bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Modified Scarf Osteotomy for Male Hallux Valgus
Authors: Scott Daniel J. , Ford Samuel E. , Alejandro Shannon F. , Myer David K. , Taniguchi Akira , Brodsky James W. 
Published: November 2020

Category: Bunion Introduction/Purpose: Compared to women, hallux valgus in men is less common, more severe, and has higher rates of undercorrection, recurrence and greater distal metatarsal articular angle (DMAA). Bunionectomies that correct metatarsus primus varus (MPV) by valgus rotation paradoxically increase 1stMTP valgus in high DMAA, contributing to recurrence and undercorrection. While proximal valgus osteotomy or arthrodesis plus distal varus-producing metatarsal osteotomy can correct both components, there is a simpler solution. A modified Scarf osteotomy technique was developed in which the osteotomy is simultaneously translated laterally to correct MPV, while rotating the distal metatarsal in varus to correct DMAA. While previous literature on male hallux valgus is comprised of many studies using a combination of surgical techniques, all patients in this series had the same procedure. Methods: A retrospective review of prospectively collected data was performed in male patients treated with modified scarf osteotomy and soft tissue realignment for symptomatic hallux valgus, who failed conservative treatment. Preop and postop range of motion (ROM), radiographs, and validated patient reported outcome (PROM) scores including Pain VAS and SF-36, were tabulated, as well as complications, and AOFAS Hallux scores for historical comparison. There were 22 patients (26 feet), mean age 53 (17-79). Mean clinical and radiographic follow up was 24 months, and mean postop PROM’s follow up was 4.7 years. Six of 26 feet (23%) required a modified Akin osteotomy for a congruent 1stMTP joint. A subset of patients with minimum 4-year and mean 7.6 -year follow up (9 patients, 10 feet), was also analyzed. Weightbearing radiographs were evaluated for DMAA, hallux valgus angle (HVA) and 1st-2ndintermetatarsal angles (IMA). Results: Statistically significant improvements were found in VAS scores (5.8 to 1, p<0.001); SF-36 physical (44 to 56.7, p<0.001); IMA (15.9 to 8.7, p<0.001), HVA (36.1 to 15.1, p<0.001), DMAA (12.7 to 6.9, p=0.01) and AOFAS scores (44 to 79, p<0.001). Total 1stMTP ROM decreased from 60.9 to 50.8 degrees (p=0.06). One patient had delayed wound healing requiring oral antibiotics and wound vacuum application. Statistically significant improvements were maintained over time in the 7.6-year follow up sub-group, with VAS scores 6.2 to 1.3 (p<0.001), SF-36 physical from 40.8 to 61.3 (p=0.008), and SF-36 mental from 55.7 to 62.3 (p=0.002). Conclusion: This study found statistically significant improvements in both subjective validated PROM’s and objective radiographic measures using a special modification of the scarf osteotomy to address the characteristic increased DMAA that underlies complications and under correction previously reported in male hallux valgus. The corrections were well maintained at long-term follow-up including a robust correction of the DMAA.
Transcuneiform Screw Fixation in Ligamentous Lisfranc Injuries
Authors: Shaheen Philip J. , Crawford Benjamin , Kopydlowski Nathan J. , Patel Shwetang , Bledsoe John G. , Kaar Scott G. , Karges David E. 
