bluuebunny/crossref_metadata_2025_split huggingface dataset:
A New Method for Reduction and Stabilization of the Distal Tibiofibular Syndesmosis
Authors: Baquero Andres E. O’Daly , Kreulen Timothy R. , Shafiq Babar , Hasenboehler Erik A. , Pisano Alfred 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Fixation strategies for distal tibiofibular syndesmotic injuries are associated with risk of malreduction. We describe a new method of reduction and fixation of the syndesmosis with two suture buttons placed through a single sagittal tunnel through the fibula and across the tibia at the attachment sites of the anterior and posterior-inferior tibiofibular ligaments. Methods: Eighteen frozen cadaveric lower leg specimens were divided in two groups of nine and subjected to syndesmotic injury followed by reduction and fixation. Nine were repaired with the new method and 9 with the conventional method. Post-reduction CT images were obtained and compared to pre-injury CT images to assess quality of reduction. Specimens were then tested on an MTS machine and loaded between +\-5Nm at 0.5Hz of internal and external rotation for 500 cycles. Cyclic loading was paused at 0, 100, and 500 cycles to assess torsional resistance, fibular rotation, and fibular translation with the foot first internally rotated 10 degrees and then externally rotated 15 degrees. Peak torque and translation of the fibula was measured. Results: A statistically significant difference was detected between groups, with the new method of fixation showing less lateral translation of the fibula. Data that did not reach statistical significance showed a trend towards decreased post reduction translation in the sagittal plane and improved rotational alignment with the new method. Decreased fibular rotation that reached statistical significance was noted in the new technique with internal rotation at 0, 100 and 500 cycles and during external rotation at 100 and 500 cycles. No differences were noted for torsional resistance or fibular translation between groups. Conclusion: The new method of syndesmotic fixation facilitated reduction of the syndesmosis that resulted in improved alignment, and better rotational stability compared with the conventional technique. This may be a reliable alternative to current methods of syndesmosis reduction and fixation.
Early Outcomes of Minimally Invasive Surgery Using Percutaneous Technique for Hallux Valgus
Authors: Park Jae Han , Park Kwang Hwan , Park Yoo Jung , Han Seung Hwan , Kim Sang B. , Lee Jin Woo 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: There are myriad procedures for hallux valgus deformity. Minimally invasive Surgery (MIS) using percutaneous technique has been recently introduced for the treatment of hallux valgus. The purpose of this study was to evaluate early radiological and clinical outcomes of MIS using percutaneous technique for hallux valgus deformity. Methods: This was a prospective cohort study of 19 feet (13 patients) undergoing operative correction of hallux valgus using MIFS technique with minimum 2-year of follow-up. Outcome measures include the visual analogue scale (VAS) for pain and the American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale, Foot Function Index (FFI), hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). Results: All patients were traced for a mean of 27.2 (range 24.7 - 30.4) months. The VAS, AOFAS-HMI scale and FFI were improved respectively with significance after operation (p<0.05). The mean HVA and 1-2 IMA showed significant improvements from 37.5’+-9.2 and 14.0+-3.1’ to 11.5+-7.9’ and 5.8+-3.6’ (p<0.05, p<0.05). The DMAA was decreased from 16.5+-3.9’ to 5.1+- 2.5’ (p<0.05). One patient underwent a revision surgery because of a screw loosening. Conclusion: The MIS using percutaneous technique for hallux valgus deformity achieved enough correction and relief of pain. All patients were satisfied with the clinical assessments. However, a long-term study is necessary to compare with other techniques.
Management of Periprosthetic Osteolysis after Total Ankle Arthroplasty
Authors: Park Yoo Jung , Park Kwang Hwan , Park Jae Han , Han Seung Hwan , Kim Sang B. , Lee Jin Woo 
Published: November 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our updated result of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: We retrospectively evaluated our consecutive series of 440 primary TAAs performed between May 2004 and August 2018 and identified those who had a subsequent bone graft procedure. A total of 38 bone graft procedures for periprosthetic osteolysis after TAA were performed. Mean time-interval between primary TAA and bone graft was 5.09 years (range 17.0 to 127.0 months). Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed periprosthetic osteolysis in 51.8% (58/112) of distal tibial lesions and 41.1% (46/112) of talar lesions. Autogenous iliac bone graft was used in most of procedures. Both mean VAS and AOFAS scores improved significantly at the last follow-up (p<0.05) One patient needed a repeat bone graft procedure with additional bone cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.
A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus
Authors: Pereira Gregory F. , Steele John , Fletcher Amanda N. , Adams Samuel B. , Clement Ryan B. 
Published: November 2020

