bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total Ankle Arthroplasty Results Using Fixed Bearing CT-Guided Implants in Post-Traumatic Versus Non-Traumatic Arthritis
Authors: Albagli Assaf , Ge Susan M. , Park Patrick , Cohen Dan , Chaytor E. Ruth , Volesky Monika 
Published: November 2020

Category: Ankle; Ankle Arthritis; Trauma Introduction/Purpose: The majority of ankle osteoarthritis are post-traumatic in etiology. Previous studies have shown that patients with post-traumatic ankle osteoarthritis are less satisfied, experience significantly more pain during normal activities and have higher revision rates. However, these studies were performed with older generation implants. The objective of this study was to compare patients hat had undergone total ankle arthroplasty secondary to either post-traumatic or non-traumatic etiologies using patient specific, third generation fixed bearing implants and compare clinical as well as radiographic outcomes. Methods: A retrospective chart review was conducted on 41 patients who had undergone total ankle arthroplasty using a third- generation fixed bearing implant with CT-based patient specific cutting guides from July 21, 2015 to December 13, 2017 performed by 2 foot and ankle surgeons. Demographic and operative data was collected. Etiology was determined based on clinical notes, operative notes, and x-rays. Clinical outcomes were obtained using the Foot and Ankle Ability Measure questionnaire. Radiographic assessment of the coronal and sagittal alignments were carried out to assess implant migration or loosening. Results: We had 26 patients in the post-traumatic group and 15 in the non-traumatic group with a mean follow-up of 32.5 months and 30.4 months respectively. There was no significant difference between both groups in terms of FAAM ADL subscore with the post-traumatic group did slightly better with 7 patients scoring ‘nearly normal’ (26.9%) and 18 patients scoring ‘normal’ (69.2%). Whereas in the non-traumatic group 5 patients score ‘nearly normal’ (33.3%) and 9 patients score ‘normal’ (60%). In terms of the self-rated subjective functioning score, mean score of 79.2% and 73.4% respectively. On radiographs, there was no subsidence or significant implant movement for both groups at mean follow-up of 28.3 months for the post-traumatic group and 26.3 months for the non-traumatic group. Conclusion: Unlike in previous studies in older implants where clinical outcomes were worse in post-traumatic ankle arthritis, our study showed that those receiving total ankle arthroplasty due to post traumatic osteoarthritis do slightly better than those with non-traumatic osteoarthritis, with more patients reporting normal levels of activity. These results may help quantify improvements in newer generation patient specific implants as well as to gain insight into how different implant designs affect post- operative outcomes based on etiology of ankle osteoarthritis.
Level of Evidence and Authorship Trends in Foot and Ankle Related Trauma Publications
Authors: Alexander Bradley , Jones James R. , Solar Spaulding F. , Agarwal Abhinav , Cage Benjamin B. , Greco Elise M. , Shah Ashish 
Published: November 2020

Category: Other Introduction/Purpose: Evidence-based research in the field of foot and ankle related trauma surgery has increased significantly over the past two decades and considerable emphasis is being put on publication quality and level of evidence (LOE). With foot and ankle surgery being a relatively new and growing field of orthopedics, minimal analysis has been performed on the LOE and authorship trends in foot and ankle related trauma publications. The purpose of this study is to evaluate LOE and authorship characteristics in foot and ankle related trauma publications in three different high impact factor journals. Methods: All of the foot and ankle related trauma publications from the years 1997, 2002, 2007, 2012, and 2017 in Foot and Ankle International (FAI), Journal of Trauma (JOT), and The Journal of Bone and Joint Surgery (American and British volumes) (JBJS) were analyzed. LOE of each article was determined by two external reviewers based on the JBJS LOE grading system. Country of origin for the first, last, and corresponding author of each article was evaluated, and fellowship data was obtained from a database for all United States authors. LOE, authorship, and publication trends were compared between both journals and publication year. Results: Over the 15-year period therapeutic studies were the prominent studies in all three journals. JBJS published the highest quality level of evidence and did not publish any level V evidence. The median number of authors was highest in JBJS. JOT publishes a majority of articles from North America (65%) while JBJS publishes more internationally (48% North American). Number of authors increased over time from a median of 3 in 1997 to a median of 5 in 2017. When evaluating the articles with available authorship fellowship data, JBJS and JOT had the highest percentage of articles with a trauma fellowship trained author at 77% and 53%, respectively. FAI had the highest percentage of articles with a foot and ankle fellowship trained author at 34%. Conclusion: From 1997 to 2017, there has been an increase in level 3 evidence foot and ankle related trauma publications and an emphasis on studies being conducted by fellowship trained authors. While the percentage of authors with MDs per publication remained similar over time, this study shows that publications have gradually increased the number of authors over time. There are key differences between the journals including level of evidence. [Table: see text]
Cross-Cultural Adaptation and Validation of an Arabic Version of the American Orthopaedic Foot & Ankle Society Score (AOFAS)
Authors: Alhadhoud Meshal A. , Alsiri Najla F. , Alsaffar Maryam M. , Glazebrook Mark A. 
