bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Recurrent Syndesmotic instability after Syndesmotic Screw Fixation in Rotational Ankle Fractures
Authors: Lee Sunghyun , Kwon Hoiyoung 
Published: October 2019

Category: Ankle Introduction/Purpose: Rotational ankle fractures often have unstable syndesmotic injuries the require reduction and stabilization. Though multiple studies have focused on methods to assess accurate syndesmotic reduction, fairly high rates of recurrent syndesmosis diastasis were reported. However, there was no study to investigate possible risk factors for syndesmosis widening after surgical fixation. The purpose of this study was to identify the risk factors for recurrent syndesmosis widening after screw fixation. We hypothesized that risk factors for recurrence syndesmosis widening could be identified from patient demographic, intraoperative variables and the extent of the pathologic condition associated with fractures. Methods: We performed a retrospective review between 2009 and 2015 of consecutive patients who had sustained rotational ankle fractures with intraoperative evidence of syndesmotic instability requiring syndesmotic reduction and stabilization. The exclusion criteria included syndesmosis screws placed for diabetic neuropathy, skeletal immaturity, tibial pilon fractures, polytrauma, open fracture. Patients were sorted into 2 groups according to the presence of recurrent syndesmosis instability which was defined as a difference in the tibiofibular distance of =2 mm between the injured and uninjured ankles on CT at postoperative 1 year and a positive external rotation test. Furthermore, the statistical analysis by binary logistic regression analysis included the significance of various risk factors including age at surgery, sex, diabetes, smoking, body mass index (BMI), dominant side, type of fracture, associated fracture, initial tibiofibular distance on CT, number and size of screws, cortices. The functional outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Results: A total 126 patients met the study inclusion criteria and underwent analysis. The overall postoperative recurrent instability rate was 25.4% (without recurrence group: 94 patients, recurrence group: 32). It was significantly affected by the BMI (p=0.018; adjusted odds ratio, OR, = 30, 6.21) and concomitant posterior malleolar fracture (p=0.040, adjusted OR 3.31). The other variables were not found to be significant risk factors. There was a significant improvement in the mean clinical scores at one years postoperatively (both p < 0.001), but the mean scores in the group with recurrence were significantly lower than those in the group without recurrence (p=0.021) Conclusion: Among the risk factors, obesity and concomitant posterior malleolar fracture were significant risk factors for the recurrent syndesmotic instability after syndesmotic screw fixation. The overall results suggest meticulous attention to concomitant posterior malleolar fracture, especially in obese patients.
Prevalence and Safety of Left-Footed Driving in Right Foot Surgery Patients: A Retrospective Survey and Driving Simulation Study
Authors: McKissack Haley M. , Chodaba Yvonne E. , Bell Tyler R. , Lehtonen Eva J. , Araoye Ibukunoluwa B. , Shah Ashish B. , Stavrinos Despina , Johnson Michael D. 
Published: October 2019

Category: Post-operative Driving Introduction/Purpose: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study is to describe the driving habits of patients after right-sided foot surgery and assess the safety of left foot driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 patients to compare characteristics of left versus right foot driving. Results: Thirty six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left foot driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more (p<0.001) and hit other vehicles more (p<0.026) when driving with the right foot than the left. Time to fully brake and fully release the throttle in response to vehicular hazards were significantly prolonged in left foot driving compared to right (p = 0.019 and p = 0.034, respectively). Conclusion: A significant proportion of right foot and ankle surgery patients engaged in left foot driving during postoperative recovery. Driving with the left foot may prolong brake and throttle release times, and is therefore not recommended.
Osteochondral Lesions of the Talus: Few Patients Require Surgery
Authors: Park Seung-Hwan , Seo Sang Gyo , Lee Ho Seong 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Methods: This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3–10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results: No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle–hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Conclusion: Nonoperative treatment can be considered a good option for patients with OCL.
Evaluation of the Diagnostic Value of SPECT/CT in Defining Foot and Ankle Pathologies
Authors: Pountos Ippokratis , Charpail Christel , Tellisi Nazzar 
Published: October 2019

