bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture
Authors: Lee Wonyong , Park Joseph S. , Cooper Minton T. , Perumal Venkat 
Published: October 2019

Category: Ankle, Arthroscopy Introduction/Purpose: There is little data regarding osteochondral lesions of the tibial plafond with only a few studies reporting clinical outcomes after arthroscopic treatment. The purpose of this study is to evaluate the clinical outcomes and the level of sports activities following arthroscopic microfracture for osteochondral lesions of the tibial plafond. Methods: A retrospective review was conducted for all patients who underwent arthroscopic microfracture surgery for ankle osteochondral lesions from January 2014 to June 2017. For functional evaluation, the Visual Analog Scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. We also investigated the level of sports activity before and after the surgery. Results: 16 patients were included in the study, and the mean follow-up period was 29.8 months. The mean FAAM score was significantly improved from 57.6 (range, 6.0-88.9) for the activities of daily living subscale and 34.5 (range, 3.1-92.6) for the sports subscale to 84.3 (range, 46.4-100.0) and 65.2 (range, 23.3-55.1) for each subscale respectively at the final follow-up. There were also significant improvements in SF-12 score, from 36.3 (range, 23.3- 55.1) to 46.0 (range, 18.9-56.6) for SF-12 PCS, and from 41.3 (range, 14.2-65.0) to 52.6 (range, 32.8-60.8) for SF-12 MCS at the final follow-up. Although 16 of 16 (100%) were able to return to their sports activity, the level of sports activity was lower than their level before the surgery. Conclusion: Arthroscopic microfracture provided satisfactory clinical outcomes for osteochondral lesions of the tibial plafond. Though one hundred percentage of patients were able to return to sports activity after the surgery, the level of sports activity was lower than their level before the surgery.
Impact of Early Weight-Bearing Following Ankle Arthroscopy and Microfracture of Talar Osteochondral Defects
Authors: Lefebvre Thomas , Scott Daniel J. , Peterson Jonathan , Adams Samuel , Amendola Annunziato 
Published: October 2019

Category: Arthroscopy Introduction/Purpose: Ankle impingement and ankle osteochondral defects are common problems seen by foot and ankle specialist that often go on to require surgical managment. After conservative treatment fails, ankle impingement is often managed by arthroscopic debridement, whereas ankle OCDs are often treated with ankle arthroscopy and microfracture as a first line treatment. However, surgeons have various treatment protocols post-operatively after these procedures, with some surgeons allowing immediate weight bearing, were as other surgeons restrict patients weight bearing. There is similar heterogeneity in the manner of immobilization post-operatively. The purpose of this study is to retrospectively review the outcomes of patients undergoing ankle arthroscopy and micro fracture, to determine if immediate weight bearing or removable immobilization had any impact on outcomes. Methods: We retrospectively reviewed 79 patients at our institution who underwent ankle arthroscopy with microfracture for talar osteochondral defects over 3 years. This included surgeries performed by one of 7 fellowship trained foot and ankle surgeons at our institution. Each surgeon had different protocols for post-operative weight bearing and immobilization, allowing for a comparison of various post-operative protocols. Patient outcomes were reviewed pre-operatively and post-operatively including age, sex, comorbidities, etiology of talar pathology, post-operative weight bearing status, time to first weight bearing, as well as method and length of immobilization, VAS scores, range of motion, and complications. Clinical outcomes such as time to return to work and return to sport were also evaluated. Results: The average patient age was 38. 42 patients (53%) had an additional procedure performed at the time of ankle arthroscopy and microfracture. There was no significant difference in the average pre-op and post-op VAS or range of motion between the immediate weight bearing group and the delayed weight bearing group. There was interestingly a trend towards lower VAS scores in the immediate weight bearing group (1.4 vs 2.6). Conclusion: Following ankle arthroscopy and microfracture, we found no difference in VAS, range of motion, or complications when allowing immediate, full weight bearing as well as using removable immobilization as compared to a variety of other protocols at early follow up. In fact, there was a trend towards lower VAS scores in the immediate full weight bearing group. Though this study has early follow up, it does suggest at least the equivalency of allowing immediate weight bearing and removable immobilization following ankle arthroscopy and talar microfracture.
Demographic Factors Associated with Anterior Tibial Tendon Pathology
Authors: Levitsky Matt , Greisberg Justin , Vosseller J. Turner 
Published: October 2019