Published: November 2020

Category: Ankle Introduction/Purpose: The evaluation process is essential to optimize the management of patients with foot and ankle pathologies and disorders. The study aimed to translate and culturally adapt the four scoring systems of the American Orthopaedic Foot & Ankle Society Score (AOFAS) into Arabic and explore related psychometric properties. Methods: A multicenter observational design was used, following the forward-backward translation method. One hundred and twenty patients with foot and ankle problems were included. Construct validity and test-retest reliability were analyzed using Intra-class correlation coefficients; internal consistency was analyzed with Cronbach’s alpha, and the responsiveness was analyzed using a paired-sample test. Results: The validity ranged from 0.303-0.542 and from 0.018-0.753 when correlated to the SF-12 physical and mental component scores, respectively. Test-retest reliability ranged from 0.727-0.974; from 0.826-0.983 for internal consistency and from 0.001-0.182 for sensitivity. Conclusion: The AOFAS’s four systems were successfully translated and culturally adapted into Arabic with sufficient psychometric properties.
Intramedullary Fixation of Calcaneal Fractures: Early US Experience
Authors: Anderson Kevin C. 
Published: November 2020

Category: Hindfoot; Trauma Introduction/Purpose: The fixation of displaced intraarticular fractures of the calcaneus have posed many challenges for the surgeon, including an anatomic reduction, fracture stabilization, and soft tissue concerns. The extensible lateral and sinus tarsi approaches must be delayed until soft tissues concerns resolve and despite this are susceptible to wound necrosis and skin infections. Intramedullary fixation allows immediate fixation without soft tissue compromise. Methods: The retrospective case series is comprised of 23 patients; 19 intramedullary fixation of the calcaneus and 4 primary arthrodesis with the FH Orthopedics CalcaNail. Fracture classification, timing to surgery, accuracy of reduction, complications, and outcome were recorded. Results: There were zero wound complications. Bohler’s angle was restored as well as articular surface. One patient required implant removal after healing seconding to prominent hardware. One patient required conversion to a subtalar arthrodesis. There were no implant mechanical failures. Conclusion: The intramedullary fixation of calcaneus fractures has been performed extensively outside the US with documented success. This series of early US experience exhibits similar utility. The ability to reduce the fracture intrafocally and stabilize with a minimally invasive approach have proven useful with no incidence of wound complications. Not to mention no delay from time of injury to surgery is needed.
