinic
Authors: Fournier Matthew N , Cline Joseph T , Seal Adam , Smith Richard A , Bettin Clayton C , Murphy Garnett A 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Walk-in and “afterhours” clinics are a common setting in which patients may seek care for musculoskeletal complaints. These clinics may be staffed by orthopaedic surgeons, nonsurgical physicians, advanced practice nurses, or physician assistants. If orthopaedic surgeons are more efficient than nonoperative providers at facilitating the care of operative injuries in this setting is unknown. This study assesses whether evaluation by a nonoperative provider delays the care of patients with operative ankle fractures compared to those seen by an orthopaedic surgeon in an orthopaedic walk-in clinic. Methods: Following IRB approval, a cohort of patients who were seen in a walk-in setting and who subsequently underwent surgical treatment for an isolated ankle fracture were retrospectively identified. The cohort was divided based on whether the initial clinic visit had been conducted by an operative or nonoperative provider. A second cohort of patients who were evaluated and subsequently treated by a fellowship-trained foot and ankle surgeon in their private practice was used as a control group. Outcome measures included total number of clinic visits before surgery, total number of providers seen, days until evaluation by treating surgeon, and days until definitive surgical management. Results: 138 patients were seen in a walk-in setting and subsequently underwent fixation of an ankle fracture. 61 were seen by an orthopaedic surgeon, and 77 were seen by a nonoperative provider. No significant differences were found between the operative and nonoperative groups when comparing days to evaluation by treating surgeon (4.1 vs 4.5, p=.31), or days until definitive surgical treatment (8.4 vs 8.8, p=.58). 62 patients who were seen and treated solely in a single surgeon’s practice had significantly fewer clinic visits (1.11 vs 2.03 and 2.09, p<.05), as well as days between evaluation and surgery compared to the walk-in groups (5.44 vs 8.44 and 8.78, p<.05). Conclusion: Initial evaluation in a walk-in orthopaedic clinic setting is associated with a longer duration between initial evaluation and treatment compared to a conventional foot and ankle surgeon’s clinic, but this difference may not be clinically significant. Evaluation by a nonoperative provider is not associated with an increased duration to definitive treatment compared to an operative provider.
A Prospective, Randomized Suture-button vs Screw Syndesmotic Fixation
Authors: Giza Eric , Oliver Todd , Kreulen Christopher , Sathy Ashoke , Faerber Wade , Lin Johnny , Stannard James , Barousse Patrick , Allen Tyler 
Published: October 2019

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Syndesmotic disruption occurs in 10 to 13% of all ankle fractures. It is present in 15 cases per 100,000 of the general population. There has been debate on the best treatment for syndesmotic injuries. The typical surgical treatments include fixation with either screws or suture button devices. The purpose of this study is to compare clinical outcomes of syndesmotic injuries treated surgically with either screws or suture button devices. It was hypothesized that suture button fixation would provide equal clinical results with less need for hardware removal. Methods: This was a multi-center, randomized, prospective clinical trial comparing two surgical interventions for treatment of acute syndesmotic injury. At the time of surgical intervention, subjects were placed into either the screw fixation or the Suture-button device group by opening a randomized envelope in the operating room. Subjects with clinical signs or radiographic evidence of syndesmotic injury were asked to participate in this study. Inclusion criteria was ages 18 to 65 years old with confirmed syndesmotic instability. The primary outcomes of thestudy were VAS scores (activity, pain, satisfaction) and FFI scores (pain, disability, activity) which were collected at preoperative state, 6 weeks, and 12 months postoperatively. Results: Sixty-five subjects were enrolled in this study. Thirty-two subjects received Suture-button fixation (49%) and 33 received screw fixation (51%). VAS scores and FFI scores for subjects treated with the Suture-button device or screw fixation comparing preoperative, six-week, and 12-month scores all showed clinical improvement. There was no significant difference between the two treatment groups (p >0.05). Nine subjects (27%) in the syndesmotic screw fixation group experienced adverse events; four required repeat surgery for symptomatic syndesmotic screw removal, one for revision fixation, and four did not return to surgery despite hardware failure. One subject(3%) in the suture-button group required hardware removal. Conclusion: The short-term clinical outcomes suggest that both syndesmotic screws and suture-button devices are effective treatment options to address acute syndesmotic injuries. In the short-term (12-months), suture-button fixation resulted in significantly less adverse events compared to syndesmotic screw fixation group.
