bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus: Does Age Matter?
Authors: Lunati Matthew , Manz Wesley J. , Maidman Samuel D. , Mignemi Danielle , Bariteau Jason T. 
Published: November 2020

Category: Midfoot/Forefoot; Other Introduction/Purpose: Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. While first metatarsophalangeal (MTP) arthrodesis is utilized to improve pain and function, older patients are often considered to be higher risk surgical candidates. There are minimal data on outcomes of MTP arthrodesis and no studies comparing outcomes between geriatric and younger patients. Methods: This is a single center, prospective study of all patients who underwent MTP arthrodesis between August 1, 2015 and July 1, 2018. Patient reported-outcomes were assessed utilizing the Short Form Health survey (SF-36), LifeSpace Assessment survey (LSA), and visual analogue scale (VAS) for pain administered preoperatively as well as 6-months and 1-year postoperatively. Baseline characteristics and surgical outcomes were collected from the electronic medical record. All operations were performed by one foot and ankle fellowship-trained orthopedic surgeon. Clinical and patient-reported outcomes were compared between patients <65 years-old and ≥ 65 years-old. Results: Of 143 included patients, 79 were placed in the younger (mean of 56.5 years) and 64 were in the older (mean of 72.0 years) cohorts. Compared to the younger cohort, the older was more predominantly female (95.3% older group, 77.2% younger group, p=0.002). More patients in the older cohort had hypertension (73.4% older group, 50.6% younger group, p=0.005) and coronary artery disease (9.4% older group, 0.0% younger group, p= 0.005). Both age groups had similar postoperative outcomes, including antibiotic therapy for superficial infections, surgical incision and drainage, deep vein thrombosis, deformity recurrence, or revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6-months postoperative, or 1-year postoperative between younger and older patients. Conclusion: Despite more comorbidities, older patients have similar rates of postoperative complications and report similar outcomes for pain, function, and mobility following first MTP arthrodesis. These findings support increased implementation of MTP arthrodesis surgery for older patients with hallux rigidus.
Repair of a Comminuted Talar Neck Fracture using a Cellular Bone Allograft combined with a Textured Allograft Wedge
Authors: Mansour Alaa , Howard Timothy D. , Gianulis Elena , Scheunemann Danielle 
Published: November 2020

Category: Trauma; Ankle Introduction/Purpose: Talar neck fractures are uncommon and are characterized by displacement, comminution, and soft tissue injury. Treatment of talar neck fractures while avoiding complications, such as osteonecrosis and long-term morbidity, presents a unique challenge to surgeons. One option for treating talar neck fractures is cellular bone allograft containing viable lineage- committed bone cells (V-CBA), which provides the osteoconductive, osteoinductive, and osteogenic properties needed for bone formation. Additionally, a structural textured allograft (STA) wedge designed to resist migration and sustain compressive force can also be used in repairing talar neck fractures. This case study describes the successful repair of a comminuted talar neck fracture using V-CBA combined with an STA wedge. Methods: A 46-year-old male patient sustained a talar neck fracture following a fall from a 12-foot ladder. Radiographic and computed tomography (CT) imaging revealed significant comminution, consequent varus angulation, and a large bony void, as well as dislocation of the posterior subtalar joint. The patient was otherwise healthy with no comorbidities. Open reduction internal fixation was performed laterally to reduce the posterior subtalar dislocation. Medially, a 6.5mm STA wedge was used to correct the varus deformity and 1cc of V-CBA was used to fill the void. Results: At 6 months, the talar neck fracture had healed with solid osseous consolidation evident on radiographic images. Conclusion: These results demonstrate that an STA wedge, with a textured design that resists migration, used in combination with a V-CBA successfully repaired a comminuted talar neck fracture.
Does Prior Surgery Affect Total Ankle Complication and Failure Rates?
Authors: Manzi Luigi , Usuelli Federico Giuseppe , Caughman Alexander , Gross Christopher E. 
Published: November 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: Given that most ankle replacements are post-traumatic in origin, it is important to investigate if prior interventions can affect a patient’s functional outcome or the possibility of having a complication. Prior surgeries create scar, incisions, and possible affect bone health that could interfere with healing. The purpose of the study is to assess the pain and functional temporal outcomes of patients with and without prior surgeries in the ipsilateral ankle. We hypothesize that those with a previous ipsilateral ankle procedure will not have an increased complication rate or worse functional outcomes. Methods: We retrospectively identified a consecutive series of 100 primary TARs with a prior procedure who were followed for a minimum of 3 years. The follow-up time points considered were 0, 6, 12, and 36 months. Outcomes were measured using AOFAS, VAS, SF12, and range of motion scores. The mean patient age was 56.5 +- 13.4 years. Sixty-four patients had previous interventions which included osteosynthesis (49), arthroscopy (11), hardware removal (25), arthrodesis (3), prosthesis (1), open fracture (9), and other open surgery (12). Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points) between the groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed. Data and statistical analysis were conducted using Matlab (MathWorks, Natick, MA). Results: For each type of intervention, every outcome was compared to test whether presurgery interventions have an influence on the temporal evolution of the outcomes. The two groups did not show any difference on the temporal evolution of the outcomes. The type of intervention did have a weak effect on outcomes. Treatment of previous open fractures was the only pre- surgical intervention that showed a statistically significant difference in temporal evolution of functional and pain outcomes between intervention and non-intervention groups. No significant correlations were found between all outcomes and the time between the last intervention and prosthesis. Using Fisher’s-exact test, there was not a significant association between the those who had previous surgery and those who did not and the rate of complication and revision (p =0.10). Conclusion: A pre-operative discussion should center on potential complications and predicted functional outcomes. The presence, type, and timing of an intervention prior to an ankle replacement does not strongly affect the temporal outcomes of pain and functional outcome scores. Furthermore, the complication or revision rate is not affected by prior surgeries.
Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures
Authors: Martin Kevin D. , Huh Jeannie 
Published: November 2020

