bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Findings During Routine Ankle ORIF: What is Being Missed?
Authors: Howard Shain , Hoang Victor C. , Watson Troy S. , Brady Candice L. , Eudy Adam 
Published: November 2020

Category: Ankle; Arthroscopy; Trauma Introduction/Purpose: Ankle fractures are among the most common operatively treated injuries by orthopedic surgeons. However, up to 20% of patients will have continued pain and poor patient reported outcomes despite good/excellent radiographic results. Ankle fractures typically occur with varying degrees of intra-articular and soft tissue injury which can include ligamentous injury, loose bodies, and chondral lesions. The aim of study is to document intra-articular findings with ankle arthroscopy prior to ankle open reduction internal fixation (ORIF) and to contribute to the growing body of literature that shows this to be a safe adjunct to fracture fixation. Methods: IRB approval was obtained prior to chart review. This is a retrospective review of ankle fractures that were treated with arthroscopy and ORIF by a single surgeon. Between August 2016 and July 2018 Operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type. Analysis was performed with regard to fracture type, presence and location of osteochondral lesions, presence of loose-body, syndesmotic injury, and deltoid injury. Results: Fifty-seven ankle fractures were identified that met inclusion criteria. 84.2% of the fractures had intra-articular pathology, most commonly a syndesmotic injury followed by loose joint body and osteochondral defect. Conclusion: Arthroscopic evaluation during ankle fracture ORIF, particularly pronation external rotation and supination external rotation patterns give a more detailed examination of associated pathology. Arthroscopy at the time of ankle fracture fixation is a safe adjunct and should be considered a potential compliment to routine ORIF of ankle fractures.
Outcomes after Minimally Invasive Chevron/Akin Procedure and Strategies to Optimize Outcomes
Authors: Hussaini Syed H. , Neufeld Steven K. , Dean Daniel M. , Lockey Stephen D. 
Published: November 2020

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Minimally invasive surgery (MIS) is being increasingly used for bunion deformity correction. New third generation minimally invasive chevron/akin (MICA) techniques are used but limited data on patient outcomes have been reported. The goal of this IRB-approved study was to look at outcomes of percutaneous, extra-articular distal metatarsal osteotomies for mild to moderate bunion deformity, including the degree of deformity correction obtained, patient pain control, and complication rates. We also describe strategies for avoiding the intra-operative and post-operative complications that may arise with MIS bunion surgery. Methods: The participants were the treating surgeon’s first 75 consecutive patients 18 years and older who were treated with MICA procedures. Via retrospective chart review, outcome measures including pre and final post-operative intermetatarsal angles (IMA), hallux valgus angles (HVA), visual analogue scale (VAS) score, and complication rates were assessed. Statistical analysis was done utilizing student’s t-test for continuous variables and chi square test for categorical variables. Results: Average follow-up was 105.0 days. VAS scores dropped one week post-operatively, from 5.4 pre-operatively to 2.5 (p< 0.05). IMA angles improved from 12.7 degrees (range 6.1-18.1) pre-op to 6.1 (range 1.2-12.5) at final follow-up (p< 0.05). HVA angles improved from 27.2 degrees (range 9.7-43.4) to 10.4 (range 1.3-25.9) (p<0.05). A major infectious complication occurred in one patient, requiring operative irrigation/debridement and hardware removal. Another patient had a DVT treated successfully with medication. Minor complications included intra-operative fracture (3 patients), persistant paresthesias (3), cellulitis (1), minor loss of reduction (2), hardware prominence/backout (3) and medial prominence pain (3). One patient had surgical removal of a prominent screw head one year after surgery. Complication rates were similar between the first and second half of patients chronologically. Conclusion: Our data suggests that MICA osteotomies are associated with rapid, significant improvement in pain scores, significant deformity correction, and low frequency of major complications. While there is a learning curve, MICA is a reproducible technique, is safe, and allows immediate post-operative weightbearing. All osteotomies achieved union, and there were no tendon injuries. Only two patients required a second surgery. We also present strategies to avoid and limit pitfalls and complications encountered with the procedure. Although our data is exciting, additional studies looking at long-term outcomes, larger sample sizes, and more physicians should be conducted.
Safety Profile of Artelon Use for Soft Tissue Reconstruction in Foot and Ankle Surgery
Authors: Hussaini Syed H. , Dean Daniel M. , Kelly Michael , Cuttica Daniel J. 
Published: November 2020