Published: November 2020

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Ligamentous Lisfranc injuries represent a devastating injury complex to the midfoot. Treatment with screw fixation across the first tarsometatarsal (TMT) joint and across the first cuneiform-second metatarsal joint (C1-M2) joint has been described, however there are no studies examining the utility of adding a transcuneiform screw across the first cuneiform-second cuneiform (C1-C2) joint. The purpose of this study was to evaluate the effectiveness of transcuneiform screws at minimizing interosseous displacement in ligamentous Lisfranc injuries when added to traditional Lisfranc screw fixation. Methods: Unstable ligamentous Lisfranc injuries were created on ten fresh-frozen cadaveric specimens by sectioning the interosseous ligaments in a manner that has been described previously. Simulated weight bearing stress (222.4 N) as well as manual abduction and adduction stresses were applied to each specimen and interosseous displacement at the C1-C2 and C1-M2 joints was measured on gross images using calibration with 2mm radiographic marker balls. These measurements were performed initially with no screws, followed by with two-screw fixation across the C1-M2 joint and the first TMT joint, and finally with a third transcuneiform screw across the C1-C2 joint. The images were analyzed and statistical analysis was performed to determine the effect of transcuneiform fixation on interosseous displacement at the C1-C2 and C1-M2 joints. Results: The addition of transcuneiform screw fixation to traditional two-screw fixation decreased the amount of interosseous widening at C1-M2 by an average of 0.03mm at rest, 0.39mm during abduction stress, 0.21mm during adduction stress, and 0.19mm during weight bearing. The interosseous widening at C1-C2 decreased with the addition of transcuneiform fixation by an average of 0.30mm at rest, 0.11mm during abduction stress, 0.18mm during adduction stress, and 0.05mm during weight bearing. Of these findings, only the change in interosseous widening at C1-M2 during abduction stress demonstrated a statistically significant difference (p=0.031) with the addition of the transcuneiform screw compared to traditional two-screw fixation. Conclusion: The addition of transcuneiform screw fixation in ligamentous lisfranc injuries allows less interosseous widening at the C1-M2 joint during abduction stress when compared to traditional two-screw Lisfranc fixation. Further research is required to determine the clinical significance of fixing the transcuneiform joint in Lisfranc injuries and whether or not this potential reduction in motion affects outcomes such as pain control, healing, or function.
Influence of Cannabinoid on Interleukin-1β Treated Cartilage: An In Vitro Study
Authors: Shang Jiangyinzi , Hu Yuning , Alexander Peter , Hogan MaCalus V. , Lin Hang , Yan Alan Y. 
Published: November 2020

Category: Basic Sciences/Biologics Introduction/Purpose: Cannabinoids have been reported to possess the analgesic, immunomodulatory and anti-inflammatory properties. Recent studied further shown that cannabinoids attenuated joint damage in animal models of arthritis. However, the underlying mechanism has been completely understood. Interleukin-1β (IL-1β), a proinflammatory cytokine that can result in the degradation of cartilage, is associated with the pathogenesis of osteoarthritis. In this study, we hypothesize that cannabinoid can mitigate the detrimental effect of IL-1β on cartilage, thus reduce the progression of osteoarthritis. To test the hypothesis, we insulted human chondrocyte-derived cartilage with IL-1 β for 48 hours and then applied a synthetic cannabinoid agonist, Win- 55,212-2(Win-55), into the culture. The tissue phenotypes were assessed by real time polymerase chain reaction (PCR), histology and immunostaining. Methods: With the approval from CORID, human chondrocytes were isolated from healthy articular cartilage. P2 cells were used. MTS assay were employed to test the half-maximal (50%) inhibitory concentration (IC50). To generate cartilage in vitro, chondrocytes were pelleted and subjected to 14 days chondrogenic culture. The engineered cartilages were stimulated with 10 ng/ml IL-1β for 48 hours and then treated with different concentration of Win-55 (0.01, 0.1, or 1 µM) for another 48 hours. The tissue phenotype was assessed by glycosaminoglycan (GAG) assay, real-time PCR and histology. Results: We tested 10 doses, from 0.001µM up to 10 µM, and determined that the IC 50 of Win-55 on human chondrocytes for 2 days was ˜ 2 µM. Interestingly, this dose is significantly lower than the doses reported in similar studies. As shown in Figure 1, treatment with 2µM Win-55 causes the complete loss of GAG from engineer cartilage. In a relatively safe dose (<=1 µM), we did not observe obvious changes in all tested genes after the treatments of Win-55 (Figure 2). Conclusion: High dose of Win-55 may directly cause the degeneration of cartilage, while low dose of Win-55 doesn’t show beneficial influence on the phenotype of IL1-β-insulted cartilage. The reported anti-inflammatory effect of Win 55 on chondrocytes may due to the cytotoxicity or global inhibition of high dose Win 55 on cell activities. Therefore, if cannabinoid can be used to treat OA requires further investigation.