Category: Arthroscopy; Trauma Introduction/Purpose: The treatment of posterior malleolar fractures within a trimalleolar ankle fracture pattern can be challenging to manage. Due to anatomical constraints that inhibit visualization of the articular surface, reduction of the posterior malleolus relies on cortical read and/or intraoperative fluoroscopy. Posterior ankle arthroscopy is a tool that may address this shortfall by providing a means to assess the intra-articular and syndesmotic reductions, while removing any loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) for the posterior malleolar fragment in trimalleolar ankle fractures. Methods: From November 2015 to May 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF for the posterior malleolar fragment by a single surgeon. Patient demographics, surgical details, and fracture characteristics, as determined by computed tomography (CT) scan, were obtained. At final follow-up the main outcome measures collected were: The Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud and Molander Ankle Score (OSMA), the Visual Analog Score (VAS), and surgical complications. Preoperative and postoperative CT scans were interpreted and compared by two blinded musculoskeletal radiologists for articular congruity, syndesmosis congruity, and presence of loose bodies. Results: A total of 29 trimalleolar ankle fractures were treated with PARIF, including 15 fracture-dislocations. Mean patient age was 36 (range, 19-69) years. Mean prone tourniquet time was 58 (range, 35-79) minutes. Preoperative CT scans demonstrated intra-articular loose bodies in 53% of fractures and syndesmosis incongruity in 80% of fractures. Postoperative CT scans showed one ankle with a retained loose body and residual syndesmosis incongruity in 17% of fractures. 100% of fractures healed and demonstrated intra-articular reduction within 2mm. There were 2 complications (hardware irritation and sural nerve numbness). 2-year patient reported outcomes were available in 13 patients. These included mean VAS 1 (range 0-4), mean AOFAS score 84 (range, 63-100), mean FADI 85 (range, 59-100), and mean OSMA 76 (range, 40-100). Conclusion: Posterior ankle arthroscopic reduction and internal fixation (PARIF) is a safe and effective option for management of posterior malleolar fractures. The technique results in improved intra-articular and syndesmosis congruity, while removing loose bodies. Future studies are needed that compare this technique with current practices.
Trends in Industry Payments to Orthopedic Foot and Ankle Surgeons from 2014 to 2018
Authors: Mody Kush S. , Liou Lathan , Joshi Tej , Mikhail Christopher , Barbera Joseph , Selverian Stephen , Vulcano Ettore 
Published: November 2020

Category: Other Introduction/Purpose: The establishment of the Open Payments Database (OPD) in 2014 made public all financial payments to physicians and hospitals by pharmaceutical and medical device companies. Since then, numerous studies have analyzed industry payment data to elucidate any correlations and trends. The purpose of this study is to examine trends in industry payments to orthopedic foot and ankle surgeons from 2014 to 2018. Methods: The Open Payments Database (OPD) was queried to collect information regarding industry payments to orthopedic foot and ankle surgeons and all orthopedic surgeons from 2014 to 2018. Information was collected on physician education, regional distribution of physicians paid, number of physicians paid, median payment amount, and payment type. Further analyses were conducted on the median payment amount to the top 5% of earners and the other 95%. Median amounts were analyzed using Mann-Whitney U non-parametric tests. Results: Of the 1,416 physicians classified as orthopedic foot and ankle surgeons, Doctors of Osteopathy and Medical Doctors received significantly higher payments than Doctors of Podiatric Medicine (597 vs. 35, P=9x10-113). Only osteopathic and allopathic physicians were included in the main analyses. No significant difference was reported from 2014 to 2018 in the median payments to orthopedic foot and ankle surgeons overall ($616 vs. $810; P=0.13), in the top 5% ($148,864 vs. $158,349; P=0.53), and other 95% ($542 vs. $730; P=0.10). There was no significant difference in payments related to consulting fees, entertainment, food and beverages, gifts, grants, honoraria, royalty and licensing fees, speaker and faculty fees, and travel and lodging. There was a significant increase in industry payments related to education ($750 vs. $1370; P=0.002). Conclusion: Following the establishment of the Open Payments Database in 2014, it was expected that industry payments would decrease significantly. However, no change was seen in payments to orthopedic foot and ankle surgeons and there remains a very large distribution in surgeon compensation. In fact, the top 5% of surgeons compensated account for over 99% of the total industry payments. While there are many factors that could account for this, foot and ankle surgeons should use data extracted from the OPD as a guide to ensure fair and equitable compensation for their work in industry.
Lateral Column Lengthening Versus Medial Displacement Calcaneal Osteotomy in Stage II Tibialis Posterior Tendon Dysfunction: Randomized Controlled Trial
Authors: Mohammed Amr A. , Abubeih Hossam , Osman Ahmed , Eladly Wael , Khalifa Ahmed , Gafary Kamal 
Published: November 2020