Category: Basic Sciences/Biologics; Ankle; Hindfoot; Midfoot/Forefoot; Sports Introduction/Purpose: Artelon is a synthetic degradable polyurethaneurea graft which has been investigated and utilized for soft tissue reconstruction in a variety of orthopaedic settings. However, in the field of foot and ankle surgery, there is very limited reported clinical data on outcomes of surgery utilizing Artelon. The goal of this study was look at outcomes of foot and ankle surgery in which Artelon is used, including post-op VAS scores and complications including adverse foreign body reaction, infection, repeat surgery, and implant failure. Our hypothesis was that soft tissue reconstruction procedures utilizing artelon will have a low complication rate, similar to established complication rates for other soft tissue reconstruction procedures such as those utilizing allograft, autograft, or other synthetic tissue. Methods: The treating surgeon’s first 55 consecutive patients 18 years and older who were treated with artelon graft as part of a foot and ankle surgery are being included in this IRB-approved study. Through retrospective chart review, outcome measures including the procedure for which artelon was utilized, pre and post-op Visual Analogue Scale (VAS) scores, and complications including repeat surgery for graft failure, foreign body reaction, wound healing issues, infection, and osteolysis were assessed. Statistical analysis was done utilizing Student’s t-test for continuous variables and chi square test for categorical variables. Results: Average follow-up time was 246.5 days. The majority of patients had artelon placed for spring ligament reconstruction, brostrom procedures, or achilles tendon reconstruction. VAS scores dropped significantly from before surgery to 3 weeks post- operatively (5.6 to 3.2, p<0.05). VAS scores stabilized after 3 weeks, with final follow-up score at 2.9. There were no reports of osteolysis in the area of the graft placement, adverse foreign body reaction, or episodes of graft failure. There were two major complications involving artelon surgical sites: one patient required a free flap for wound coverage, and another required an operative debridement with hardware and artelon removal, antibiotic spacer placement, and subsequent hindfoot fusion. Other minor complications not requiring operative intervention included cellulitis (3 patients) and delayed wound healing (5). Conclusion: Artelon is a safe and effective implant that can be utilized for soft tissue reconstruction in the foot and ankle, with similar post-operative pain recovery and wound complication rates compared to established historical data for these procedures. Additional studies must be done looking at long-term patient outcomes with utilization of artelon, and direct comparative studies with other soft tissue reconstruction techniques and materials in the foot and ankle.
Fractures of the Talar Head: A Series of 16 Patients
Authors: Ibrahim Ishaq , Kwon John Y. , Miller Christopher P. , Smith Jeremy T. 
Published: November 2020

Category: Hindfoot; Trauma Introduction/Purpose: Fractures of the talar head are very rare accounting for just 5-10% of talus fractures and fewer than 1% of all fractures. As such, limited clinical literature is available to guide management of these injuries. We present the largest clinical series on talar head fractures to date. Methods: We performed a retrospective review of all patients presenting to three level-1 trauma centers with major fractures of the talus (fractures of the neck, body or head) over a 14-year period. From this cohort of patients, we identified patients presenting with fractures of the talar head with available computed-tomographic (CT) imaging of the foot allow proper fracture evaluation and characterization. In total, 258 patients with major fractures of the talus were identified. Sixteen patients (6.2%) with talar head fractures met inclusion criteria. Results: Most injuries were due to falls from height and only 4 were isolated. The navicular was fractured in 7 patients (43.8%). Six patients (37.5%) exhibited comminuted fracture patterns, while the remaining demonstrated simpler shear or impaction injuries. Four patients underwent fixation of the talar head, 3 were treated with primary stabilization or fusion of the talonavicular joint, and two patients were treated with head fragment excision. The talar head was managed in a closed fashion in the remaining seven patients, five of which presented with comminuted fracture patterns. Eight patients showed radiographic evidence of post- traumatic arthritis (PTA) at mean follow-up of 15.5 months. In all instances of PTA, the patient had sustained a comminuted talar fracture, an associated navicular fracture or both. Conclusion: Talar head fractures are extremely rare injuries with sparse literature to guide clinical management. Simple shearing or impaction fractures may be amenable to surgical fixation with favorable radiographic outcomes. Comminuted fractures and/or concomitant navicular trauma at the time of injury may be associated with increased incidence of talonavicular arthrosis.
Quantitative Analysis of the Deltoid Ligament Degradation in Chronic Ankle Instability Patients using the CT Value
Authors: Ikuta Yasunari , Nakasa Tomoyuki , Sumii Junichi , Nekomoto Akinori , Adachi Nobuo 
Published: November 2020