Category: Ankle Introduction/Purpose: The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs. Methods: PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures. Conclusion: The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up. [Table: see text]
Primary Arthrodesis Versus Open Reduction and Internal Fixation Outcomes for Lisfranc Injuries: An Analysis of Conflicting Meta-analysis Results
Authors: Peters Wesley D. , Panchbhavi Vinod K. 
Published: November 2020

Category: Midfoot/Forefoot Introduction/Purpose: The superiority of Primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in Lisfranc injuries has been debated for decades. In recent years, researchers have attempted to use meta-analyses to reach a definitive conclusion. However, they have reached uncertain and contradicting conclusions when comparing these treatment options, which has led to more confusion. The goal of this paper is to navigate the primary source data of each meta-analyses to determine why different conclusions were reached and provide surgeons with more clarity on the comparable outcomes of PA and ORIF treatment options in Lisfranc injuries. Methods: A systematic literature review was conducted by searching for ‘meta-analysis’ AND ‘Lisfranc’ with keywords such as ‘ORIF’ OR ‘open reduction’ OR ‘Arthrodesis’ OR ‘fusion’. Five meta-analysis articles discussing PA and ORIF in Lisfranc injuries were identified. Study outcomes were extracted from each article for comparison. Contradicting conclusions were identified, and the primary sources used by each meta-analysis was analyzed. Results: All meta-analyses agreed that PA had lower rates of hardware removal and that there is no significant difference between PA and ORIF when considering revision surgery, anatomic reduction, postoperative infection, total complications, and patient satisfaction. However, contradicting conclusions were reached regarding functional patient outcomes such as return to duty, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and visual analogue scale (VAS) score. Conclusion: PA has favorable rates of hardware removal compared to ORIF, while no difference between PA and ORIF was found for revision surgery, anatomic reduction, postoperative infection, total complications, and patient satisfaction.While certain meta-analyses had contradicting conclusion as to which treatment option is favorable for returning to duty, AOFAS score, and VAS score, it was determined there was no significant difference in PA and ORIF for return to work and VAS score. Repeat meta- analysis with truly equivocal outcomes would be necessary to reach a valid conclusion for return to full activity and AOFAS midfoot scores.
The Safety of Foot and Ankle Surgical Procedures at an Ambulatory Surgery Center
Authors: Peters Wesley D. , Adamson Peter J. , Janney Cory , Panchbhavi Vinod K. 
Published: November 2020

Category: Ankle; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: There is a growing trend to perform surgical procedures at freestanding ambulatory surgical centers. No literature exists evaluating the rate of adverse events and overall safety of foot and ankle outpatient surgeries at a freestanding ambulatory surgery center (ASC). Methods: A retrospective review of all foot and ankle cases performed over a two year period at a single freestanding ASC. A total of 313 cases were performed. Adverse events are state-reported events that cause harm or lead to additional treatment. Using state-reported adverse events criteria and previous literature from hand and upper-extremity cases, we categorized our adverse events into seven categories: 1) infection requiring intravenous abx or return to the operating room, 2) postoperative transfer to a hospital, 3) wrong-site surgery, 4) retention of a foreign object, 5) postoperative symptomatic thromboembolism (DVT), 6) medication error, and 7) bleeding complications. Results: The overall rate of adverse events was 3.5% with 11 events identified over the two year period. There were a total of 10 infections and 1 symptomatic DVT. There were no cases that resulted in transfer to a hospital, hospital admission after discharge, medication error, bleeding complications, wrong-site procedures, or retained foreign bodies. Conclusion: Outpatient foot and ankle procedures are not without complications, but the overall rate of complications postoperatively is farly low (3.5%). Overall, foot and ankle surgeries can be performed safely in an outpatient setting at an ASC.
Factors Affecting the Outcomes of Tibiotalocalcaneal Fusion
Authors: Pitts Charles C. , Alexander Bradley , Washington Joshua L. , Barranco Hannah M. , Patel Romil K. , Cage Benjamin B. , Greco Elise M. , Shah Ashish 
Published: November 2020

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. Methods: We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome. Results: Patients with a preoperative diagnosis of Charcot arthropathy and non-traumatic OA had significantly higher nonunion rates of 44.4% (12 patients) and 39.1% (18 patients) (p = 0.016) and infection rates of 29.6% (eight patients) and 37% (17 patients) compared to patients with traumatic arthritis, respectively (p = 0.002). There was a significantly increased rate of nonunion in diabetic patients (RR 2.22; p = 0.010). Patients with chronic kidney disease were 2.37-times more likely to have a nonunion (p = 0.006). Patients aged over 60 years had more than a three-fold increase in the rate of postoperative infection (RR 3.60; p = 0.006). The use of bone graft appeared to be significantly protective against postoperative infection (p = 0.019). Conclusion: We were able to confirm, in the largest series of TTC ankle fusions currently in the literature, that there remains a high rate of complications following this procedure. Those with diabetes, chronic kidney disease, or aged over 60 years had an increased risk of nonunion. These findings help to confirm those of previous studies. Additionally, our study adds to the literature by showing that autologous bone graft may help in decreasing infection rates. This helps surgeons further understand which patients are at a higher risk for postoperative complications when undergoing TTC fusion. [Table: see text]
Preoperative and Postoperative PROMIS and FFI Scores Based on Region of Foot Pathology and Surgery
Authors: Pitts Charles C. , Alexander Bradley , Greco Elise M. , Cage Benjamin B. , Solar Spaulding F. , Sinha Tanvee , Shah Ashish 
Published: November 2020