Category: Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: The precise localisation of degenerative or inflammatory pathologies in foot and ankle can be difficult due to the complex anatomy of the joints. MRI plays a vital diagnostic role in these scenarios aiding the diagnosis and preoperative planning. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) is a relatively new imaging technology that combines the sensitivity of nuclear medicine examinations with the anatomical detail of CT. The aim of this study is to analyse the diagnostic effectiveness of SPECT/CT in evaluating foot and ankle pathologies. Methods: The authors retrospectively reviewed the medical records of all patients with a foot and/or ankle -related complaint that received SPECT/CT. Exclusion criteria included patients with inadequate follow-up and those that were not initially assessed by a senior foot and ankle surgeon. Collected data included demographic information, results from imaging, clinical progress and outcomes. Results: 272 included in the study comprised of 156 females and 116 males with a mean age of 52,8 years (range 17-92 years). The acquisition of a SPECT/CT changed the initial diagnosis (from either clinical or radiographs or MRI) in 55% of the cases. SPECT/CT finding correlated with MRI only in 34% of the cases. From the remaining cases SPECT/CT partially correlated with MRI in 26% of cases no correlation was noted in 40%. In regards to patients that undergone a USS or CT guided injection following the finding of a SPECT/CT, 86% reported a transient or long-term improvement in the pain. Overall, the SPECT/CT added confidence to the clinical diagnosis in 89% of the cases while reduced the need of further investigations in 93%. Conclusion: SPECT/CT is a valuable tool in depicting foot and ankle pathologies. It was able to provide additional diagnostic value by demonstrating co-existing pathologies as a potential cause of pain. SPECT/CT and MRI exhibit different diagnostic specificity and the limitations of each scan should be taken into consideration. This study strongly supports the use of SPECT/CT as a complementary imaging method to MRI for enhancing diagnostic specificity and outcomes.
Bilateral Sander IV calcaneus fractures: Primary fusion or fixation?
Authors: Shah Rajiv 
Published: October 2019

Category: Trauma Introduction/Purpose: Primary subtalar fusion for Sander IV calcaneus fractures was considered to be the standard of care till recent past. Presently debate is on whether to manage Sander IV calcaneus fracture cases with primary subtalar fusion or with open reduction and internal fixation. Bilateral Sander IV calcaneus fractures are seen in cases with fall from height. No study has ever been conducted till date to compare the results of primary fusion of a Sander IV calcaneus fracture on one side and open reduction and internal fixation on another side in cases with bilateral Sander IV calcaneus fractures. We present a study comparing the results of primary fusion versus open reduction and internal fixation for bilateral sander IV calcaneus fracture cases. Methods: Twelve cases with bilateral closed Sander IV calcaneus fractures where included in the present study. Cases were operated between four to six weeks by a single surgeon after the appearance of wrinkles. All right sided fractures underwent open reduction and internal fixation with proximal tibia grafting. While all left-sided fractures underwent subtalar fusion with the use of ipsilateral anterior iliac crest grafts. Cases were followed up for 24 months. Results: Though operative time was more in the fusion group wound problems were equal in both the groups. Four months of average time to union was the same in both the groups and so was time to return to work. At two years, the AOFAS score was slightly better in the fusion group but it was not statistically significant. Conclusion: Primary subtalar fusion is with almost similar results as those with open reduction and internal fixation in bilateral Sander IV at 24 months. Long term follow up with more number of cases is required to prove the benefit of one over other.
Correlation of Health Insurance Provider to Orthopedic Patient Reported Outcome Measures
Authors: Smith Jeremy T. , Abdurrob Abdurrahman 
Published: October 2019