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult acquired flatfoot deformity is a complex deformity associated with the collapse of the medial longitudinal arch. Several factors have been proposed in the etiology of adult acquired flatfoot deformity including arthritic, neuromuscular, and traumatic conditions; however, posterior tibial tendon dysfunction remains the most common etiology. A spectrum of conditions affecting the posterior tibial tendon has been identified, with tendinitis occurring early in the disease process and tendon rupture occurring at the more advanced stages. Adult-acquired flatfoot deformity requires a complex operative plan that often utilizes several procedures to correct deformity, at both the hindfoot and midfoot. The objective of this study was to compare the efficacy of two different osteotomies commonly used to correct flexible flat feet. Methods: 42 Patients (21 males and 21 females) with stage II PTTD acquired flexible flatfeet were included with a mean age of 49.62 +- 6.2. Twinty-two patients had medial displacement calcaneal osteotomy (MDCO) while 20 cases had latercal column lenghtening (LCL). Strayer procedure, spring ligament plication and FDL transfer were done in all patients. Pre- and Post-operative clinical assessment was done using AOFAS and FFI questionaire. Six radiographic parameters were analyzed, two in the anteroposterior view ( talo-navicular coverage and talo-calcaneal angle), three in lateral view ( talo- first metatarsus angle, talo- calcaneal angle and calcaneal inclination angle) and tibio-calcanal angle in axial view. Results: At a mean follow up of 12 months, significant improvement in AOFAS and FFI scores in MDCO and LCL groups with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups. LCL group showed significant better correction in TNC and calcaneal inclination angles when compared to MDCO group. However, MDCO procedure showed significantly better correction in axial tibial calcaneal angle. Both techniques correct the deformity, however cases received LCL has better correction than MDCO cases and less reoperation rate. Conclusion: Reconstructions performed with LCL produced a greater change in the realignment of adult acquired flatfoot, maintained more of their initial correction over time, and were associated with a lower incidence of additional surgery than reconstructions with a MDCO of the calcaneus. However, a higher incidence of degenerative change in the hindfoot was observed in the LCL group. The ability of LCL to correct the deformity in anteroposterior and lateral plan and MDCO in lateral and axial plan suggests that proper osteotomy should be planned according to the existing deformity. Combination of both techniques may be required in certain cases.
Impact of Early Weight Bearing on Outcomes after Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures
Authors: Myers Devon , Umbel Benjamin D. , Forsting Shane , Taylor Benjamin C. , Pulido Sergio H. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: There is a current trend to allow earlier weight-bearing of unstable ankle fractures after fixation. This study offers a unique comparison of early (EWB) versus late weight-bearing (LWB) in operatively stabilized trimalleolar ankle fractures. The purpose of this study was to evaluate union rates, clinical outcomes and complications in patients managed with EWB versus LWB. Methods: We performed a retrospective review of 185 patients with trimalleolar ankle fractures who underwent surgical stabilization. Fixation of the posterior malleolus and weight-bearing status were determined by surgeon preference. EWB was defined as ≥3 weeks and LWB was defined as >3 weeks. Patients were evaluated for fracture union and implant failure. Complications and clinical outcomes included ambulatory status, infection rate and return to surgery. Results: There were 47 (25.4%) patients in the EWB group and 138 (74.6%) in the LWB group. There were 7 nonunions, 1 (14.3%) in the EWB and 6 (85.7%) in the LWB group. Seventy-two (38.9%) posterior malleolar fractures were operatively stabilized which did not affect union rates. Syndesmotic fixation was required in 12.5% of patients despite posterior malleolar stabilization. Syndesmotic fixation increased union rate 2.5 times. Deep infection and open fracture decreased union. There was no difference in implant failure, union rate, infection or return to surgery between groups. Conclusion: No deleterious effect of EWB of operatively treated trimalleolar ankle fractures were found with regards to union, implant failure, infection or reoperation. Syndesmotic fixation may offer an advantage to posterior malleolar fixation with improved union rates.
Ability to Show the Knuckles in Forefoot Helps to Assess Intrinsic Muscle Function
Authors: Panchbhavi Vinod K. , Poliner Michael , Finegan Patrick , Jupiter Daniel 
Published: November 2020