The “AdductoValgus” Foot: Description of Deformity and Technique for Surgical Reconstruction
Authors: Gorman Robert R. 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: The literature is replete with descriptions of metatarsus adductus (pediatric patients) and metatarsus primus varus (adult patients) deformities along with recommendations for treatment. For adult deformities isolated to the first ray, a technique involving a cuneiform-metatarsal arthrodesis (e.g. Lapidus procedure) is often employed. There is a paucity of literature describing adult manifestations of adduction deformities involving multiple metatarsals. The senior author has treated a number of adult patients with these types of deformities. This case series is presented here with a description of the deformity and a technique for surgical reconstruction. Methods: Five patients having undergone surgical reconstruction for symptomatic midfoot/forefoot deformities involving adduction of multiple metatarsals (and valgus metatarsophalangeal joints) were retrospectively reviewed. The first ray deformities were treated with arthrodesis of the first metatarsal to the medial cuneiform, along with a distal soft tissue release and medial eminence resection as appropriate. Lesser ray deformities were corrected with oblique osteotomies of the metatarsal shafts (and metatarsophalangeal joint capsulorraphies and/or pinning as appropriate). Results: All patients went on to radiographic union of their arthrodeses and osteotomies. The midfoot (metatarsus adductus) deformities, and hallux valgus deformities, maintained correction compared to preoperative alignment. There were some lesser metatarsophalangeal joint valgus recurrences. There were no severe complications of deep infection or revision surgery. Conclusion: The “AdductoValgus” foot deformity presents in adult patients with adduction of multiple metatarsals and corresponding metatarsophalangeal joint valgus. The deformity can result in pain with mobility and difficulty with shoewear. Surgical reconstruction including first ray tarsometatarsal arthrodesis and osteotomies of the involved lesser metatarsals appears a viable option for deformity correction and symptomatic relief.
Intramedullary Fixation of Distal Fibula Fractures
Authors: Hanselman Andrew , Scott Daniel , Adams Samuel 
Published: October 2019

Category: Trauma Introduction/Purpose: The current gold-standard for unstable distal fibula fractures is plate and screw fixation; however, intramedullary distal fibular fixation is becoming more commonplace. Although surgeons may consider this technique only for patients requiring extra soft tissue protection, recent studies are showing that it is a safe and effective technique for maintaining adequate reduction and promoting proper fracture healing in a wide-variety of ankle fractures. As newer techniques and equipment are developed, it is important to continue with analyzation of patient outcomes. Our study evaluates a intramedullary device that contains a unique proximal locking mechanism that deploys fins against the inner cortex to help maintain fracture length and control rotation. To our knowledge, no other study in the literature has evaluated this technique for distal fibula fractures. Methods: A retrospective case-series was conducted on all patients >18-years old with unstable ankle fractures treated with the same intramedullary distal fibular fixation, that contained the unique proximal locking system. Surgeries were performed at a single institution by a single surgeon between September 2015 and June 2018. Patient imaging was carefully assessed for quality of reduction using previously established guidelines classifying reductions as “good”, ”fair”, or “poor”. Patient charts were also assessed for comorbidities, initial fracture classification, postoperative complications, and need for additional surgery. Results: Forty-one patients were included in the study. Twenty-five patients were female and 16 patients were male. Average age was 52. Average follow-up was 10.0 months. Eleven fractures were bimalleolar (27%), eight were isolated distal fibula fractures (20%), eight were bimalleolar-equivalent fractures (20%), nine were trimalleolar fractures (22%), and five were pilon fractures (12%). Seventy-one percent were Weber B and 29% were Weber C. Based on the classification system, 37 fracture reductions (90%) were classified as ”good”, four were “fair” (10%), and no reductions were ”poor”. There were no instances of hardware failure, loss of reduction, or nonunion. One patient had a superficial wound infection, one patient had a deep wound infection, five patients require painful hardware removal, and one patient had a delayed union. Conclusion: This large case-series is the first study, to our knowledge, in the Foot and Ankle literature to evaluate this specific intramedullary distal fibular fixation system that contains a unique-proximal fixation mechanism within the canal itself. This technique was used for a variety of unstable ankle fractures and was shown to be both safe and effective, and will help guide future prospective studies comparing outcomes with the gold-standard plate and screw fixation.