Category: Sports, tendon Introduction/Purpose: The tibialis anterior serves an important role in ankle motion as it provides the majority of strength with dorsiflexion. Despite the importance of this muscle, there is a relative dearth of information regarding risk factors and demographic information that might predispose people to tendinopathy or rupture. The goal of this study is to further investigate the features of patients in a single institution who presented with either tibialis anterior tendinopathy or rupture. We also examined the ways in which these patient characteristics might differ in traumatic (patient remembers feeling a pop after a specific activity) versus atraumatic tendon ruptures (happened spontaneously without patient realizing). Methods: We used ICD-9 and ICD-10 codes to find patients who presented with tibialis anterior pathology to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, and medical comorbidities. Physical examination findings, such as gastrocnemius equinus, were noted as well. Characteristics of patients with traumatic and atraumatic tibialis anterior ruptures were compared using Student’s T-tests and chi-squared tests. Results: The characteristics of 93 consecutive patients between 2007 and 2018 were analyzed. There were 80 cases of tendinopathy, and 13 cases of tibialis anterior rupture. The average age of our patient group was 56 years, and the ratio of female to male was 73:20 (3.67:1). The average BMI was 27.2 kg/m2. 15 patients had a gastrocnemius equinus (16%). 75 patients had a neutral arch (81%), 16 patients had pes planus (17%), and two patients had pes cavus (2%). With regards to those who ruptured, there were two traumatic ruptures and 11 atraumatic ruptures. Average age for traumatic rupture was 39 years compared to 73 for atraumatic rupture (p<.05). Average BMI for traumatic rupture was 21 compared to 27 kg/m2 (p>.05). Conclusion: Our study investigates the features of patients in a single institution who presented with tibialis anterior pathology. This pathology was much more common in women and generally occurred in an older cohort. With regards to tendon ruptures, though, younger patients tend to suffer traumatic ruptures, while older patients are more likely to suffer more degenerative ruptures that required less energy for tensile failure of the tendon.
Percutaneous Treatment of Achilles Tendon Rupture: A Patient Report Outcome Study
Authors: Lima Mateus C. , Patel Milap S. , Kadakia Anish R. 
Published: October 2019

Category: Sports, Achilles Tendon Introduction/Purpose: Achilles tendon rupture is a common injury with increasing incidence in adults. While multiple studies have been conducted to determine the optimal surgery for an Achilles rupture, there is a lack of consensus around which surgical method serves as the best treatment. The predominant surgical options that are currently performed include open repair and minimally invasive or percutaneous Achilles rupture surgery (PARS), with comparative studies between open and PARS showing similar functional results. However, there is a lack of objective patient reported outcomes (PRO) for these procedures in the literature. To our knowledge, our study is the first prospective study to use validated patient reported outcomes (PROMIS®) to compare pre-operative and post- operative outcomes for the PARS surgery. Methods: Pre- and post-operative data for the PROMIS Physical Function and Pain Interference Computer Adaptive Tests (CATs) was collected for over 100 Achilles rupture patients at a major tertiary care facility and level I trauma center starting in 2014. Each of these patients were contacted at regular intervals for repeat survey evaluation at multiple post-operative time points via email or phone. Patients treated for chronic Achilles rupture as well as patients without adequate post- operative follow up of a minimum of 2 years were excluded. We conducted a preliminary analysis on a total of 21 patients with acute Achilles rupture Injury treated with PARS and 2 years post- operative PROMIS follow up. For each outcome, a Wilcoxon signed-rank test was used to assess the mean difference between pre-operative and post-operative scores. The statistical analysis was conducted by statisticians who were blinded and worked independently of the orthopedics department. Results: Based on the Wilcoxon signed-rank test, there was significant mean difference between pre-op and post-op physical function scores (p=0.0009 < 0.05) and no significant mean difference between pre-op and post-op pain scores (p=0.1743 > 0.05). Mean post-operative scores were at the 54th percentile for function and 44th percentile for pain. Conclusion: While our study is a preliminary investigation into the use patient-reported outcomes in determining the outcomes of PARS, we aim to expand on our findings as more patients reach 2-year post- operative status. Our preliminary findings are however consistent with the literature regarding the viability of PARS in treating acute Achilles ruptures with positive results similar to other techniques. While patients’ experience a minor loss in post-operative physical function as compared to their pre- injury status, PARS restores physical function scores to that of the mean population while restoring pain scores to baseline levels.
Radiographic Predictors for Adverse Outcomes Following Surgical Correction of Hammertoe Deformity
Authors: Maidman Samuel D. , Erwood Amalie A. , Brodsky James , Daoud Yahya , Fantry Amanda , Tenenbaum Shay , Bariteau Jason T. 
Published: October 2019

Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are common, often painful deformities of the lesser foot and are known to severely affect physical function. When patients seek surgical management, x-ray imagining is utilized for diagnosis, evaluation for surgical candidacy, and selection of the operative technique. Postoperatively, radiographs are retaken to assess bone health, healing status, and alignment. Despite their frequent use, no previous data support particular X-ray findings as being indicative of clinical presentation nor surgical outcomes. The aim of this study is to identify specific radiographic parameters that are predictive of pain and function outcomes after surgical correction of hammertoe deformity. Methods: Prospectively collected data was reviewed on 116 patients who underwent hammertoe correctional surgery. Patient demographics, comorbidities, and postsurgical complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative pain Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component (SF-36 PCS) scores with 1-year follow-up. Radiographs were scored by a foot & ankle fellowship-trained orthopaedic surgeon to assess preoperative severity, postoperative joint fusion, and both pre- and postoperative joint instability. Data was examined using chi-squared, t-test, and ANOVA analyses. Results: Preoperatively, 14.7% of patients had a deformity classified radiographically as mild, 37.1% as moderate, and 48.3% as severe. X-rays prior to surgery showed that 65.5% had MTP joint instability, 9.5% had joint dislocation, and 18.1% had joint arthritis. Postoperatively, 78.5% had PIP joint fusion, 38.8% had MTP joint arthritis, and 17.2% had MTP joint instability. A significant association was found between postoperative MTP joint instability and a lower 1-year SF-36 PCS (p=0.0032). There were no associations found between the other radiographic findings and postoperative outcomes, and no parameters were associated with pain VAS scores. Conclusion: After undergoing surgical correction of hammertoe deformity, the postoperative radiographic finding of MTP joint instability was determined to be predictive of physical function. However, neither metatarsophalangeal joint arthritis nor PIP fusion were predictive of outcomes. This work informs foot and ankle specialists that proper joint alignment and stabilization is critical to ensuring success in hammertoe surgery.
Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF for Ankle Fractures
Authors: Malik Azeem Tariq , Khan Safdar N , Phieffer Laura , Ly Thuan V , Wiseman Jessica , Sheridan Elizabeth , Quatman Carmen E 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >=80 years). Past literature has shown octogenarians to be a potentially vulnerable population that have drastically different adverse outcomes and higher resource utilization as compared to individuals below the age of 80 years. Methods: The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) was queried using Current Procedural Terminology codes for patients undergoing open reduction internal fixation (ORIF) for isolated uni-malleolar (CPT-27766, CPT-27769, CPT-27792), bi-malleolar (CPT-27814) and tri-malleolar (CPT-27822, CPT-27823) ankle fractures. The study cohort was divided into three distinct groups for comparisons (Age <65 years, Age 65-79 years and Age=>80 years/octogenarians + nonagenarians). Multi-variate regression analyses were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for differences in baseline clinical characteristics (age, gender, sex, race, fracture type/severity, open vs. closed fracture, admission status, BMI, co-morbidities, functional health status, ASA group and operative time). For comparison purposes, Age<65 years was taken as reference group in multi-variate regression models. Results: A total of 19,585 patients were included – out of which 1,033 (5.3%) were octogenarians/nonagenarians (=>80 years). Following multivariate analysis, individuals aged =>80 years were at a significantly higher risk of 30-day wound complications (OR 1.84; p=0.019), pulmonary complications (OR 3.88; p<0.001), renal complications (OR 1.96; p=0.015), septic complications (OR 3.72; p=0.002), urinary tract infections (OR 2.24; p<0.001), bleeding requiring transfusion (OR 1.90; p=0.025), mortality (OR 7.44; p<0.001), readmissions (OR 1.65; p=0.004) and non-home discharge (OR 13.91; p<0.001). Individuals between the age of 65-79 years only had a higher risk of pulmonary complications (OR 2.30; p=0.004), urinary tract infections (OR 2.24; p<0.001), readmissions (OR 1.41; p=0.005) and non-home discharges (OR 3.55; p<0.001), with the effect sizes being small as compared to age >=80 years group. Conclusion: Based on the findings, it appears that octagenarians and nonagenarians (age =>80) are a fundamentally distinct and vulnerable age group that is at a higher risk of complications, readmissions, mortality and non-home discharges as compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Providers should understand the importance of pre-operative counselling and risk-stratification in this vulnerable patient population.
Applications of the Vascularized Medial Femoral Condyle for Nonunion with Associated Bone Loss of the Foot: A Case Series
Authors: Mangold Devin , Bishop Allen T. , Moran Steven L. , Shin Alexander Y. , Ryssman Daniel B. 
Published: October 2019

Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Persistent nonunions with large bone defects continue to represent a challenging problem for foot and ankle surgeons. Vascularized corticocancellous grafts have been well described for various applications and represent a comprehensive solution to these difficult nonunion cases. We describe four cases of nonunions with concomitant large bony defects treated with a vascularized medial femoral condyle (VMFC). Methods: We retrospectively identified four cases of VMFC flaps used for foot nonunions with large bone defects. Surgical indications included talonavicular nonunion with associated avascular necrosis of the navicular, talonavicular-cuneiform nonunion, navicular-cuneiform nonunion, and first metatarsophalangeal nonunion. All cases had large associated segmental bone defects. The average age at the time of surgery was 62-years-old. The average follow up was 2.6 years (1.5-5.0). One patient had a remote history of tobacco use. Another patient quit smoking pre-operatively and had normal nicotine metabolite levels at the time of surgery. There was one Type II diabetic. Results: Two patients underwent staged reconstruction with placement of an antibiotic cement spacer, but intra-operative cultures were negative. No patient had a previous infection. The average graft dimensions were 3 x 2.25 x 1.5 cm. After obtaining adequate compression, all grafts were secured with bridge locking plates. The average time to weight bearing was 14.5 weeks. All patients had knee pain post-operatively that resolved with time. Two patients required reoperation. In one patient, the VMFC graft did not adequately fill the defect requiring supplement allograft. The VMFC-allograft interface went on to nonunion requiring tricortical iliac crest bone grafting. Another patient developed a split-thickness skin graft (STSG) infection requiring debridement and repeat STSG. There were no VMFC graft failures, and all patients went on to successful union. Conclusion: Vascularized medial femoral condyle autografts are a technically demanding solution to difficult nonunion cases with significant associated bone loss of the foot.
Late Abduction Deformity of the Midfoot Following the “Medial Double” (Diple) Procedure for Hindfoot Valgus Deformity
Authors: Manoli Arthur 
Published: October 2019

Category: Hindfoot Introduction/Purpose: There has been considerable interest in recent years in performing a combined talonavicular and subtalar arthrodesis instead of a standard triple arthrodesis for a rigid hindfoot deformity. The ”medial double” (diple) avoids fusing the calcaneocuboid joint with its lateral incision, common bone block graft and high rate of complications. Although the results of the “medial double” are generally satisfactory, there are no reports of late midfoot abduction deformity, although it was predicted by Evans in 1975. Methods: A 79 year-old-male with long-standing skin psoriasis with joint involvement presented with severe bilateral flatfoot deformities. The left hindfoot was arthritic, deformed and painful. Despite a conservative course of orthotics and ankle braces, the pain persisted. Because there was a psoriatic plaque over the lateral side of the foot, it was decided to perform a ”medial double” arthrodesis with screw fixation, a plantarflexing 1st tarsometatarsal joint fusion for medial column stabilization, and a heel cord lengthening Results: Skin and bony healing were uneventful. Over the subsequent three years a progressive abduction deformity developed through the naviculocuneiform joints and the unfused calcaneocuboid joint. The patient had only occasional pain in the midfoot and wore wide shoewear to accommodate the deformity. Conclusion: A late abduction deformity can develop through the midfoot in patients who have the ‘medial double” procedure for hindfoot valgus. The cuboid settles proximally against the short distal calcaneus, and the naviculocuneiform joints sublux laterally. In patients with hindfoot valgus with severe lateral column shortening secondary to calcaneocuboid joint remodeling, it may be better to perform an actual triple arthrodesis with a bone graft in the calcaneocuboid joint instead of a “medial double.” Alternatively, one could add a naviculocuneiform arthrodesis to the ”medial double” arthrodesis to prevent this complication.
Fracture Immobilization in an Austere Environment: A Comparative Study of Military Special Operations Medical Personnel using a SAM Splint vs a One-Step Spray on Foam
Authors: Martin Kevin D. , Unangst Alicia , Chisholm Jaime 
Published: October 2019

Category: Trauma Introduction/Purpose: Improved body-armor and mine resistant vehicles have improved battlefield survivability, but now nearly 50% of casualties have a musculoskeletal extremity injury. The purpose of the current study was to evaluate current SAM splint techniques utilized for a distal Tib/Fib fracture verse a new one-step spray on foam immobilization technique. Methods: A cadaveric model with a distal third combined tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (SAM splint, 6in Ace wrap). The test group immobilized the injury with a one-step in-situ spray on foam splint. Results: Twenty-one military Joint Special Operations Command (JSOC) medical personnel (11 Medics, 4 PAs, 6 Physicians) participated with an average of 7.7 years as a provider and 25.4 months deployed in a combat theater. Each participant was observed and scored by a single orthopedic foot and ankle surgeon using a Likert scale based on 10 splinting criteria. Standard SAM splinting resulted in an average score of 32.2 (range, 5-50), with significant deficiencies in fracture traction (1/5), fracture motion (2.9/5), protection of neurovascular structures (3/5), and soft tissue manipulation (3/5). The average time to completion was (203 sec), with one splint failure. The spray on foam splinting technique yielded a significantly higher score of 48.5 while completing the task significantly faster at 68 sec with no failures. Conclusion: JSOC medical personnel demonstrated overwhelming success in immobilizing a complex extremity fracture with a SAM splint. Testing demonstrated the inherent inability of the SAM splint to provide longitudinal traction while simultaneously allowing excessive fracture motion and potential injury to the soft tissues. In addition, our spray-on foam proof of concept technique eliminated motion and provided traction by allowing in-situ application with adequate rigidity.