Category: Midfoot/Forefoot; Lesser Toes Introduction/Purpose: The plantar plate stabilizes the metatarsophalangeal joint (MTPJ). When the plantar plate is disrupted the static forces resisting the strong extensor muscles are compromised, overwhelming the intrinsic muscles of the foot resulting in toe deformities. The proposed ‘knuckle test’ is a clinical exam to evaluate for intrinsic muscle weakness. Patients with negative knuckle tests are unable to plantar flex their toes at the MTPJ to prominently display the knuckles. This study seeks to determine the prevalence of negative knuckle tests in patients with and without associated toe deformities. Methods: This is an observational case-control study to compare the prevalence of a negative knuckle test in participants with evidence of toe deformities or plantar plate incompetence based on physical exam findings (case group) to participants with normal feet (control group), defined as no signs or symptoms of a current or past plantar plate tear. A participant will qualify for the case group if they have a positive MTPJ drawer test or an associated toe deformity (medial deviation, hyperextension of the MTPJ, floating toe, hammer toe deformity, or crossover toe). The participants will also complete a short survey to identify factors associated with plantar plate injuries such as BMI, gender, age, smoking history, diabetes, sports history, injury history, heel or boot wear, hyper flexibility, and collagen disorders. Results: The research team has gathered 75% of the participant data. Preliminary data shows that the majority of participants in both groups have negative knuckle tests. The final results will be analyzed once all the data has been collected. Conclusion: The percentage of negative knuckle test in patients without toe abnormalities or symptoms was unexpectedly high. The implication is that there is a high incidence of weak intrinsic foot muscles. Foot intrinsic muscle exercises may help to prevent toe deformities. Other findings will be interpreted after all data has been collected.
Surgical Management of Insertional Achilles Tendinopathy in the Young and Elderly Result in Similar Clinical Outcomes
Authors: Phen Huai M. , Manz Wesley J. , Greenshields Joel T. , Mignemi Danielle , Bariteau Jason T. 
Published: November 2020

Category: Other; Ankle Introduction/Purpose: Insertional Achilles tendinitis (IAT) is a common cause of chronic posterior heel pain. Non-operative treatment has demonstrated evidence of success, with similar failure rates in both the young and the elderly. Surgical management can reproducibly improve patients’ pain and functional status. Older patients are considered to be at a higher risk for surgical complications due to associated comorbidities when compared to patients under the age of 60. The aim of this study is to investigate the impact of comorbidities and peri-operative variables on functional patient reported outcomes following surgical treatment of IAT in those over and under the age of 60. Methods: Retrospective review of prospectively collected data pertaining to a consecutive series of adult patients who underwent surgical management of IAT by a single surgeon (J.B.). Patients were separated into those 60 years of age and younger, and those above 60. Patients undergoing concomitant surgical procedures or revisions were excluded. Patient demographics, co- morbidities, perioperative variables, and post-operative complications were collected. Visual Analogue Scale (VAS), Short Form Health Survey Physical Component Score (SF-36 PCS), wound infection, and recurrence were assessed with a minimum follow-up of 12 months. Statistics were obtained using linear regression mixed models, and chi-squared analysis. Results: 38 operative cases were identified including 17 patients over and 21 patients under 60 years of age (mean 66.8 +/- 5.1yrs, 49.1 +/- 8.4yrs, respectively). There were no significant differences in demographics, rates of co-morbidities, or post-operative infection between the two groups. Both young and elderly groups experienced improvements in mean VAS pain scores at 6 months (3.3 and 2.7, respectively, P = 0.416) and 12 months (5.0 and 4.1, respectively, P = 0.322) post-operatively. SF-36 PCS improvements were also observed in both young and elderly cohorts at 6 (mean 22.1 and 9.3, respectively, P = 0.122) and 12 months (mean 30.4 and 20.4, respectively, P = 0.158). Linear regression analysis showed no statistical difference between the presence of co-morbidities, or age, on clinical outcomes. Conclusion: None of the co-morbidities nor peri-operative variables assessed were linked to increased risk of failed surgical correction of IAT in elderly patients, suggesting surgical correction of IAT in geriatric populations is an appropriate and reproducible treatment option. Further higher-powered studies, with longer follow-up times would be of use to better elucidate the influence of co-morbidities on recurrence.