Functional Implications of the Flat-Topped Talus Following Treatment of Idiopathic Clubfoot Deformity
Authors: Shivers Claire , Siebert Matthew , Zide Jacob R. , Tulchin-Francis Kirsten , Stevens Wilshaw , Borchard Justine , Riccio Anthony , Zide Jacob R. 
Published: November 2020

Category: Hindfoot; Other Introduction/Purpose: The flat-top talar dome is a well-known potential consequence of both operative and non-operative clubfoot management. While it is assumed that patients with a flat-top talus will have greater problems with daily activity, the functional impact of this deformity has not been characterized in the literature. The purpose of this study is to analyze the relationship between talar dome morphology and ankle function at skeletal maturity in patients treated for idiopathic clubfoot deformity during infancy. Methods: 33 skeletally mature patients (average age 17.9 years, SD 1.6 years) with 52 idiopathic clubfeet were identified from our institution’s clubfoot registry. Plain weight bearing lateral foot films, gait analysis and patient reported outcomes (PRO) using the Pediatric Orthopaedic Data Collection Instrument (PODCI) were obtained in all patients. Radius of curvature (ROC) of the talar dome and tibial plafond were measured along with numerous other parameters of talar and calcaneal morphology. Other measurements included talar dome radius to talar length (R/L) ratio, opening angle of the talar dome (alpha-angle), and talar dome to tibial plafond ROC (TD/TP) ratio. All measurements were correlated to PODCI scores and gait analysis data. Results: Patients demonstrated variability in talar dome ROC (mean 33.1mm, SD 19.6mm), R/L ratio (mean 0.60, SD 0.39), alpha- angle (mean 88.7°, SD 29.5°) and TD/TP ratio (mean 1.17, SD 0.44). Increased TD/TP ratio correlated negatively with maximal plantarflexion (r=0.404, p=0.005), ankle range of motion (ROM) (r=0.383, p=0.008) and maximum power generation during step off (r=0.381, p=0.008). Higher alpha-angle correlated positively with plantarflexion (r=0.404, p=0.005), ankle ROM (r=0.383, p=0.008) and maximum ankle power generation (r=0.381, p=0.008). Lower talar dome ROC correlated with increased maximum power generation (r=0.326, p=0.025). Increased R/L and TD/TP ratios correlated negatively with PODCI happiness domain scores (r=-0.353, p=0.044; r=-0.377, p=0.025, respectively). Talar length correlated with higher happiness and global function scores (r=0.393, p=0.024; r=0.360, p=0.040, respectively) and lower pain scores (r=0.354, p=0.043). Conclusion: While flatness of talar dome correlates significantly with altered gait mechanics, the effects on patient reported function are more modest during the second decade of life. Further study is required to assess the longer-term effects of the flat top talus on function and joint health.
A Multicenter Retrospective Study Examining Complication Rates Following Syndesmotic Screw Removal
Authors: Shoap Seth C. , Freibott Christina , Baumbach Sebastian F. , Herterich Viktoria , Polzer Hans , Vosseller J. Turner 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: 20% of ankle fractures in the US involve a concomitant injury to the syndesmosis. What syndesmotic fixation is most appropriate is a subject of some debate. When syndesmotic screws are used, many of the variables surrounding treatment are unclear. One recent study quoted an alarmingly high rate of complications after syndesmotic screw removal (reference). The authors of the current study have routinely removed syndesmotic screws with little in the way of complications. This multicenter study was conducted in order to compare complication rates following syndesmotic screw removal in two institutions that regularly remove syndesmotic screws. Methods: Patient selection was based on the ankle fracture databases of the orthopedic department in two major academic institutions. At both institutions, databases includes all patients treated surgically for any type of ankle fracture between 01/2010 and 12/2016 in patients older than 18 years. Patients meeting the following inclusion criteria were selected: patients suffering any type of an acute, closed ankle fracture, syndesmotic disruption treated using a syndesmotic screw, removal of the syndesmotic screw in the same institution, and patient chart available for review. Exclusion criteria: pilon fractures, and tibial shaft fractures, as well as any postoperative infection following the original osteosynthesis. Data from the chart included age, sex, height, weight, BMI, days until screw removal, smoking status, alcohol use, diabetes status, and any wound complications or complication related to the screw removal. A logistic regression analysis was conducted to assess for predictors of wound complications after syndesmotic screw removal. Results: In our cohort of 152 patients, 1.3% of patients had wound complications. When looking at the cohorts separately, there was a reported wound complication in 3.2% (1 out of 31) of patients in institution 1, whereas there was a 0.83% (1 out of 121) wound complication rate in the cohort at institution 2 (p=0.296). There were no significant predictors of wound complications when looking at age (p=0.992), height (p=0.511), weight (p=0.735), BMI (p=0.755), days until screw removal (p=0.80), sex (p=0.404), smoking status (p=0.999), alcohol use (p=0.102), or diabetes status (p=0.269). Chi-square analysis revealed that there was not a significant association between wound complication and smoking (p=0.177), alcohol use (p=0.461) and diabetes status (p=0.602) in each cohort. Conclusion: A recent study reported a high rate of complications as a result of syndesmotic screw removal. Our multicenter study found minimal complications after syndesmotic screw removal. Further, out of two patients that did have reported complications, neither required secondary intervention as a form of treatment. These complications were considered minor and were treated with oral antibiotics.