Category: Insurance, Outcomes Introduction/Purpose: Previous research has suggested that patient insurance type can influence health-related measures, including patient survival, quality of care, clinical outcomes after certain injuries, and likelihood of returning to work following orthopedic injury. Patient reported outcome measures (PROMs) are a way of evaluating patients’ self-perception of health and function. The aim of this study is to determine if insurance type is associated with trends in PROMs scores in a general population of orthopaedic foot and ankle patients. Methods: We retrospectively reviewed the electronic medical records of 14,447 adult foot and ankle patients who had completed PROMs questionnaires from 2015 to 2017. We evaluated the following validated PROMs: Foot and Ankle Ability Measure (FAAM), PROMIS Global Short Form (both Physical and Mental Sub-scores), and PROMIS Physical Function Short Form 10A. Descriptive analyses, ANOVA, and Tukey HSD post-hoc analyses were conducted to evaluate trends of PROMs scores relative to insurance type. Results: The mean age of patients was 54.6 years, with 64.8% of patients being female (Table 1). Patients with Workers Comp/Motor Vehicle insurance (n=61) had the lowest mean FAAM, PROMIS Global – Physical Score, and Physical Function Short Form 10A score. Medicaid patients (n=836) had the lowest mean PROMIS Global – Mental Scores. Patients with Commercial insurance (n=9088) consistently had the highest PROMs scores (Table 1). Statistical analyses showed the scores of patients with Commercial insurance to be statistically significantly higher than the pooled scores of all other patients (Table 2). Significantly poorer scores were also seen for Workers Comp/Motor Vehicle as compared to the rest of the cohort (Table 2). Conclusion: This analysis reveals differences in PROMs amongst patients with different health insurance providers. In general, patients with Workers Comp/Motor Vehicle and Medicaid had poorer outcomes scores than those with Medicare or Commercial insurance. These differences were statistically significant and exceed published MCIDs for FAAM and PROMIS PF 10A. While further research is required, as we did not control for different diagnoses, we believe this is useful information in characterizing how patient insurance type can impact patient reported outcomes.
Single-Nucleotide Polymorphisms in the P2x7 Receptor Gene are Associated with Bone Mineral Density and Ankle Fractures
Authors: Stéfani Kelly Cristina , Fernandes Túlio Diniz 
Published: October 2019

Category: Ankle, Basic Sciences/Biologics, Trauma, Osteoporosis Introduction/Purpose: The objective of this study is to determine the associations among genetic variations in the P2X7 receptor gene, decreased bone mineral density (BMD), and the risk of osteoporosis in patients older than 50 years with ankle fractures. Methods: A Level-1 diagnostic study was conducted. Patients over 50 years of age with ankle fractures who had undergone surgical treatment were divided into two groups following the result of a bone densitometry: a study group with osteopenia (bone mineral density T score between -1 and -2.5) or osteoporosis (bone mineral density T score = -2.5) and the control group with normal values (bone mineral density T score = -1). Exclusion criteria were alterations that led to secondary osteoporosis. Patients were genotyped for 15 nonsynonymous single nucleotide polymorphisms (SNPs) within the P2X7 receptor (numbered from 1 to 15) obtained from saliva. We evaluated 121 patients with ankle fractures, 56 being from the control group, and 65 from the study group. All patients were sedentary, did not take any medication for the treatment of osteoporosis, did not smoke, and had suffered a low-impact trauma. Results: The grouped assessment of the SNP alterations showed that if a gene has three or more SNP variants (36.4% of the 121 patients), out of the 15 possibilities, it is altered with clinical repercussions related to the loss or gain of the function of the gene. In evaluating the SNP alterations individually, the results suggest that: SNPs 1,4,14, and 15 are loss of function variants; SNPs 5 and 10 are described as loss of function variants; however, they have no influence on our study population; SNPs 11 and 13 are loss of function variants and not gain of function function as is described in the literature; and SNP 12 was associated with a loss of function in our population. Conclusion: In conclusion, we demonstrate that functional polymorphisms in P2X7 are associated with BMD and with an increased risk of ankle fractures. The limitations of our study are its focus on non-synonymous polymorphisms, which do not cover all genetic variations in P2X7, and its small sample size compared to the international literature. One of this study’s strengths is the fact it is the first to evaluate P2X7 in the Brazilian population.
High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery
Authors: Tsai Justin , Daniel Joseph N. , McDonald Elizabeth , Rogero Ryan , Nicholson Kristen , Shakked Rachel J. , Pedowitz David I. , Raikin Steven M. 
Published: October 2019