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) has become increasingly utilized in orthopaedic foot and ankle surgery to assess outcomes and better understand patient function, pain, and disability. Similarly, the Foot Function Index (FFI) is used to assess pain, disability, and activity limitation. PROMIS scores have been shown to predict, preoperatively, which patients will benefit most from foot and ankle surgery from a general perspective. It is currently unknown, with regard to chronic foot pathology, which region of the foot has the greatest effect on PROMIS and FFI scores and which region is affected the most by surgical intervention. Methods: PROMIS physical function, pain index, and depression scores along with FFI scoring subsets of pain, disability, and activity limitation were retrospectively reviewed for patients at a tertiary referral center with chronic pathology in either the hindfoot, midfoot, or forefoot that underwent surgery. Scores were obtained preoperatively and at 6 weeks postoperatively, and a preoperative to postoperative difference was calculated. Once the mean of each subcategory was obtained, an analysis of variance (ANOVA) was conducted in order to compare the means and identify statistically significant differences. Significance was set at p < 0.05 and p < 0.10. Results: There was no statistically significant difference between the mean preoperative PROMIS or FFI scores in the forefoot, midfoot, or hindfoot regions. There was also no statistically significant difference between means of PROMIS or FFI categories at 6 weeks postoperatively. However, the mean pre- to postoperative differences between PROMIS physical function scores of the forefoot, midfoot, and hindfoot were statistically significantly different at 9.12, 8.16, and 2.88, respectively (p=0.037). There was no statistically significant difference between the remaining scoring categories. Conclusion: Physical function, pain, depression, disability, and activity limitation are not affected disparately by the location of chronic pathology within the foot. Surgical intervention for problems in the forefoot, midfoot, and hindfoot does not provide differences in outcomes with regard to pain, disability, depression, or activity limitation based on region. Patients who have undergone surgical intervention for forefoot or midfoot pathology may experience greater improvements in physical function postoperatively when compared to patients who have undergone hindfoot surgery. [Table: see text]
Factors Affecting Emergency Department Visits, Readmissions, and Reoperations within 30 Days of Ankle Fracture Surgery: An Institutional Retrospective Study
Authors: Prather John C. , Alexander Bradley , Halstrom Jared R. , Sutherland Charles R. , Patel Akshar , McGwin Gerald , Shah Ashish 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: With the U.S. healthcare system focused on value of care, providers and hospitals are increasingly measured by factors that increase patient care and decrease healthcare cost. Early postoperative adverse events not only increase healthcare cost, but also illuminate areas of potential improvement in patient care. This study aims to delineate factors that may influence emergency department visits, admissions, and reoperations within 30 days of ankle fracture surgery. Methods: This retrospective review of patients at a Level 1 trauma center evaluated 30-day outcomes after ankle fracture surgery over a 4-year period (2015-2018). The outcome measures assessed were emergency department visits within 30 days, unplanned readmissions within 30 days and unplanned return to the operating room (OR) within 30 days. Patient and injury characteristics were investigated as potential factors related to these 30-day outcomes. Multiple linear regression was used for outcomes. P-values less than 0.05 were considered significant. Results: A total of 619 patients were identified. After exclusion of concurrent pilon fractures, 596 patients were eligible for final analysis. Forty-three (7.2%) patients visited the emergency department within thirty days, 30 (5.0%) patients were readmitted within thirty days, and 10 (1.7%) patients requiring unplanned return to the OR within thirty days. Sex, insurance status, comorbidities such as pulmonary disease, diabetes mellitus, psychiatric disease, and chronic kidney disease, smoking status, and fracture type/location were not found to be significantly related to 30-day events. Age less than 45 was a significant risk factor for returning to the ED within 30 days (RR 2.1, p=0.02). Open fractures were more likely to require unplanned reoperation than closed fractures (RR 5.7, p<0.01). Conclusion: Age less than 45 years old was a risk factor for early ED visits. Open fractures were found to be at increased risk of needing unplanned reoperation. While further investigation into these risk factors is necessary to fully delineate a causal relationship, these findings can help physicians identify ‘at-risk’ populations after ankle fracture surgery and provide the necessary care to minimize early postoperative events. [Table: see text]