Category: Ankle; Other Introduction/Purpose: Chronic lateral ankle instability (CLAI) that is developed after multiple lateral ankle ligament injury lead to ankle osteoarthritis. Although isolated deltoid ligament injury is rare compared to lateral ankle ligament injury, deltoid ligament tear, especially deep posterior tibiotalar ligament (PTT) can be observed arthroscopically in CLAI patients. Unphysiological loading of the ankle joint with CLAI might cause degradation of the deltoid ligament. This study aimed to investigate image findings of the deltoid ligament using computed tomography (CT) value for quantitative analysis of degenerative ligament changes in CLAI patients. Methods: Among the enrolled patients who underwent ankle magnetic resonance imaging (MRI) and CT scans of the ankle, this retrospective analysis included 24 ankles without ankle osteoarthritis, osteochondral lesion of the talus (OLT), flatfoot and ankle fractures (14 males and 10 females; mean age, 42.8 years) as a control group, and 14 CLAI ankles without OLT (7 males and 7 females; mean age, 31.1 years) as CLAI group. The CT scans were performed using a 64-slice multidetector row CT. Deep PTT was detected on coronal T2-weighted MR images. Both the coronal MR and CT images were matched for analysis, then average CT values were measured using the region of interest that was applied to the detected area of deep PTT on the CT images. Spearman’s correlation coefficient was used to evaluate the correlation between age and CT value in the control group. Results: The strong negative correlation was identified between age and CT value in the control group (Spearman ρ= -0.88; p < 0.001). The CT value of the deep PTT are degraded with aging. Mean CT value of deep PTT in participants under 60 years old were 79.9 HU (95% CI, 75.1-84.8) in the control group (18 ankles), and 66.5 HU (95% CI, 58.6-74.5) in the CLAI group (14 ankles) (Welch’s t test; p = 0.005). Conclusion: MRI techniques and protocols recently have been developed, however, some limitations remain such as a quantitative evaluation of the ligament. Our findings suggest that the CLAI can lead to degradation of the deltoid ligament via an overloading of medial ankle structures. Additionally, CT values should be useful for quantitatively evaluating ligament status including degenerative changes.
Combined Internal and External Fixation for Charcot Neuroarthropathy: A Learning Curve
Authors: Iqbal Muhammed H. , Qasim Sultan N. , Chambers Simon 
Published: November 2020

Category: Diabetes; Trauma Introduction/Purpose: Management of complex foot and ankle deformities secondary to charcot neuroathropathy represents a significant challenge. This is a consequence of medical co-morbidities, vascular disease, peripheral neuropathy, and immune compromise with the surgical challenges of progressive bony defomity and bone resorption. To combat these challenges ‘superconstructs’ have been developed to improve fixation. These aim for fusion beyond the zone of injury with adequate deformity correction all whilst maintaining viability of the soft tissue envelope and mechanical function. This can be achieved with internal fixation using indication specific plates and beaming techniques, external fixation with a circular frame or a combination of the two. The aim of this study was to evaluate of a tertiary referral hospital in the operative management of charcot neuroarthopathy. Methods: This is a retrospective two surgeon case series with all cases jointly operated upon. Cases were identified from a locally held diabetic patient registry as those undergoing charcot foot and ankle reconstruction from 2017 to 2019. No exclusion criteria were outlined. Patient demographics and co-morbidities were collected, pre-op radiological markers (meary’s angle) measured and repeated at 6 weeks and one year. Pre-op radiographs were classifed accroding to brodsky classification. Patient outcomes were recorded of amputation, mortality, ulcer recurrence, reported pain, stable heel, ability to ambulate, need for revision surgery, need for prolonged antibiotics, fusion and surgical complications. PROMS were requested and still awaited at time of submission. Results: Eleven Cases were identified from ten patients, all were included for analysis. Three patients had internal fixation, two had external fixation and six had combined internal with external fixation. Eight patients were Brodsky 1, two patients were Brodsky 3 and one patient was Brodsky 2. Limb salvage was 100% with nil amputations, mortality 0%, ulcer recurrence 0%, 100% improved pain score, and 100% with a stable heel. Meary’s angle improved by a mean of 14o from -16o to -2o at 1 year. Fusion rate determined clinically and radiologically with X-ray was 100% with mean of 129 days and range of (360 - 52). Mean follow-up 454 days and range (547-417). Complications of 2 tibial fractures and 1 deep infection with delayed wound healing. Conclusion: The outcomes of using all three methods is positive with 100% limb salvage, 100% fusion rate, 100% ulcer free and maintenace of Meary’s angle at 1 year post op. We believe that combined internal and external fixation, not widely reported in the literature, is a good option in these cases. The complications reported here were in the first three patients undergoing said technique and represent a learning curve.
Return to Sport and Activity after Total Ankle Arthroplasty and Arthrodesis: A Systematic Review
Authors: Johns William L. , Sowers Christopher , Walley Kempland C. , Jackson J. Ben , Thordarson David B. , Gonzalez Tyler A. 
Published: November 2020

