bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Patient Catastrophizing Score Predicts Poor Outcome in the Complex Foot and Ankle Patient
Authors: Gagné Oliver , Veljkovic Andrea , Anderson Lindsay , Symes Michael , Abbas Kaniza Zahra , Penner Murray J , Wing Kevin , Younger Alastair S.E. , Syed Khalid , Lau Johnny T.C. 
Published: October 2019

Category: Ankle Introduction/Purpose: Patients perspective and experience is heavily modulated by their understanding of their pre-operative disability along with their overall coping strategy and life philosophy. It is well appreciated that patient’s catastrophization and emphasis on outcomes can affect their outcome. Given that we are relying on patient-reported outcomes more and more, the orthopedic community must be diligent in differencing patients that may have the same objective outcome vary widely on a patient-centered subjective basis. Catastrophization has been reported to affect outcomes in the arthroplasty litterature and this was the first study to look at its effect in the foot and ankle world. Methods: This current study set out to look at a cohort of complex consecutive foot and ankle cases and describe the relationship between Patient Catastrophizing Score (PCS) and multiple functional outcomes that are used routinely. The PCS has three subcategory rumination, helplessness and magnification. In the end, 46 patients were found to be eligible in the study with an average age of 54.72 ± 14.41 years-old, a majority female 30 / 46 (65.22%), a minority employed at the pre-operative visit 19/46 (41%) and with an average BMI of 26.2 ± 5.56. We used univariate and multivariate regression analysis for further statistical analysis. Results: We found that the mental component of the SF12 had a statistically significant negative effect with the rumination score (-1.03) and the helplessness score (-1.05). There was no statistically significant effect for the physical component of the SF-12. Looking at the FAOS Pain component, it correlated with the PCS rumination and helplessness. Otherwise the FAOS ADL component showed correlation as well with the PCS rumination (M -4.67 (p=0.02) U: -1.85 (0.01)), helplessness (M -5.89 (p = 0.01) U -1.81 (p = 0.001)) and total score (M: 3.74 (p=0.02) U -0.75 (p=0.01)). The FAOS Quality of life component was statistically significant for the rumination score (-11.59) (p > 0.05) and the helplessness score (-9.65) (p = 0.002) also the PCS total (8.54). Conclusion: This study confirms that post-operative patient reported outcome (SF- 12MCS, FAOS) are affected by pre-operative catastrophization scores. This has extensive implications in the patient selection, counselling and tailoring of surgeries offered to patients. This is also a symbolic finding highlighting that certain outcomes measure need to be adjusted or updated. This was a pilot study to capture the initial trend and within the limits of our methodology we would recommend future larger study trials and careful pre-operative selection based on PCS scores.
Disclosures Undisclosed
Authors: Janney Cory F. , Safavi Kiya Shazadeh , Schneider Greg , Jupiter Daniel , Panchbhavi Vinod 
Published: October 2019

Category: Ethics Introduction/Purpose: The objective of our study was to analyze COI nondisclosure for US based research articles that were published to three prevalent orthopaedic journals from the beginning of 2014 to the end of 2016. Methods: All US-based research articles published to FAI, JBJS, and JOA from the beginning of 2014 to the end of 2016 were reviewed. COI disclosure sections were analyzed to determine if a disclosure was made for first and/or last authors. Authors disclosing any financial relationship involving employment, royalties/licensing, speaking, and consulting fees were recorded as having disclosed a potential COI. First and last authors were then searched for using CMS Open Payments search tool to determine if they had received any of the aforementioned payment types. To determine if a COI nondisclosure (disclosure discrepancy) was present, an author’s disclosure statement for a published article was compared to CMS Open Payments data from the year prior to publication of the article. We used CMS data from the year prior to a publication to account for the time it takes to construct a paper and have it published. Results: Across all journals and years, we obtained disclosure accuracy data for 3,465 total first and last authors publishing 1,770 research articles. Within this sample, 7.1% (245/3,465) of the authors had a recorded undisclosed conflict-of-interest and 13.2% (233/1,770) of articles had a first and/or last author with an undisclosed potential conflict-of-interest. When looking at each journal individually over the three-year period, FAI contained the highest percentage of authors with undisclosed COI’s (42.3%), JBJS contained the lowest percent of authors with an undisclosed COI (4.6%), and JOA had an intermediate amount of authors with an undisclosed COI (7.0%). Conclusion: Discrepancies between payment disclosures made by authors and those published in the CMS database were present in all three journals reviewed in this study. The percentage of articles containing an author with a disclosure discrepancy varies widely between these journals. However, when analyzing the percentage of disclosure discrepancies by year, no trend was found.
