bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Microvasculature of Normal versus Torn Lesser Toe Metatarsophalangeal Joint Plantar Plates Using Nano-CT Imaging
Authors: Singer Natalie , Walton David M. , Holmes James R. , Talusan Paul G. 
Published: November 2020

Category: Lesser Toes Introduction/Purpose: Recent surgical techniques have focused on anatomic repair of lesser toe metatarsophalangeal (MTP) plantar plate tears. MTP instability has been implicated in a number of common toe deformities as well as metatarsalgia. Recently, a study demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments. The purpose of this study was to compare the intact plantar plate microvasculature network to the microvasculature network of plantar plates in the presence of toe deformity using similar perfusion and nano-CT imaging methods. Methods: Eight fresh frozen human cadaveric lower extremities with lesser toe deformities including hammertoe or crossover toe were perfused using a barium solution. The soft tissues of each foot were counterstained with phosphomolybdic acid (PMA). Then using nano-CT imaging the second through fourth toe metatarsophalangeal joints of 8 feet were imaged. These images were then reconstructed, plantar plate tears were identified, and eleven toes remained. The plantar plate microvasculature for these eleven toes was analyzed and calculation of vascular density along the plantar plate was performed. Using ANOVA analysis this experimental group was compared to a control group of 35 toes from cadaveric feet without deformity and the vascular density compared between quartiles of plantar plate length proximal to distal. Results: Demonstrated in Figure 1, of the torn plantar plates the average percent vascular density (vascular volume/tissue volume) in the first quartile of length (proximal to distal) is 0.365 (SD 0.058) compared to 0.281 (SD 0.036) for intact plantar plates; in the second quartile it is 0.300 (SD 0.044) vs 0.175 (SD 0.025); third quartile it is 0.326 (SD 0.051) vs 0.117 (SD 0.015); and fourth (most distal) quartile is 0.600 (SD 0.183) vs 0.319 (SD 0.082) respectively. Using ANOVA testing all differences were found to be significant to p<0.001. Conclusion: Torn plantar plates demonstrate increased vascular density throughout the length of the plantar plate with an increase in density most notable in the region at or just proximal to the attachment to the proximal phalanx. The clinical significance of the increased vascularity of torn plantar plates is unknown at this time. However, the increase in vasculature may suggest that the plantar plate is a structure that is attempting to heal.
Trends in Foot and Ankle Publications
Authors: Sleasman Brian T. , Caughman Alexander , Gross Christopher E. 
Published: November 2020

Category: Ankle; Other Introduction/Purpose: Scientific publication and original articles remain the primary method of sharing scientific findings and thus advancing the knowledge base of that subject. These articles have the potential to reinforce or change current practice. Despite the value of these publications, little research has gone into surveying what topics are being published. Our goal was to identify and characterize the most common topics of publication in current foot and ankle literature. Methods: To determine the rate of publications in the literature, we reviewed all published articles in a 3.5-year period (January 2016 - June 2019) in three foot and ankle specific journals: Foot and Ankle International, Foot and Ankle Orthopaedics, and Foot and Ankle Surgery. We then sorted these articles into the topic of the article to identify the four most common domains of publication. These domains were further characterized by level of evidence as well as citations/year. Results: A total of 845 articles were published in the 3.5-year study period. During this time, the four most published topics in foot and ankle literature were hallux valgus (10%), arthroplasty (9%), ankle fracture (7.5%), and achilles pathology (6.4%). These four subjects accounted for 280/845 articles (33%). The average level of evidence for articles on hallux valgus, arthroplasty, ankle fracture, and Achilles pathology were 3.3 (3.1, 3.4, 3.4, and 3.4 respectively), and the average number of citations/year for these articles was 2.6 (2.3, 3.0, 2.3, and 3.1 respectively). Based on our study there is no correlation between level of evidence and number of citations. Conclusion: Despite the wide variety of cases (176 unique CPT codes) performed by an orthopedically trained foot and ankle surgeons, a small subset of publications represent a significant portion of scientific publication within the field.
Predictive Variables for Patient Compliance with Physician Prescribed Orthotics
Authors: Stevens Trenton T. , Bettin Clayton C. , Murphy G. Andrew , Richardson David R. , Grear Benjamin J. , Hartline Jacob T. 
Published: November 2020