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). Better understanding on this topic will allow orthopaedic foot and ankle surgeons to set evidence-based goals and expectations with their patients in regards to postoperative activity recommendations and quality of life. We aimed to summarize the evidence on return to sport and activity after surgical management with either TAR or AA for ankle osteoarthritis (OA). Methods: A literature search of PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in January 2020. The bibliographies of all relevant publications were searched for further applicable studies. Included studies were required to report sport and activity outcomes in patients undergoing TAR and AA, with primary outcomes being percentage of sport participation and level of sport participation. Excluded studies were non-English and did not assess level of sport activity after TAR or AA. Results: Twelve studies met inclusion criteria for analysis. There were 1,270 ankle procedures, of which 923 TAR and 347 AA were performed. Mean reported patient age was 59.2 years old and mean BMI was 28 kg/m2. Mean follow-up was 43 months. Fifty-four percent of patients were active in sports preoperatively compared to 63.7% postoperatively (Figure 1). Mean preoperative activity participation rate was 41% in the TAR cohort, but improved to 59% after TAR, whereas preoperative activity participation rate of 73% was similar to postoperative rate of 70% in the AA cohort. The most common sports in TAR and AA groups were swimming, hiking, cycling, and skiing. Conclusion: Participation in sports activity is nearly 10% improved after surgical management of ankle OA. The existing literature demonstrated a large improvement in pre-to postoperative activity levels after TAR, with minimal change in activity after AA, however, AA patients were more active at baseline. The most frequent postoperative sports activities after surgical management of ankle OA are: swimming, hiking, cycling, and skiing. Despite preoperative participation in high-impact sports such as tennis, soccer, and running, these were consistently limited after surgery. This review of the literature will equip patients and physicians with the knowledge to appropriately establish realistic expectations for postoperative physical activity and return to sport goals. [Table: see text]
Total Ankle Arthoplasty as a Day Case Surgery: How Safe and Effective it is?
Authors: Kayum Shahin , Daniels Timothy R. , Khan Ryan M. 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. Total ankle arthroplasty (TAA) is a surgical procedure commonly used for patients with painful arthritis. As the number of TAA procedures increase, so does the associated economic burden. The purpose of this study was to evaluate patients undergoing total ankle arthroplasty, who were discharged on the same day as undergoing surgery. These patients have stayed in the hospital for <12 hours, and are referred to as ‘‘outpatients.’’ Outpatients were evaluated with regard to the following outcomes: (1) postoperative pain; (2) perioperative complications and healthcare provider visits (readmission). We also assessed patients’ satisfaction regarding discharge on the same day as surgery. Methods: The medical records of 46 consecutive TAA outpatients from July 2018 to June 2019 with a minimum 1 month post- operative follow-up, were reviewed. All patients received an Integra Cadence TAA. Prior to surgery, all patients received popliteal blocks. Patients were discharged home with a popliteal catheter, which they were to remove themselves after 48 hours. After removal of the catheter, patients were prescribed oral pain medication to help with any pain or discomfort. The following data was collected: demographics, comorbidities, (ASA) class, and perioperative complications, including wound breakdown, infection, revision and non-revision surgeries. At their 1-month post-operative visit, patients completed a questionnaire regarding their satisfaction post-surgery, which consisted of six questions. Results: There were no readmissions for pain control, no signs of wound infection among the 46 outpatients. All patients were ‘very satisfied’ with the surgical procedure and with recommend methods of pain control. The majority of patients were also very satisfied with discharge on the same day as surgery with the exception of patients who would have liked to stay overnight. When asked if they would recommend the care they experienced to a friend with the same condition, 46 patients said that they would definitely recommend this process to a friend. In terms of rating their pain on a scale of 0-10 (0 being no pain, 10 being worst pain imaginable), the average score for the 46 patients was 2.03. Conclusion: Our study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory outpatient experience and no readmissions for pain control.