The Outcomes of Bone Grafting of Peri-Prosthetic Total Ankle Osteolytic Lesions: A Meta-Analysis
Authors: Mahmoud Karim , Alhammoud Abduljabbar , Metikala Sreenivasulu , O’Connor Kathryn , Farber Daniel 
Published: October 2019

Category: Ankle Introduction/Purpose: Total ankle replacement (TAR) has become an increasingly popular alternative to ankle arthrodesis as a treatment option for end-stage ankle arthritis. However, total ankle implants are not without short and long-term complications and one of the most common is peri-prosthetic osteolysis, Many studies have been done on the incidence of peri-prosthetic bone cysts as well as the etiology, but there have been limited reports on the optimal management of these lesions. The most widely accepted method of treatment is curettage and grafting of the lesion with or without polyethylene exchange. Our aim was to perform a systematic review of the literature on the outcome of bone grafting in the management of periprosthetic osteolytic following TAR. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Medline, PubMed, Scopus, and Google Scholar databases were searched in November and December 2018 for all observational or experimental studies that evaluated bone grafting of peri-prosthethic total ankle osteolytic cysts. The primary outcome was the rate of major revision to either component replacement or ankle arthrodesis and the secondary outcome was the rate of radiological cyst progression after grafting. Descriptive, quantitative, and qualitative data were extracted. Results: Of the 70 articles identified, 6 studies were eligible for the meta-analysis for a total of 120 patients with 123 total ankle replacements. Average age of subjects was 58.5 years. 4 papers included details of patient gender revealing 50 males and 26 females in those studies. The most common type of total ankle replacement was the Ankle Evolutive System(AES) followed by the Scandinavian total ankle replacement (STAR). With an average follow up 5.1 years (1.4-15.4), the rate of conversion to major revision after curettage and bone grafting was 15% (7.6%- 22.4%). Despite that apparent success, there was a 40.4% (5.4%-75.4%) rate of radiological cyst progression after grafting Conclusion: Our systematic review shows that curettage and bone grafting of the osteolytic lesions around TAR is safe procedure which can increase the survivorship of the implant and delay the need for further major surgeries. Providing better bone stock for later revision may also be of benefit. However, the high rate of cyst progression is worrisome for future complications. This highlights the need to further research the etiology of the cyst and to explore treatments aimed at eliminating the cause of cysts to prevent the need for repeat procedures and the potential for implant failure.