Category: Other; Midfoot/Forefoot Introduction/Purpose: Custom and off-the-shelf orthotics frequently are prescribed by foot and ankle orthpaedic surgeons. This study aimed to quantify the rate at which patients receive their prescribed orthotic and explore the variables that could be predictive of patients’ receiving and using orthotics. Methods: We analyzed the demographics of 382 patients who received an orthotic prescription from a group of foot and ankle surgeons to assess variables predictive of patients receiving their prescribed orthotic. Of these 382 patients, 186 (49%) completed a survey regarding insurance status, cost of the orthotic, education, income, and satisfaction with the orthotic. This information was used to identify variables that may help identify patients who are at an increased risk of failing to receive their prescribed orthotic. Results: Patients received their orthotic at an overall rate of 61.2% (235/382). Patients with commercial insurance were more likely to receive their orthotic (67%) than patients with Medicaid (40%). Of the 186 patients who completed the survey, those whose insurance covered all or part of their orthotic were more likely to receive their orthotic (100% and 96%, respectively) compared to those whose insurance did not cover the orthotic (81.5%). Overall 86.5% reported being ‘better’ or ‘completely relieved’ with orthotic use, and 13.4% reported ‘no difference’ or ‘worse.’ There were no differences in receive rates according to age or gender, but there was a disparity in race, with 71% (155/219) of white and only 48% (72/151) of black patients receiving their orthotics. Conclusion: A substantial number of patients (38.8%) do not receive their physician-prescribed orthotic. Patients who do receive and use their orthotic report positive results. Insurance status, race, and coverage of costs by the insurance company play important roles in predicting which patients are at risk for failing to receive their orthotic.
The Lateral Trans-Malleolar approach for Posterior Malleolar Fracture of the Ankle: A Clinical and Computed Tomography Evaluation
Authors: Taki Masanori , Hio Naohiro 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Posterior malleolar fracture reduction including the articular surface of trimalleolar ankle fracture has been reported to be an important prognostic factor. The lateral trans-malleolar approach (LTA) is a surgical approach that provides direct visualization of the articular surface of the posterior malleolus. We herein report the clinical results and computed tomography (CT) findings for the articular reduction status after LTA for posterior malleolar fracture of the ankle. Methods: Sixteen patients (9 men, 7 women, mean age 52.6+-18.1 years old) who underwent the LTA for posterior malleolar fracture of the ankle and were followed for at least 1 year were evaluated retrospectively. The types of ankle malleolar fracture according to the Lauge-Hansen classification were Supination-External rotation (SER) in 13 patients and Pronation-External rotation (PER) in 3 patients. The CT classifications of posterior malleolus fracture by Haraguchi were Type 1 in 6 cases, Type 2 in 10 cases and Type 3 in 0 cases. The AOFAS score, post-surgical complications and reduction status of the posterior malleolus on CT were investigated. Results: The mean follow-up period was 15.5 months. The AOFAS score was 93.0+-5.2 points. Postoperative complications were seen in one case of superficial infection; however, delayed union, nonunion and fibular necrosis were not observed. The articular step-off in CT improved significantly after surgery (5.9+-2.9 mm preoperatively vs. 0.6+-0.8 mm postoperatively). The 2 patients who showed an articular step-off exceeding 1 mm were both Haraguchi type 2 posterior malleolar fracture. Conclusion: Several approaches for managing posterior malleolus of the ankle have been reported. However, few provide direct visualization to the articular surface. The LTA requires relatively substantial invasion, but it can facilitate surgery in the supine position and thereby reduce the articular surface directly. In our experience, the LTA provided favorable clinical results and fracture reductions. Even when utilizing the LTA, it remains difficult to confirm the fracture reduction of medial articular surface for Haraguchi type 2 medial extension fractures. Therefore, it remains important to also perform appropriate intraoperative X-ray controls.
Fresh Cadaveric Study of the Distances between the Deep Plantar Arch and the Lesser Metatarsals at Risk During Osteotomy of the Lesser Metatarsals
Authors: Tonogai Ichiro , Tonogai Ichiro 
Published: November 2020