Comparison of Tibial and Talar Bone Density as a Function of Resection Level in Patients Undergoing Total Ankle Replacement vs Demographic-Matched Controls
Authors: Harnroongroj Thos , Volpert Lauren , Sturnick Daniel , Sofka Carolyn , Ellis Scott J. , Deland Jonathan , Demetracopoulos Constantine 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: Initial implant fixation is critical for long-term success of total ankle replacement (TAR). One important factor which contributes to implant stability is the quality of the surrounding bone. Previous studies characterized a decrease in bone density with increasing distance from the level of the joint in the tibia and talus in non-arthritic ankles. However, ankle arthritis affects bone density remains unclear. The objective of this study is to compare the bone density in patients with and without ankle arthritis as a function of resection level from the joint. We hypothesized that there would be no difference in bone densities at each resection level between groups and bone density would decrease with greater distance from articular surface in both groups. Methods: We retrospectively reviewed 93 end-stage ankle arthritis patients with available preoperative non-weight bearing ankle computed tomography scans (CT)(Group A) and identified another cohort of 83 patients with non-arthritic ankles as a demographic-matched control group(Group B). Patients with retained ankle hardware, history of osteomyelitis, osteoporosis, and cysts greater than 1 cm in diameter at the ankle were excluded. There was no difference in term of gender, age and body mass index (BMI) between the groups(Table 1). The ROI tool in Sectra IDS7 picture archiving and communication system (PACS) was used to calculate Hounsfield Unit (HU) values in the cancellous region of the tibia and talus around the ankle joint. Measurements were obtained on axial CTs from 6 mm to 12 mm above the distal tibial plafond, and from 1 mm to 4 mm below the talar dome. The HU measurements and percentage decrease of HU values at each level were compared between groups. Results: Patients with ankle arthritis demonstrated significantly greater bone density than the control group between 6 mm and 10 mm from the joint in the tibia. There was no significant difference in bone density between 10 mm and 12 mm from the joint on the tibia, and at all levels in the talus between groups (Table 1). In both groups, bone density decreased significantly at each successive level from the joint for the tibia and talus. In addition, the percentage decrease of HU values at each relative level was the same in both groups. Conclusion: Patients with ankle arthritis demonstrated greater bone density at 6 mm to 10 mm from the joint in the tibia compared to demographic-matched controls. The increased bone density close to the joint may stem from bone eburnation that occurs as part of the arthritic process. In TAR, a tibial bone resection between 6 mm and 10 mm may provide improved initial stability of the implant. Contrary to traditional thinking, fixation into the talus may be of less concern.