Three-Dimensional Displacement after a Medializing Calcaneal Osteotomy in Relation to the Hindfoot Alignment and Osteotomy Angle
Authors: Peiffer Matthias , Belvedere C. , Clockaerts S. , Leenders T. , Barg Alexej , de Cesar Netto Cesar , Lintz Francois , Richter Martinus , Leardini A. , Burssens Arne 
Published: October 2019

Category: Hindfoot Introduction/Purpose: An adult-acquired flatfoot deformity is a three-dimensional (3D) condition characterized by a loss of the medial longitudinal arch, valgus alignment of the hindfoot, and abduction of the midfoot. When conservative measures are not sufficient, a medializing calcaneal osteotomy (MCO) is frequently performed to correct the deformity, but there is lack of data on the associated three-dimensional variables defining the final correction. A possible reason for this shortcoming could be the current image-based analyses, mainly performed on bi-dimensional radiographs. These are hampered by errors in 3D rotations and superimposition of bony structures. The aim of this study was therefore to assess the correlation between the preoperative hindfoot valgus deformity and calcaneal osteotomy angle and the postoperative calcaneal displacement by use of weightbearing CT (WBCT). Methods: Weight-bearing CT scans obtained pre- and post-operatively were analyzed for sixteen patients with a mean age of 49.4 years (range: 18-66 years). Indication for surgery was adult-acquired flat foot deformity stage II. Based on the WBCT images, pre- and post-operative 3D bone morphological models of the tibia, talus, calcaneus, and the second metatarsal were created, on which anatomical bony landmarks were computationally identified to define a Foot Anatomical reference Frame (FAF). This FAF was used to measure valgus deformity pre- and post-operatively, inclination of the osteotomy plane, and displacement of the calcaneus (Fig. 1). Linear regression was conducted to assess the relationship between these measurements. Results: On average, the hindfoot valgus changed from 13.1° (±4.6) preoperatively to 5.7° (±4.3) postoperatively. A mean inferior displacement of 3.2 mm (±1.3) was observed along the osteotomy with a mean inclination angle of 54.6° (±5.6), 80.5° (±10.7), - 13.7° (±15.7) in the axial, sagittal and coronal planes, respectively. A statistically significant positive relationship (P < .05, R2 = 0.6) was found between the preoperative valgus, the axial osteotomy inclination, and the inferior displacement. Conclusion: This study shows that the degree of preoperative valgus of the hindfoot and the axial osteotomy angle are predictive factors for the amount of postoperative plantar displacement of the calcaneus. These findings contrast the general recommendation of performing a 90° calcaneal osteotomy angle, i.e. perpendicular to the lateral calcaneal wall in every patient. The obtained factors should be taken into account when performing a MCO and could be integrated in a computer-based pre- operative planning.
Outcomes of Isolated Peroneal Tendoscopy for Treatment of Peroneal Tendon Disorders
Authors: Smith Jeremy T. , Abdurrob Abdurrahman , Sangeorzan Adam , O’Donnell Seth , Bluman Eric M. 
Published: October 2019

Category: Arthroscopy Introduction/Purpose: Peroneal tendoscopy may be used to treat patients with peroneal tendinopathy. It is typically used for diagnostic purposes and to address tendinopathy in the absence of large tendon tears. Its value includes preservation of the superior peroneal retinaculum, small incision size, and faster postoperative recovery compared to open treatment. The goal of this study is to explore the functional outcomes of patients who have undergone isolated peroneal tendoscopy. Methods: Consecutive adult patients who underwent isolated peroneal tendoscopy between January 2010 and January 2018 at a single Foot and Ankle center were identified. The electronic medical record and operative notes were reviewed to identify patients with a minimum 12-month follow-up. Those undergoing open tendon repair, tendon transfer, peroneal groove deepening, and any other concurrent foot or ankle procedure were excluded from the study. Eligible patients were administered the PROMIS Physical Function-Short Form 10A (PF SF10A), Foot and Ankle Ability Measure (FAAM), and the Visual Analog Scale (VAS). Demographic information was also collected. Data was pooled, and descriptive analyses and unpaired T-tests were conducted. Results: Thirty patients met inclusion criteria and 22/30 patients (73%) were able to be reached. Our patient cohort was predominantly female (90.9%), had a mean age of 46.4 years, and an average BMI of 27.6. The mean pre-operative FAAM and PROMIS PF SF10A for patients were 58.3 and 39.7, while the mean post-operative FAAM and PROMIS PF SF10A were 83.3 and 50.5, respectively. There was a statistically significant improvement between the mean pre-operative and post-operative FAAM and PROMIS PF SF10A scores for patients (p =0.0050 and 0.0025, respectively) with a mean improvement of 25.0 in FAAM and 10.8 for PROMIS PF SF10A scoring. At an average of 33.4 month follow-up, the mean VAS for pain was 20.9 out of 100. Conclusion: Isolated peroneal tendoscopy is an effective treatment for patients who have peroneal pain in the absence of frank tears or tendon instability. The improvement in FAAM and PF SF10A scores was statistically significant and exceeds published MCIDs for both FAAM and PROMIS PF SF10A. Additional research is required to further evaluate the effectiveness of peroneal tendoscopy as compared to other methods of treating peroneal tendinopathy, such as open peroneal tenosynovectomy.