Category: Midfoot/Forefoot Introduction/Purpose: Osteotomy of the lesser metatarsals is useful to treat forefoot deformity. Although there is the possibility that some arteries supplying the lesser metatarsals are injured during osteotomy, there are few informations about the distances from the deep plantar arch to the lesser metatarsals. This study aimed to identify the distances from the deep plantar arch to the lesser metatarsals and to reveal how osteotomy of the lesser metatarsals might injure the deep plantar arch. Methods: Twenty fresh cadaveric feet were injected with barium through the external iliac artery, and enhanced computed tomography images were assessed. The distance between the deep plantar arch and each lesser metatarsal was measured on both axial and sagittal images. Results: The distances between the deep plantar arch and the second, third, and fourth metatarsals on the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The distances from the distal epiphysis to the line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal on the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the proximal epiphysis were 23.0, 21.0, and 18.6 mm, respectively. The deep plantar arch coursed at the level of the middle third, proximal to this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) feet, respectively. Conclusion: This study suggested that overpenetration into the medial-plantar direction of the second metatarsal or the proximal-plantar direction of the fourth metatarsal during the shaft or proximal osteotomy might injure the deep plantar arch easily. This study also suggested that on the plantar aspect, the shaft or proximal osteotomy about 45-47 mm proximal to the distal epiphysis of the lesser metatarsal or 18-23 mm distal to the proximal epiphysis might damage blood flow of the deep plantar arch.
Influence of Platelet Rich Plasma on the Skeletal Muscle Fibrosis after Limb Lengthening in Mice
Authors: Tonogai Ichiro , Tonogai Ichiro 
Published: November 2020

Category: Basic Sciences/Biologics Introduction/Purpose: Skeletal muscle fibrosis induced by the increase of collagen occurs after limb lengthening which is also called distraction osteogenesis. Although there are studies about influence of platelet rich plasma (PRP) on tissues healing process, its effectiveness is still controversial. The aim of this study was to examine whether PRP decreased the skeletal muscle fibrosis induced by limb lengthening. Methods: Tibial osteotomy was done to 8-week-old wild type mice. Tibia was lengthened at a rate of 0.42 mm/day during 2 weeks, launching 1 week after tibial osteotomy. Just after lengthening completed (3 weeks after tibial osteotomy), PRP was injected into the gastrocnemius muscle (PRP group). As a sham group, phosphate buffered saline (PBS) was injected into the gastrocnemius muscle (non-PRP group). The gastrocnemius (GC) muscles were taken and analyzed at 4, 6, 8 and 10 weeks after tibial osteotomy. Results: The fibrotic area of the GC muscles in the both groups increased at 4 weeks after tibial osteotomy in histological analysis (Figure). Then, it gradually decreased at 6, 8, and 10 weeks after tibial osteotomy. There were no significant differences between the both groups at 6, 8, and 10 weeks after tibial osteotomy. Hydroxyproline, which was a major constituent of collagen, increased in the non-PRP and PRP groups by limb lengthening as well. However, significant changes were not found between the both groups at all any points. Conclusion: At first, we anticipated that PRP should reduce the skeletal muscle fibrosis after limb lengthening significantly. But our results implied that PRP did not decrease the skeletal muscle fibrosis induced by limb lengthening.
Medial Displacement Calcaneal Osteotomy: Loss of Correction with Varying Drilling Techniques
Authors: Umbel Benjamin D. , Sharpe B. Dale , Halverson Adam L. , Prissel Mark A. 
Published: November 2020

Category: Hindfoot Introduction/Purpose: Surgical correction of Stage 2 posterior tibial tendon dysfunction typically involves a combination of soft tissue and bony corrections, often including a medial displacement calcaneal osteotomy (MDCO). This osteotomy is often fixated utilizing two parallel screws; however, it remains unknown how much correction is lost based on various accepted drilling techniques for common fixation of this osteotomy. Our cadaveric study compares three different surgical drilling techniques, using two parallel cannulated screws for fixation, to best maintain desired translation of the MDCO. Methods: Fifteen above knee, fresh-frozen, matched pair cadaveric specimens (30 limbs) were randomized equally into three groups. Calcanealosteotomies were performed, followed by manual 10 mm medial translation of the tuberosity. Two parallel 2.5mm guide wires were advanced across the osteotomy site under fluoroscopy. The first group involved a ‘staggered’ drilling technique in which one guide wire was over drilled to the osteotomy site with a 4.5mm cannulated drill and then a 7.0 mm cannulated screw was placed across the osteotomy, followed by a second screw in similar fashion. The second, ‘simultaneous’ group consisted of over drilling both guide wires sequentially followed by placement of both screws. The third control group involved simultaneously over drilling only the near cortex, followed by placement of the 2 screws. Following screw fixation, the calcaneal tuberosity was manually translated in a lateral direction. The loss of correction was then marked and measured in millimeters. Results: All thirty cadaveric specimens underwent standard medializing calcaneal displacement osteotomy without significant variation, or complication. Loss of medialization was measured in millimeters following a manual lateral displacing force after the screw fixation of the osteotomy. The ‘simultaneous’ drilling group experienced the greatest loss of medial displacement with the mean loss of correction being 2.6 mm (range 1.37 - 3.48 mm) following manual lateral translation. The ‘staggered’ group showed an average loss of 1.16 mm (range 0.36 - 2.67 mm). The control group, that simply involved drilling of the near cortex, demonstrated the greatest maintenance of medial displacement with a mean loss of only 0.036 mm (range 0.01 - 0.06 mm). Conclusion: Our cadaveric study comparing three different drilling techniques for maintaining the intended correction following MDCO demonstrates that simultaneous over drilling of only the tuberosity near cortex prior to screw fixation was the most resistant to loss of medial displacement; whereas mean loss of correction with simultaneous drilling of both wires to the osteotomy resulted in the greatest loss of correction at an average of 26%.
Development of an Anatomic Landmark-Based Measurement of the Achilles Tendon
Authors: Urness Daniel , Thompson Austin R. , Ensrud Erik , Meeker James E. 
Published: November 2020