Tibial Sesamoidectomy: Indications and Outcomes
Authors: He Jun Kit , Christie Matthew , Robin Joseph , McKissack Haley , Shah Ashish 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Tibial sesamoidectomy has been reported to be a safe and effective procedure of treating a range of sesamoid pathologies including chronic sesamoiditis and fracture nonunion. The purpose of this retrospective case series was to determine common clinical indications for tibial sesamoidectomy and to evaluate the postoperative clinical course and outcomes. Methods: A retrospective chart review was conducted on patients who had isolated tibial sesamoidectomy after failed conservative treatment from 2009 to 2018. Demographics, comorbidities, physical exam variables, operative findings, radiographic measurements including hallux valgus angle (HVA) and intermetatarsal angle (IMA), and clinical outcomes including visual analog score (VAS), Foot Function Index (FFI), and complications were gathered. Results: Twenty-six patients (13 males and 13 females) were identified who have undergone tibial sesamoidectomy with a mean age of 49.8±18.5 years. For those 21 non-ulceration patients, VAS was significantly improved from 5.27±2.41 pre-operatively to 0.91±1.14 post-operatively (p<0.01). There was no statistically significant change in IMA (8.35±1.87º to 8.29±1.79º, p=0.93) or HVA (14.94±6.82º to 14.28±7.78º, p=0.79). Postoperative FFI was obtained for 10 patients with a mean of 132.75±50.68. For those five patients who had chronic ulceration on the plantar surface of the medial metatarsal head, four had complete healing at a mean of 15.6±5.37 weeks post-operatively. There was a 17% incidence of complications including neuritis, transfer metatarsalgia, and persistent cock-up deformity. Conclusion: When utilized judiciously and with the right indications, isolated tibial sesamoidectomy is a safe procedure which can improve pain and ulcer healing. HVA and IMA remained unchanged at final follow-up.
Lateral Calcaneal Artery: Pertinent Anatomy for Sinus Tarsi Approach and Calcaneal Osteotomy
Authors: Henrikson Karl J , Aydogan Umur 
Published: October 2019

Category: Trauma Introduction/Purpose: The lateral calcaneal artery provides critical arterial supply for healing of the extensile lateral approach to the calcaneus. A recent study has shown that preoperative doppler ultrasound showing non-patency of the lateral calcaneal artery is strongly correlated with wound complications when using this approach. Plate and screw fixation of calcaneus fractures through the sinus tarsi approach has gained popularity, including techniques involving percutaneous screw placement into a plate. Avoidance of lateral calcaneal artery injury may be improved with further quantification of its anatomy and associated variation. Finally, while the lateral approach to the calcaneus for osteotomy is routinely performed with minimal wound complications, the relationship of the lateral calcaneal artery to this approach was studied as well. Methods: This is a cadaveric anatomic study performed using six fresh frozen cadaver specimens. The specimens were treated with intra-arterial injection of latex and dye. The specimens were first utilized in a separate study in which an orthopedic resident, blinded to the present study, performed a standard, oblique osteotomy of the calcaneal body. The cadavers were then examined for the relationship of the lateral calcaneal artery to the previous dissections. Finally, an extended sinus tarsi approach was made, and the relationship of the lateral calcaneal artery was quantified relative to the posterior facet and the posterior most point of the tuberosity, and relative to screw holes in a percutaneous calcaneal plate. Results: Lateral calcaneal artery injury was observed in six out of six cadavers in which calcaneal osteotomy had been performed. The lateral calcaneal artery was encountered when performing the extended sinus tarsi approach at a mean ratio of 0.4 (standard deviation 0.11) of the distance from the posterior facet to the posterior aspect of the tuberosity. It crossed the posterior-most hole in the posterior facet portion of the plate in two cadavers. It also passed within 2 mm of the posterior most hole in the tuberosity portion of the plate in one cadaver. Conclusion: Careful dissection is warranted when extending the sinus tarsi approach beyond the posterior facet to preserve the lateral calcaneal artery. Injury is also possible with percutaneous tuberosity screw placement into a plate, and the consequences for sinus tarsi approach healing are unknown. Lateral calcaneal artery injury is difficult to avoid with the traditional lateral approach for calcaneal osteotomy, and while it has no implications for that approach which heals reliably, it indicates that preoperative doppler would be warranted if extensile lateral approach were considered in a patient who has previously undergone calcaneal osteotomy.