Incidental Findings on Foot and Ankle Radiographs as Compared to Other Anatomic Regions
Authors: Velasco Brian , Ye Michael , Chien Bonnie , Kwon John Y. , Miller Christopher P. 
Published: October 2019

Category: Orthopedic Radiology Introduction/Purpose: Radiographs are one of the most common and widely available diagnostic imaging techniques that are used to evaluate orthopedic conditions. However, incidental findings on imaging may be observed as well, some of which may be very serious and have significant heath as well as legal ramifications if missed. This study evaluates the number of clinically relevant incidental findings reported for orthopaedic radiographs ordered in an academic orthopedic multispecialty group over one year. Methods: A retrospective review was conducted of 13,948 eligible radiographs recorded at our institution over a 12-month period. Reports were categorized based on exam type. Incidental findings were first categorized as either concern for malignancy or non-malignancy. The possibly malignant findings were further subdivided into malignancies in Bone or Lung tissues. The non- malignant findings were categorized into the following groups: Benign Bone Disease, Gastrointestinal Pathology, Gynecologic Pathology, Incidental Fracture, Infection, Inflammation, Respiratory Pathology, Soft Tissue Mass, Urologic Pathology, Vascular Pathology or Other. Results: Of the 13,948 radiographs, 286 radiographs reported at least one incidental finding totaling to 287 (2.06%) incidental findings. The 3 studies with the highest rates of incidental findings were Leg Length Alignment films (3.94%), Spine (3.88%), and Pelvis & Hip (2.76%). The three categories with the lowest rates of incidental findings were Hand & Wrist (0.56%), Tibia/Fibula Foot & Ankle (0.84%), and Forearm & Elbow (1.13%). Over one-third of incidental findings concerned malignancy or metastases with 87 (30.1%) and 18 (6.23%) identified in bone tissue and lung tissue, respectively. Benign Bone Disease (24.9%), Gastrointestinal Pathology (6.57%), and Gynecologic Pathology (5.88%) were categories with the highest rates of non-malignant incidental findings. Follow-up was recommended for 122 (42.5%) incidental findings. Conclusion: This study describes the rates of incidental findings on orthopedic radiographs. Radiographs of midline structures are more likely to report an incidental finding as opposed to radiographs of distal extremities. The exception is leg alignment films because these image the entirety of the lower extremity and the pelvis and thus a far larger volume of the body. Over one-third of incidental findings concerned possible malignancy or metastases and therefore follow-up with focused imaging should be recommended if suspicious. This information will be particularly useful for orthopaedic surgeons who read their own radiographs without a radiologist formally reviewing the films.
