bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Comparison of the Influences of Two Proximal Metatarsal Osteotomies on First Ray Articular Contact Characteristics
Authors: Reddy Sudheer C. , Li Jihui , Cuttica Daniel J. , Theiss Mark 
Published: October 2019

Category: Bunion Introduction/Purpose: Proximal metatarsal osteotomies are commonly employed to treat moderate to severe hallux valgus deformities. An understudied area with respect to these procedures is the effect on articular contact properties following the surgeries. Potential long-term risks include altered joint mechanics and possible arthritic progression. A biomechanical comparison of articular characteristics of the proximal opening wedge and Ludloff osteotomies was performed in this study. It is hypothesized that the proximal opening wedge osteotomy (POWO) would lead to greater alterations in articular contact properties along the first ray. Methods: Seven paired fresh-frozen below-knee cadaveric limbs with hallux valgus deformity were selected. The first ray inclusive of the navicular-medial cuneiform articulation was dissected and potted in resin. Specimens in each pair were tested in the intact state and then randomized to receive either a Ludloff or POWO. A 4 mm opening wedge osteotomy was used in all cases. The FHL was dissected and isolated. Testing was conducted in a customized apparatus with the cuneiform pinned to the apparatus and positioned at 10 degrees of declination. Loading of the FHL was conducted to 100 N utilizing an instrumented tensioner. A 28 N load was added at the distal phalanx to simulate the ground reaction force(Fig.1). First MTP and TMT articular properties were recorded simultaneously using two pressure sensors. For each state, a pressure map was generated and contact area, peak pressure and center of pressure were calculated. Results: Average peak pressure was noted to be elevated at the MTP (4.6 mPa vs 6.9 mPa, P = 0.08) and TMT (3.3 mPa vs 5.1 mPa, P = 0.16) joints when comparing the Ludloff and the POWO respectively, but was not significant. Contact area was also noted to be lower in the POWO vs Ludloff states for the MTP (86. 6mm2 vs 69.1mm2, P = 0.15) but not the TMT joints (89.1 mm2 vs 88.5mm2, P = 0.96). A trend towards decreased contact force within the TMT joint was noted following opening wedge osteotomy relative to the intact state (103.8 N vs 113.9 N, P = 0.31), while forces were elevated at the MTP joint (104.3 N vs. 96.0 N, P = 0.63), although not statistically significant. Conclusion: POWO can potentially change articular contact characteristics along the TMT and MTP articulations of the first ray. This could possibly lead to altered loading patterns and possible long-term arthritic progression versus other osteotomies. However, it is unlikely that the changes observed with the sizes of the osteotomy commonly used would lead to long term significant consequences.
Risk of Complications with the Total Contact Cast in Diabetic Foot Disorders
Authors: Riopelle Alexandria , LeDuc Ryan , Pinzur Michael S. , Schiff Adam P. 
Published: October 2019

Category: Diabetes Introduction/Purpose: The total contact cast is an important component of the clinical treatment algorithm for diabetic foot ulcers and Charcot Foot Arthropathy. Few studies have reported on the complications associated with this treatment modality. Methods: Over a ten year period, 2265 total contact casts were placed on 384 patients during their treatment for diabetic foot disorders. All of the casts were applied by a Certified Orthopaedic Technologist under the supervision of a University Faculty member. Complications were grouped as: (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change / removal. Complications were then associated with Hemoglobin A1C levels at the time of treatment. Results: Using this very stringent definition of a complication, ten percent of patients had some form of a complication. Most complications resolved following cast change or cast removal. Conclusion: The total contact cast has been demonstrated to be a valuable tool in the treatment of diabetic foot disorders. This retrospective chart review should serve as a valuable reference to assist clinicians when counseling patients during treatment for diabetic foot disorders.
Mid Term 5-Year Follow Up of a Novel Algorithm for Non-Operative Weber B Ankle Fractures
Authors: Rooney Edward M , Finney Fred T , Talusan Paul , Holmes James R , Walton David 
Published: October 2019