Safe Level for the Syndesmotic Stabilization: A Simulated MRI Study
Authors: Angthong Chayanin 
Published: November 2020

Category: Trauma; Sports Introduction/Purpose: Great saphenous vein and saphenous nerve were reported as the high risk of injury from the syndesmotic stabilization. However, little is known about the safe level and area of the syndesmotic stabilization regarding the risks on the great saphenous neurovascular structures. This study was to demonstrate the safe level of syndesmotic stabilization via a simulated MRI study. Methods: A total of 10 living volunteers with intact conditions of syndesmosis on their ankle MRI was recruited in this study. Each volunteer’s ankle MRI was divided into 3 groups as 15-mm, 20-mm, and 25-mm level above the ankle joint line. The simulated reduction and fixation (stabilization) line was created through the tibiofubular syndesmosis at each level in accordance with the direction guidance by Phisitkul et al. The distance between great saphenous neurovascular structures and simulated line was measured in each level of simulated stabilization for each subject. The statistical analyses using IBM SPSS version 22 were performed to demonstrate the differences among the three groups (pair 1: 15-mm vs 20 mm groups; pair 2: 20-mm vs 25-mm; pair 3: 15-mm vs 25-mm level above the ankle joint line). Results: The mean distances between great saphenous neurovascular structures and simulated line of syndesmotic stabilization were shown in an attached picture. The syndesmotic stabilization at the 15-mm level above the joint line demonstrated the closest distance to the mentioned neurovascular structures. For the comparison among the three groups, pairs 2 and 3 showed the statistically significant differences at p-values as 0.004 and 0.001 respectively. A pair 1 did not show the significant difference at p- value as 0.260. Conclusion: Based on the results of this study, all levels of syndesmotic stabilization above the ankle joint line are safe for the great saphenous neurovascular structures. However, a 25-mm level above the joint line was the safest level for the syndesmotic stabilization when compared to other lower levels. Mini-open incision is recommended during the syndesmotic reduction and fixation on the tibial side to prevent the iatrogenic injury to the great saphenous neurovascular structures especially on the 1.5- mm and 2-mm level above the ankle joint line. [Table: see text][Table: see text]
Accuracy and Reproducibility of a Patient-Specific Instrumentation in Total Ankle Arthroplasty
Authors: April Pierre-Marc , Champagne Philippe Hugo , Angers Magalie , Lalonde Karl-Andre R. , Meulenkamp Brad , Martinez Adriana P. , Seidel Angela 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis (OA) is a frequent and debilitating disease with the two primary surgical options being ankle arthrodesis or total ankle arthroplasty (TAA). TAA has the advantages maintenance of range of motion (ROM), a more normalized gait and potentially improved functional outcome over arthrodesis. Malaligned protheses have been demonstrated to have increased peak component pressures, potentially leading to component loosening, failure and overall worse outcomes. One TAA system uses pre-op CT to build patient-specific surgical instrumentation, with purported benefit of more reliable and accurate component positioning. The goal of this study is to evaluate reproducibility and accuracy of this system by surgeons without affiliation with the prosthesis design team. Methods: A retrospective radiological study was performed including two centers with four fellowship-trained foot and ankle surgeons using the patient-specific TAA system. All patients operated on between 2015-2018 were included. The primary outcome was alignment of the tibial implant in coronal and sagittal orientation relative to the tibia anatomic axis. All measurements were performed in duplicate an orthopaedic foot and ankle fellow and a musculoskeletal fellowship-trained radiologist. Secondary outcomes included accuracy of prediction of tibial and talar component size implanted compared to the engineered pre-operative plan, rate of prosthesis revision (at least one component) and overall re-operation rate. Results: 79 patients were included in the final review. The mean absolute deviation of the tibial component from tibial anatomical axis was 1.31° +/- 1.14in the coronal plane and 2.68°+/- 1.74 in sagittal alignment. 94.7 % of the implants were implanted within 3°of varus or valgus and 73.7% within 3°of dorsiflexion or plantiflexion. 86 % of the implanted tibial component were of the size predicted by the pre-op plan whereas it was found to be the case in 63 % of the talar component.At a mean follow-up of 22 months(3-52), two TAA (2.5%) have been revised due to aseptic tibial implant loosening. Conclusion: The patient-specific guide has been found to be a reliable system for coronal tibial implant alignment but less in the sagittal plane in the hand of surgeons not involved in the design of any TAA system. Accuracy of prediction of the tibial component size is high, moderate on the talar side. In this series there was a low rate of early component revision (2.5 %).