Learning Curve for Open Reduction and Internal Fixation of Displaced Intra-Articular Calcaneal Fracture by Extensile Lateral Approach Using the Cumulative Summation Control Chart
Authors: Ahn Jungtae , Kim Tae Yong , Kim Tae Wook , Jeong Bi O 
Published: October 2019

Category: Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) of displaced intra-articular calcaneal fracture (DIACF) by extensile lateral approach is widely used but is technically challenging. In this study, the learning curve for ORIF of DIACF by extensile lateral approach was investigated. Methods: Between March 2014 and July 2018, 45 cases consisting of 40 patients underwent operative treatment for DIACF by the extensile lateral approach performed in all instances by a single surgeon. A moving average and cumulative summation control chart (CUSUM) were used for learning curve analyses. Operative failure was defined when at least one of the following parameters were unsatisfactory: reduction of Gissane angle and Böhler angle, posterior facet congruency, calcaneal width, subfibular impingement, axial alignment, or calcaneocuboid joint congruency. Results: The mean operating time was 117.4 min. Regarding the quality of reduction, the mean preoperative sum of the 7 parameters was 5.1 and improved to 0.6 postoperatively. The CUSUM for operative success peaked in the 20th case. The CUSUM and moving average graphics of operating time peaked at the 9th case and registered nadirs at the 34th case, with slight ascent and decent. The operating time for twenty cases in phase 1 (1–20) and for twenty-five cases in phase 2 (21–45) of the learning curve did not differ significantly. There was no statistical difference in the severity of fracture pattern. By comparison, significant differences in phase 2 patients showed a better postoperative reduction quality. Conclusion: As indicated by multidimensional statistical analyses, primary technical competence in improving the reduction quality of DIACF was achieved after the initial learning period with 20 cases. After the learning curve for ORIF of DIACF, a better reduction quality in the sum of reduction parameters was observed.
Change in Bone Mineral Density after Total Ankle Replacement: Two Year Follow Up
Authors: Alkhreisat Mohammad , Al-Maiyah M , Ramaskandhan Jayasree Ramas , Nicolas Andrea Pujol , Rawlings D , Purushothaman B , Farrier A , Siddique Malik 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Bone strength about the components is an important factor in Arthroplasty survival. This importance has been studied in total hip & knee replacement. However, there is paucity of literature Where little has been published regarding the quality of the bone and bone mineral content postoperatively surrounding Ankle Arthroplasty and circumstances surrounding the development of stress fracture. This prospective study used a method to quantify Bone Mineral Density BMD in different regions of the surrounding bones adjacent to tibia and talar components of uncemented Mobility ankle prosthesis, and to study the effect of loading on local ankle bone in the presence of un-cemented three components ankle replacement, by analyzing the BMD of the areas around tibia and talus before and after Mobility total ankle replacement. Methods: Twenty three Ankles (7Females, 15 Males) who underwent a Mobility Total Ankle Arthroplasty (TAA) between March 2008 and April 2009 were included prospectively in this study. They underwent a Bone Density Scan using the DEXA HOLIGIC Scanner with the specific method designed for measuring BMD. Seven areas (R1-R7) around the prosthesis were studied (Please see attached figure). Scans were carried out pre-operatively and repeated at 1 and 2 years post-operatively. The results were also compared with clinical outcomes, using (AOFAS scores) both pre, 1 and 2 years post-op. Results: Mean age of patients was 63.3 years (SD 9, range 43 to 80). AOFAS scores showed significant improvement (from 28.8 pre-op to 78.7,76.9 at 12 and 24 months post-op respectively; p<0.05). BMD within the lateral malleolus decreased significantly from 0.5g/cm2 to 0.42g/cm2 (17%, P < 0.01), at one and two years postoperatively - R2. There was an insignificant increase in Mean BMD at medial side metaphysis of tibia increased by,7% (+0.07 g cm -2, R6), but this just failed to reach statistical significance, mean BMD within medial malleolus decreased slightly from 0.67g/cm2 to 0.64 g/cm2 at the same period which was statistically insignificant. There was little insignificant increase in BMD in tibia just proximal to implant (R7) and at talus (R5). Conclusion: Stemmed implant causes changes in Tibial BMD around prosthesis. There was stress shielding over the lateral malleolus resulting in decrease BMD in lateral malleolus and to a lesser extent of the medial malleolus. The increase in BMD at tibial metaphysis indicates an increase in mechanical stresses at that region, which may explain occasional postoperative stress fracture of medial malleolus or medial sided ankle pain. There is no further change in BMD from year 1 to year 2 following TAR.