Retrospective Comparison of Complications with Open versus Minimally Invasive Achilles Tendon Repair
Authors: Shoap Seth C. , Freibott Christina , Polzer Hans , Vosseller J. Turner 
Published: November 2020

Category: Sports; Other Introduction/Purpose: Despite the relatively high frequency of Achilles ruptures, there is no clear consensus on the optimal treatment method. The debate has traditionally been framed by the tension between the risk for rerupture seen with nonoperative treatment and the risk for wound issues seen with operative treatment. Studies have demonstrated conflicting results when comparing complications associated with each treatment. The current study analyzed complications of patients with Achilles tendon ruptures that received either minimally invasive repair or open standard repair by a single surgeon. Methods: We conducted a retrospective chart review of patients that had Achilles tendon repair performed by the senior author between July 1st 2011 and January 22nd 2020. The senior author’s preferred operative technique transitioned from an open standard procedure to a minimally invasive procedure within this time frame, and patients were divided accordingly. Patient demographics, medical history, social history, surgical details, and additional surgeries were recorded. Patient outcomes and any complications were also recorded. Complications included any wound related issues or infection, erythema, DVT, wound breakdown, drainage, equinus contracture, and calcaneus stress reaction. Pain, swelling and/or tenderness were not considered complications. Independent sample t-tests and chi-square analyses were conducted to assess for differences in patient demographics and operative outcomes between the minimally invasive and open procedure treatment groups. Results: Of the 127 included patients, 75.6% were male with an average age of 41.85 (+-14.02). 30 (23.6%) patients had the minimally invasive approach, while 97 (76.4%) had the open approach. 82.7% were non-smokers, and the average BMI was 31.47(+-29.84). A majority of injuries (63.8%) occurred while playing sports. There were 10 complications, all of which were wound-related and all of which were in the open group (p=0.06). There were no revision surgeries in the minimally invasive group, and 10 in the open group (p=0.06). There were no recorded reruptures in either group. Conclusion: This study sought to determine the complication profile of two operative treatments for Achilles tendon ruptures, open standard and minimally invasive repair. Recent literature has suggested that minimally invasive repair results in superior outcomes to open repair. Our study found that both repeat surgery and complications trended towards a higher rate following open repair compared to minimally invasive repair, although the difference was not statistically significant (p=0.06). It is notable, however, that there were fewer total patients in the minimally invasive group and that there was not a single wound complication in the minimally invasive group.
Minimally Invasive Surgery for Correction of Adult Acquired Flat Foot Deformity: An Anatomic Study
Authors: Shofoluwe Ademola I. , Bailey Erroll J. , Stewart Gary W. 