Category: Bunion Introduction/Purpose: Despite absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard preoperative radiographs. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods: We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Intraoperatively, the first metatarsophalangeal and sesamoid metatarsal joint were assessed for arthritic changes. The articular surface of the metatarsal head was divided into zones 1-6 (Figure 1). Cartilage loss in each zone was graded from 0-2 based on a novel grading system, with a score of 0 representing the absence of arthritis. A score of 1 indicated fissures without exposed bone, and a score of 2 represented degenerative changes to the level of exposed bone. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. Spearman’s correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results: One-hundred two out of 200 feet (51%) assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head, and 40% (80/200) at the plantar lateral aspect. The mean preoperative hallux valgus and intermetatarsal angles were 29.6 ± 8.5 (range, 9.8-55.3) and 14.2 ± 3.3 (range, 6.6-25.9), respectively. Those presenting with an intermetatarsal angle (IMA) >/= 14 degrees had a significantly higher level of arthritis when compared to those presenting with an IMA < 14 degrees (p < 0.001). No difference in arthritis scores was found for HVA. Age was found to have a strong and significant (p < 0.001) correlation with zone 5, zone 6, total plantar zone, and total arthritis scores. Conclusion: The high prevalence of arthritic changes at the metatarsal head articulation with the sesamoids may be partially responsible for suboptimal outcome following hallux valgus correction surgery. Since these changes were associated with greater age and preoperative deformity, operating earlier in the pathology of hallux valgus may be of benefit.
Early versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Repair: A Systematic Review and Meta-analysis
Authors: Vopat Matthew L. , Tarakemeh Armin , Morris Brandon , Hassan Maaz , Garvin Pat , Zackula Rosalee , Mullen Scott , Schroeppel Paul , Vopat Bryan G. 
Published: October 2019

Category: Ankle, Sports, Post-op protocol Introduction/Purpose: Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. Some patients, however, experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization which can include primary lateral ligament repair to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament repairs remains unknown, as surgeon vary in how they balance protection of surgical repair with immobilization with the need for ankle joint mobilization to restore range of motion. The aim of this review is to provide insight into early and delayed mobilization post- operative protocols in patients undergoing primary lateral ankle ligament repairs to determine if an optimal evidence-based post- operative rehabilitation protocol exists in the literature. Methods: Following PRIMSA criteria, a meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947- 10/16/2017). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical and non-English language were excluded. Protocols were reviewed and divided into two categories; early mobilization (within 3 weeks of surgery) and delayed mobilization (after 4 weeks of surgery). Return to sport, outcome scores (AOFAS, Karlsson scores) and complications of both populations were recorded and statistically analyzed. Results: 31 out of 1,844 studies met the criteria for the final analysis, representing 1,608 patients undergoing primary lateral ligament repair. There was no statistical difference in pre-operative AOFAS scores with delayed mobilization having a score of 67.3 and early mobilization having a score of 67.6 (p<0.639). There was statistical significance in the post-operative AOFAS score comparing delayed mobilization group versus early mobilization group with 91.8 versus 98.8, respectively (p<0.001) and post- operative Karlsson scores with values of 90.0 vs. 92.2 in delayed versus early respectively (p<0.001). Return to sport in the delayed group was 11.8 weeks versus 10.9 in early (p<0.044). No significant difference was found in complication rates between groups with delayed having a rate of 3.7% and early 4.8% (p<0.389). Conclusion: Patients may benefit from early mobilization protocols after lateral ankle ligament repair. The early mobilization protocols group had improved functional outcomes and decreased time until return to sport without a difference in complications. More studies are needed to definitively evaluate early versus delayed rehabilitation protocols due to heterogeneity of the studies.