Kinematics after Syndesmotic Injury: Assessing the Magnitude of Talus and Fibula Rotation and Displacement
Authors: Bartolomei Jonathan , Bowers Mark W. , Hunt Kenneth J. 
Published: November 2020

Category: Ankle; Sports; Other Introduction/Purpose: High ankle sprains, or injuries to the distal tibiofibular syndesmosis, are predictive of long-term ankle dysfunction. Our objectives were to evaluate ankle mortise stability, radiographically, and kinematically, using a cadaveric model with a simulated syndesmotic injury. We also measured the ability of a suture-button system to restore natural joint motion. Methods: Eight cadaveric specimens underwent serial sectioning of the anterior-inferior tibiofibular (AITFL), interosseous (IOL), posterior-inferior tibiofibular (PITFL), and deltoid ligaments. Specimens underwent external rotation and lateral translation testing after ligament release to obtain kinematic data (using a validated infrared LED motion capture system) and radiographic measurements. We then repeated external rotation and lateral translation testing after implementing a suture-button system. Repeated measures ANOVA with a Bonferroni/Dunn post-hoc test calculated the interspecimen comparisons. Results: Sectioning of each ligament, beginning with the AITFL, significantly increased talar external rotation. After releasing the AITFL and IOL, fibular external rotation increased significantly. Posterior displacement of the fibula began following the release of AITFL. Significant radiographic widening of the medial clear space and the syndesmosis occurred only after the release of the deltoid ligament. Syndesmotic and medial clear space widening was not significantly different from the intact state under lateral translation until after the release of the deltoid ligament. Placement of the suture-button system successfully reduced the medial clear space but was unable to restore the native stability of the ankle joint. Conclusion: This project addresses rotational and kinematic changes in the ankle after syndesmotic injury by quantifying the effect of ligamentous disruption on the tibiotalar articulation. The change in joint kinematics may explain why patients with moderate-to-severe syndesmosis injuries take longer to heal and develop long-term dysfunction. Significant talar rotation and posterior fibular displacement occur during external rotation, even with moderate syndesmosis injury, and before the disruption of the deltoid ligament. Stress radiography does not appear to be a reliable indicator of mild or moderate syndesmosis injuries.
Brazilian Experience with Zennith – Corin System Total Ankle Replacement
Authors: Baumfeld Daniel , Lemos André V. , Baumfeld Tiago S. , Godoy-Santos Alexandre L. , Nery Caio A. 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty is already a reality in Brazil, although there are few publications of clinical outcomes in our country. The objective of this publication is to evaluate the results of TAA in a series of patients treated with corin system total ankle replacement Methods: 26 TAA were implanted from Jan / 13 to Aug / 16, (26 patients - 15F: 58% / 11M: 42%) (mean age: 55 years: min 37a / max 69a) using the implants Zennith from Corin (UK). Data from the clinical status (VAS, AOFAS, ADM), implant positioning and osteotomies (LTS, tibial slope, Alpha, Beta and Teta angles and distances ‘a’ and ‘b’) were evaluated in addition to the qualitative bone evolution (Peri-prosthetic cysts, sagging and wear of the components). Immediate and late information of associated surgeries, complications, and re-interventions were collected. Figure 1 present pre and post operative image Results: At 31 months of follow-up (min 4m: max 48m), there was a significant improvement in VAS (pre 8: post 2), AOFAS score (pre 37: post 77) and tibio-talar movement arch (pre 12: post 25 ) (P <0.001). There were some complications: 7 (27%) had peri-prosthetic cysts, 3 (12%) talar subsidence, 2 (8%) tibial subsidence and 2 (8%) poly wear. 8 patients (31%) had associated surgeries (19%: malleolar fracture). As major complications: 1 (4%) postoperative infection, 3 (12%) skin complications and 2 failures (8%). Conclusion: Despite the high morbidity, total ankle replacement represents a valuable therapeutic resource.