Category: Ankle, Ankle Arthritis, Trauma Introduction/Purpose: It is important to understand which isolated fibular fractures require surgical intervention. Several different radiographic guidelines have been used to interpret and predict stability of the injured ankle. Holmes et al previously described a novel algorithm used to assess stability and the ability to treat the stable injuries non-operatively. The one year results demonstrated favorable outcomes of these non-operative patients, however there is a question about the durability of these results and whether these patients developed post-traumatic degenerative changes over mid to long term follow up. Methods: An observational study based on a previous cohort of 51 patients studied from 2010 to 2013 with isolated Weber B ankle fractures was performed. These were defined as stable at the time of injury when the medial clear space (MCS) was less than 7 mm on the initial gravity stress radiographs along with a normal mortise relationship on weight bearing radiographs. 27 patients that were treated non-surgically, were brought back for a mid-term follow up with a mean of 6.8 years. American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot scores, Olerud-Molander Ankle (OMA) Score, and visual analog scale (VAS) pain score were collected in accordance with the prior study. Patient Reported Outcome Measurement Information System (PROMIS) scores were also collected including lower extremity, physical function, depression, and pain interference. Standing bilateral ankle radiographs were obtained, and assessed for MCS widening, and ankle arthritis using the Kellgren-Lawrence grading scale. Results: Average functional score results were (in comparison to 1-year outcomes): AOFAS Hindfoot, 95.7 (93.2); OMA Score, 95.2 (91.0); and visual analog scale pain score, 0.24 (0.57). Using a Wilcox Signed Ranks Test, there was a statistically significant increase in 5-year AOFAS Hindfoot scores as compared to 1-year scores in those same patients (p=0.005) There was no evidence of significant post-traumatic osteoarthritis based on the Kellgren-Lawrence grading scale. Conclusion: The previously described, novel at the time, algorithm for assessing stability of isolated Weber B ankle fractures and nonsurgical treatment with protected weight bearing has shown to produce excellent results for mid-term follow up with an average of 6.8 years. Additionally, these patients are not at increased risk for rapid progression of post-traumatic osteoarthritis. This further supports initial weight bearing radiographs as a reasonable assessment of ankle stability and validates the aforementioned algorithm as a safe and cost-effective functional treatment regimen.
Short-Term Results of Lisfranc Injuries Treated with the Suture Button Technique
Authors: Saito Guilherme H. , Mendes Alberto A. M. , Nishikawa Danilo R. C. , Devito Beatriz , Netto Cesar de Cesar , Devito Leticia , Prado Marcelo P. 
Published: October 2019

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button. Conclusion: The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.
Fatigue Strength of Highly Crosslinked Polyethylene in Total Ankle Arthroplasty
Authors: Schipper Oliver N. , Dharia Mehul A. , Hertzler Justin S. , Bischoff Jeffrey E. 
Published: October 2019

Category: Ankle Introduction/Purpose: Highly crosslinked polyethylene (HXLPE) was developed for its superior wear properties in comparison to conventional polyethylene (CPE). The higher dose irradiation required for HXLPE may also cause embrittlement, which reduces fatigue resistance and leads to surface cracking or fracture of the polyethylene bearing. Concern over fatigue resistance has prevented widespread adoption of HXLPE for use in in total ankle arthroplasty (TAA). The aim of this study was to determine whether HXLPE has sufficient fatigue strength for total ankle arthroplasty under simulated physiologically relevant motion profiles and loading in the ankle. Methods: A bicondylar, semi-constrained HXLPE TAA design was subjected to 10 million cycles (Mc) of fatigue testing under loading conditions representative of a walking gait. Kinetics and kinematics of gait were incorporated into a computational model (Dassault Systemes / SIMULIA, Johnston, RI), for prediction of peak stresses on the HXLPE insert. Based on predicted peak stresses, worst case component size and loading configuration were identified. Ten samples were tested on a closed loop servohydraulic test frame (MTS Systems Corp., Minneapolis, MN) for 10Mc. Testing was conducted to a peak load of 5600 N (1259lbs), representing approximately 5 times body weight for a 240 lb individual. Following testing, all samples were evaluated for evidence of polyethylene fracture or surface cracking. Results: Peak stresses in the HXLPE insert occurred during heel off, closely corresponding to both peak axial force and dorsiflexion during gait. The smallest sized component had the highest polyethylene insert stresses, whereas larger sized components had more material to bear the same load, resulting in up to a 30% decrease in stress. All 10 specimens completed 10Mc of testing at 5 times body weight without fracture or surface cracking of the polyethylene insert. Conclusion: HXLPE has sufficient fatigue strength to withstand 10Mc of loading at 5 times body weight at the point of peak stresses during gait in total ankle arthroplasty, and therefore, may be mechanically strong enough to withstand the demands of the ankle. Further clinical evidence is necessary to determine if these results translate to adequate fatigue strength with clinical use of HXLPE.
Minimally Invasive Knotless-Bridge Suture Technique for Acute Achilles Tendon Rupture
Authors: Shi Zhongmin , Wang Xiaokang 
Published: October 2019