Category: Ankle; Sports Introduction/Purpose: Achilles tendon ruptures (ATRs) occurred with an incidence of 2.5 per 100,000 person-years in 2016. This rate has been increasing over the last decade and it has been postulated that this is due to the increasing activity level of older people. With a high and increasing incidence of such a significant injury, further investigation must be done to optimize the treatment of ATRs. The degree of tendon lengthening has been correlated with clinical outcomes, with greater elongation being associated with worse outcomes. MRI and ultrasound techniques have been validated in measurement of Achilles tendon. We sought to develop a reliable, reproducible, and accurate measurement technique utilizing the manual palpation of anatomic landmarks that will be cost effective as well as convenient to perform, particularly intraoperatively. Methods: Both lower legs of 10 healthy subjects without history of Achilles tendon injury were examined using ultrasound and anatomic landmark-based measurement techniques. Subjects sat upright on the exam table and legs were held in flexion at the knee with slight external rotation with the ankle held at 90o, allowing the lower leg to rest flat on the exam table. The length from the medial head of the gastrocnemius to the bottom of the non-compressed heal pad was measured by three raters using the ultrasound and anatomic landmark-based techniques for inter-rater reliability. The measurements were repeated one week later for intra-rater reliability. Ultrasound measurements had excellent inter-rater (0.93) and intra-rater (0.82) correlation coefficients, while good inter-rater (0.76) and intra-rater (0.86) correlation coefficients were observed among anatomic landmark-based measurements. Achilles tendon length measured with ultrasound and anatomic landmark-based techniques were compared using a paired t-test. Results: The anatomic landmark-based technique produces longer measurements of the Achilles tendon (23.2 cm (sd 2.6 cm)) compared to measurements made using ultrasound (22.4 cm (sd 2.6)) (p<0.001). On average, the anatomic landmark-based technique measures 0.8 cm (95% Confidence Interval: 0.4, 1.2) longer than the ultrasound technique. The intraclass correlation coefficient between the anatomic landmark-based and ultrasound measurements is 0.90. Conclusion: While the anatomic landmark-based technique produces a longer measurement of the Achilles tendon, it may still be a reproducible measurement tool. If the change in tendon length is of interest, this technique may be a valid and simple way to monitor that variable. Comparison with MRI may be warranted to better determine the accuracy of the anatomic landmark-based Achilles tendon measure. These results compared with MRI may set the stage for further evaluation of this measurement technique in the operating room in subjects undergoing ATR repair.
Reduction of Foot Width with Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus Deformity: A Multicenter Study
Authors: Vaida Justin , Ray Justin J. , Shackleford Taylor L. , DeCarbo William T. , Hatch Daniel J. , Dayton Paul , Smith Brett L. , Santrock Robert D. , McAleer Jody 
Published: November 2020

Category: Bunion; Hindfoot Introduction/Purpose: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar tarsometatarsal (TMT) arthrodesis achieves this by three-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar TMT arthrodesis. Methods: After receiving IRB approval, charts were retrospectively reviewed for patients undergoing triplanar TMT arthrodesis for hallux valgus deformity at four institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (e.g., Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. Bony width was defined as the distance from the most medial aspect of the first metatarsal head to the most lateral aspect of the fifth metatarsal head. Soft tissue width was defined as the distance from the most medial soft tissue overlying the first metatarsal head to the most lateral soft tissue overlying the fifth metatarsal head. Results: 148 feet from 144 patients (48.1 +- 15.7 years, 92.5% male) met inclusion criteria. Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperative (p < 0.001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperative (p < 0.001). Postoperatively, patients had an average 10.4 +- 0.33 mm reduction (10.8% reduction) in osseous width and average 7.3 +- 0.33 mm reduction (6.8% reduction) in soft tissue width. Conclusion: Triplanar TMT arthrodesis reduces both osseous and soft tissue foot width providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width.