Brazilian Total Ankle Replacement Experience
Authors: Baumfeld Daniel , Lemos André V. , Martins César E. , Nery Caio A. 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early TAR generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience, Brazilian surgeon could not participate in the development of the technique and implants designs during all these years. This paper present the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed. Methods: Data since the first series of TARs in Brazil were colect from university institution, personal data base from surgeons and previous publication, survivalship, complications, number of each implant and implant availability were recorded. Results: In Brazil, indications for TAR are not so different from around the world, the data we had access demonstrate 65% of post-traumatic arthritis, 26 % of inflammatory arthritis, 2% post-infectious arthritis and 7 % of primary arthritis. In fortheen years 263 surgeries were performed, in different parts of the country, but only one surgeon performed 43 cases (27,3% of the total). Table 1 demonstrate the number of procedures performed per year. Survivor rate of each implant available in the country in the first year were 94%, 86,19% in the second year, 82,84% in the third year, 81,62% in the fourth year and 71,47% in the fifth year. Conclusion: In Brazil there are limited and different ankle arthroplasty systems available for use. The procedure itself continues to be technically demanding and require surgical sophistication and expertise. A national registry to justify the procedure indication; report the outcomes and survivorship has not been developed. This procedure is growing around the county, as well as the surgeon experience, but we should remember that TAR is not for every patient and that the appropriate indication, based on the evidence available, is fundamental to obtaining durable and predictable outcomes. [Table: see text]
Biomechanical Comparison of Zone 1 5th Metatarsal Base Fracture Fixation
Authors: Bean Bryan , Smyth Niall A. , Abbasi Pooyan , Parks Brent , Hembree Walter C. 
Published: November 2020

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: Zone 1 5th metatarsal base fractures are more common than zone 2 or 3 fractures, but significant debate still exists as to their optimum management, particularly for large fragments. The objective of this study was to compare the biomechanical strength of two headless compression screws versus a hook plate for fixation of large zone 1 5th metatarsal fractures. We hypothesized that hook plates would be biomechanically superior. Methods: Ten matched pairs of fresh-frozen 5th metatarsal cadaveric specimens were used. Large zone 1 avulsion fractures were simulated. Specimens were randomly assigned to fixation with two 2.5-mm headless compression screws or an anatomic 5th metatarsal hook plate. Specimens were mounted on a test frame and cyclically loaded through the plantar fascia, peroneus brevis tendon, and metatarsal base. Each specimen underwent 100 cycles at 50% physiological load (12 N on bone, 70 N on plantar fascia, 17.5 N on peroneus brevis), 100 cycles at 75% load (18 N on bone, 105 N on fascia, 26.25 N on peroneus brevis), and 100 cycles at 100% load (24 N on bone, 140 N on fascia, 35 N on peroneus brevis). Maximum cycles and maximum force were recorded. Results: The hook plate group had significantly higher cycles to completion of loading or failure compared with the screw group (270.7 +- 66.0 [range 100-300] cycles versus 178.6 +- 95.7 [range 24-300] cycles, respectively; P=0.011). Seven of 10 hook plate specimens and 2 of 10 screw specimens were intact at the maximum 300 cycles. Mean maximum force on the plantar fascia did not differ between the plate and screw groups (133.0 +- 22.1 [range 70-140]) N versus 119.0 +- 4.5 (range 70-140) N, respectively; P=0.098). Nine of 10 plate specimens and 5 of 10 screw specimens were intact at maximum force of 140 N. Conclusion: To our knowledge, this is the first biomechanical study comparing fixation constructs for 5th metatarsal avulsion fractures while loading the plantar fascia, which is the primary deforming force in vivo. These data suggest an anatomic hook plate is biomechanically superior to headless compression screw fixation of large zone 1 5th metatarsal avulsion fractures, which may prove pertinent in the setting of morbid obesity, fracture comminution, and/or fracture nonunion. Limitations include the relatively small sample size and the use of cadaveric bone which imperfectly mimics living tissue.