Category: Hindfoot Introduction/Purpose: To investigate the clinical effect of minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture. Methods: Totally 23 cases of acute achilles tendon rupture were treated from August 2016 to December 2016 including 21 cases of males and 2 cases of females with an average age of 42.1 years-old (from 29-51 years). Mini-invasive knotless-bridge suture technique was performed in all cases until the soft tissue condition improved. Ankle range of motion, calf circumference difference between two lower extrenities, number of repetions for single heel-rise in one minute, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Achilles Tendon Total Rupture Score(ATRS) and time to return to work were investigated at last follow-up, as well as complications during follow-up. Results: 23 cases were followed for an average of 28 months . At last follow-up, the average ankle ROM was 60.3±2.2°, calf circumference difference between two lower extrenities was 92.7±1.8%, number of repetions for single heel-rise in one minute was 25±2, AOFAS score was 91.5±2.2, ATRS score was 92.6±2.4, time to return to work ranged from 6 to 9 weeks, averaging 7 weeks.Wound was sutured in one stage and united in one stage.No skin necrosis, superficial infection, sural nerve injury occurred.No achilles tendon re-rupture was seen during follow-up. Conclusion: Minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture is operated easily and lesser-trama, enabling patients to return to work earlier and proved to be an effective treatment.
The Relationship of the Lapidus Intramedullary Nail to Neurologic and Tendinous Structures in the Foot: An Anatomic Study
Authors: Shofoluwe Ademola , Krautmann Kurt , Marques Lucas , Stewart Gary 
Published: October 2019

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The lapidus procedure is a longstanding operation performed for the treatment of hallux valgus deformity with a concomitant hypermobile first ray. Orthopaedic surgeons have a myriad of options to choose from in performing the lapidus procedure. The implantation of orthopaedic implants comes with the risk of iatrogenic injury to surrounding anatomy. Several cadaveric studies in the humerus and femur have described potential neurovascular structures at risk during placement of intramedullary nail systems. The purpose of this study was to determine the proximity of nail insertion and interlocking mechanisms in the Lapidus Phantom Intramedullary Nail System (Paragon 28, Inc.) to neurologic and tendinous structures in the foot. Methods: A titanium intramedullary nail was inserted from the first metatarsal to the medial cuneiform spanning the first tarsometatarsal joint in 10 fresh-frozen cadaver feet. K-wires were inserted in the proximal lateral, proximal medial, and distal medial-to-lateral interlock screw paths. The tibialis anterior tendon, extensor hallucis longus tendon, and superficial peroneal nerve were carefully dissected and exposed, and the distance from each of these anatomic landmarks were then measured and recorded from four different aspects of the nail: Proximal lateral interlocking screw path, proximal medial interlocking screw path, nail insertion, distal interlocking screw path. Distances were averaged, ranges were determined. Results: The tibialis anterior tendon was in closest proximity to the proximal medial interlock K-wire with an average distance of 0.4 mm. The proximal medial interlock bisected the tibialis anterior tendon in three of the specimens. The extensor hallucis longus tendon was in closest proximity to the nail insertion with an average distance of 1.2 mm. A branch of the superficial peroneal nerve was in closest proximity to the distal interlock K-wire with an average distance of 7.5 mm, however, the nerve came in direct contact with the proximal medial interlock K-wire in two of the specimens. Conclusion: The Lapidus intramedullary nail’s proximal medial interlock screw poses the greatest threat to the tibialis anterior tendon, with the distance from the tendon to the interlock K-wire being 3 mm or less in all specimens tested. The extensor hallucis longus tendon is at risk of injury with insertion of the nail. Medial to lateral interlocking poses the greatest danger to a branch of the superficial peroneal nerve. Blunt dissection should be performed using this system with a path to bone before instrumentation to reduce the risk of nerve and tendon injury in the foot.
Peritalar Motion after Simulated Ankle Fusion in a Cadaveric Model
Authors: Smith Bryan , Schiff Adam , Havey Robert , Pinzur Michael , Muriuki Muturi 
Published: October 2019