Published: November 2020

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a complex and chronic debilitating condition characterized by a decrease in the medial arch height and, in advanced stages, a decrease in the talonavicular coverage angle as the forefoot drifts into pronation and abduction. Operative treatment of stage II deformity has changed significantly over the past few decades. Joint sparing procedures which aim to realign the hindfoot and augment the diseased tibialis posterior tendon with the flexor digitorum longus transfer are commonly performed. The introduction of minimally invasive surgery (MIS) has been associated with smaller incisions, less blood loss, and quicker recovery times. The purpose of this study was to qualitatively and quantitatively observe the tendinous and neurovascular structures at risk with MIS AAFD osteotomy procedures in cadaveric feet. Methods: MIS technique was used to perform medial displacement calcaneal, Evans, and Cotton osteotomies on nine cadaveric feet under fluoroscopic guidance. The sural nerve, superficial peroneal nerve and its branches, deep peroneal nerve, dorsalis pedis artery, saphenous vein, and peroneal and extensor hallucis longus tendons were carefully dissected from each cadaveric foot and evaluated for injuries following the MIS osteotomy cuts. The distance from the osteotomy cuts and these anatomic structures were measured and recorded. Results: On average, the sural nerve was 8.4 mm and 9 mm from the calcaneal and Evans osteotomy sites, respectively. The intermediate dorsal cutaneous nerve was on average 68.3 mm and 41.1 mm from the calcaneal and Evans osteotomy sites, respectively. The peroneal tendons were on average 16.7 mm and 0 mm from the calcaneal and Evans osteotomy sites, respectively. The extensor hallucis was an average of 1 mm from the Cotton osteotomy site. There was a partial tear injury to the peroneus brevis in four of the cadaveric specimens at the Evans osteotomy site without complete laceration. There was no injury to the sural nerve, superficial peroneal nerve and its branches, saphenous vein, deep peroneal nerve, dorsalis pedis artery, or extensor hallucis longus tendon. Conclusion: Tendinous and neurovascular structures are at risk with MIS AAFD osteotomy procedures. Care should be taken with soft tissue handling and blunt dissection to decrease iatrogenic injuries to these structures. Specifically, extra care and recognition of the peroneal tendons during the Evans osteotomy may prevent damage, as this structure was at greatest risk among the three osteotomy cuts. Future research studies evaluating this technique and the functional outcomes in patients in a clinical setting is warranted. Surgical technique studies are underway to implement smaller, yet appropriate bone grafts through mini incisions.
A Retrospective Chart Review Examining Gabapentin’s Potential Neuroprotective Effects in Peripheral Nerve Blocks
Authors: Shuster David M. , Brower Jacob , Cheney Nicholas A. , Clark Brian C. 
Published: November 2020

Category: Other Introduction/Purpose: Regional anesthesia is routinely used in association with outpatient surgical procedures to mitigate postoperative pain. This has been associated with better surgical outcomes and decreased post-surgical opioid consumption. Administration of a nerve block; however, can lead to complications. These complications are typically due to nerve damage caused by the injection and leading to lasting neurologic symptoms unrelated to the surgical procedure itself. Although nerve block complications are rare and temporary, lasting complications can be debilitating. Based upon a few total knee arthroplasty studies this study theorized that Gabapentin could be used as a neuroprotectant thereby decreasing the rates of lasting complications from peripheral nerve blocks. This study compares the number of nerve block complications with and without the use of Gabapentin peri/post operatively. Methods: This study was completed through retrospective chart analysis of the senior author’s patients from January 2019 to September 2019. Charts of patients that received a preoperative nerve block were used to calculate rates of lasting complications. The rate of complications in this subset of patients was compared to the group of patients who did not receive this medication pre and post operatively from an earlier study. Results: Nerve block complication rates when administering 600mg of gabapentin 1-hour pre-surgery along with 100 mg of gabapentin three times daily for three days post-surgery, was 7.69% (N = 78; P=0.4261). However, there was an insufficient number of study participants to make a definitive conclusion. Conclusion: Administration of pre and post-operative gabapentin does not decrease nerve block complication rates when compared to no pre and post-operative gabapentin to a statistically significant amount. This was largely due to limited sample size, which was a major limitation of this study. A previous study was done with the same physician and the same patient population. In this study they found a 10.1% complication rate, seen in the evaluation of 855 patients charts. Due to a discrepancy in sample size, a conclusion cannot be made but further research is necessary to understand gabapentin’s potential neuroprotective effects in nerve blocks.