Category: Ankle Arthritis, Basic Sciences/Biologics Introduction/Purpose: Adjacent joint disease often occurs after many orthopaedic surgical interventions. Specifically in the foot and ankle, subtalar arthritis has been demonstrated as a long term sequelae after ankle arthrodesis. The purpose of this study was to evaluate real time qualitative and quantitative motion differences in the hindfoot and midfoot during simulated gait, both before and after ankle fusion in a cadaveric model. Data recorded from each cadaveric trial is used in conjunction with a CT scan of each specimen, allowing creation of a three-dimensional, real time, anatomic model of motion of the foot and ankle. Methods: Three human cadaveric specimens (lower leg and foot) were obtained and prepared for testing. Taking care to preserve the ligamentous and tendinous attachments, radiopaque fiducial makers were placed in each bone (tibia, fibula, talus, calcaneus, navicular, all cuneiforms, 1st metatarsal). CT scan of each specimen was then performed, and used to develop a three dimensional anatomic model of the specimen. Each specimen was then mounted into a custom built apparatus, and load was applied to the construct using a follower load model. Each specimen was taken through two full cycles of the simulated stance phase. Kinematic data of the individual bones/joints were measured in real time, using optoelectronic targets, and saved for later comparison. Next, tibiotalar fusion was performed on each of the previously tested specimens using an anterior plate and screw construct. The specimens were again cycled in the same fashion and data was recorded in the same manner. Results: Tibiotalar fusion successfully eliminated motion between the talus and tibia, directly altering the normal kinematics of the foot ankle complex. Quantitatively, the motion at the subtalar and talonavicular joints increased only slightly with fusion. However, this represents a relative increased motion demand at each joint that exceeds what was observed in the non-fusion condition. Qualitatively, the motion curves for the talocalcaneal and talonavicular joints were altered when compared to the non-fusion state (Figure 1). The qualitative change in motion revealed a relative linkage of motion between the subtalar and talonavicular joints and this was consistently observed across all specimens. Conclusion: Simulated ankle fusion via an anterior plate and screw construct directly alters the kinematics of the downstream (talocalcaneal and talonavicular) joints. Real time observation demonstrates a relative linkage of the motion occurring in the subtalar and talonavicular joints. This linkage resulted in alteration from the observed physiologic motion that occurred in these joints during the non-fusion condition. These findings may provide insight into the etiology of adjacent segment disease seen in the subtalar and talonavicular joints after ankle fusion.
Durability of Smoking Cessation for Elective Lower Extremity Orthopaedic Surgery
Authors: Smith Danica H. , McTague Michael F. , Weaver Michael J. , Smith Jeremy T. 
Published: October 2019

Category: General Health Introduction/Purpose: Smoking tobacco is a risk factor for impaired wound healing, infection, delayed fracture healing, and prolonged hospital stay. Smoking cessation prior to surgery has shown a 40% relative risk reduction in total perioperative complications. The primary purpose of this study is to evaluate the impact of preoperative smoking cessation on long-term smoking habits in patients undergoing elective lower extremity orthopaedic surgery. The secondary outcome is patient-reported effectiveness of smoking cessation method. Methods: A retrospective cohort study was performed by identifying all patients who were smokers that were required to quit and subsequently had a normal nicotine/cotinine serum test prior to lower extremity orthopaedic surgery. Attempts were made to contact all patients and administer a survey inquiring about demographics, medical history, smoking history, smoking cessation process, and current smoking status. Results: Of 36 eligible patients, 23 completed the survey. Eleven patients identified as current non-smokers (48%) at the time of survey follow-up (mean follow-up 55 months with a range of 12 to 88 months). Of these 11, 82% said they were very likely to continue to refrain from smoking. Twelve patients identified as current smokers at the time of survey, over half of whom ceased smoking for at least three months perioperatively. The reasons for resuming smoking were “stress” (45%), ”falling back into the habit” (37%), and due to “friends who smoke” (18%). The majority of smoking patients (92%) decreased the number of cigarettes they smoked regularly. The most effective smoking cessation techniques were ”cold turkey”, “non-nicotine medication”, and ”trans-dermal nicotine patches”. Conclusion: Elective surgery offers a unique opportunity for smoking cessation. Of 23 patients required to quit smoking prior to surgery, 48% maintained smoking cessation at least one year postoperatively. Of the 12 patients who relapsed, 55% stated that they did not resume smoking until at least three months postoperatively, suggesting that this particular period may be an important time for intensified smoking cessation counseling.