bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes and Complications Following Treatment of Chronic Subtle Syndemotic Injury with Arthroscopic Debridement and Fixation with Suture Button
Authors: Rungprai Chamnanni , Sripanich Yantarat 
Published: November 2020

Category: Ankle; Arthroscopy Introduction/Purpose: The syndesmotic injury can be occurred 10-18 percent associated with acute ankle sprain. This injury is commonly missed due to a difficulty to diagnosis in acute setting leading to chronic pain, swelling, and inability to return to previous level of activities and sports. Anterior ankle arthroscopic examination has been proposed to be successful technique to establish the diagnosis of this subtle injury. The purpose of this study is to demonstrate outcomes and complications of the patients who isolated syndesmotic injury and treated with anterior ankle arthroscopic debridement and fixation with suture button. Methods: A prospective case series of 62 patients who had ankle sprain with chronic pain on syndesmosis between 2015 and 2019 were enrolled in this study. All patients were failed from conservative treatment including bracing, ankle range of motion and strengthening exercises, low-does laser, and ultrasound treatment for at least 6 months after initial injury. The syndesmotic injury was considered when patients had chronic pain and swelling and athletic taping test was positive, and MRI demonstrated AITFL torn or fluid was ascended more than 10mm from ankle joint line. All patients were confirmed by intra-operatively ankle arthroscopy with a 3-mm shaver could pass through the syndesmotic joint. Syndesmotic joint was debridement and was fixed by suture button. Pre- and post-operative SF-36, FAAM, and VAS were obtained and compared using a paired t-test. Operative times, complications, and recovery times including time to return to ADL, work, and sports were recorded. Results: There were significant improvements of all functional outcomes (FAAM, SF-36, and VAS (p < 0.001 all)) with an average follow-up of 20.8 months. An average operative time was 30.2 minutes. Patients reported no previous pain after the operation (VAS 0/10, 54/62) and mild pain (VAS 1-2/10, 8/62). There were 6 patients with osteochondral injury intraoperatively and 9 patients with enlargement of anteroinferior tibiofibular ligament (AITFL). Recovery times included returned to ADL 4.9 weeks, to work 6.8 weeks, and to sports 5.8 months. Four patients had saphenous nerve irritation from the medial button and this was fully recovery at 4.8 months post-operatively and 2 patients has mild pain on fibular. There were no migration or disruption of suture button and no wound complications. Conclusion: Isolated sublte syndesmotic injury after ankle injury was successfully confirmed by anterior ankle arthroscopic examination and arthroscopic debridement and suture button fixation demonstrated significant improvement of functional outcomes as measured with FAAM, SF-36, and VAS. and patients were able to return previous activities. This technique is effective, safe, and feasible for treatment in patients with isolated subtle syndesmotic injury.
Minimally Invasive Versus Open Akin Osteotomy: A Comparative Study
Authors: Schilde Sebastian , Gutteck Natalia , Delank Karl-Stefan 
Published: November 2020

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Minimally invasive techniques of Akin osteotomy grow in popularity in order to minimize wound healing problems. To date it is recommended to keep the lateral corticalis intact during first phalanx osteotomy. The lack of direct visual control makes this a challenging goal in minimally invasive surgery. This retrospective study investigates whether or not the perforation of the lateral corticalis causes clinical or radiological negative effects. The quality of fixation with crossed K-wires and double threaded screws is compared. Methods: 184 patients (210 feet) with symptomatic mild to severe hallux valgus deformity and pathological interphalangeal angle (IPA) of at least 10° underwent surgery combined with Akin osteotomy. 124 minimally invasive Akin osteotomies were fixed with two crossing K-wires and compared to 86 Akin osteotomies in open technique with double threaded screw fixation. After 6 and 12 weeks IPA and bony consolidation were assessed. Results: Preoperative interphalangeal angles were mean 13.4° (+- 3.6°) (minimally invasive group (MI)), or 13.3° (+- 3.5°) (open surgery group (OS)) degrees (p>0.05).Perforation of the lateral corticalis occurred in 12 (13.9%) (OS), or 64 (51.6%) cases (MI), respectively.12 weeks after surgery the mean IPA was 4.1° (+- 1.4°) (MI), or 4.8° (+- 1.2°) in the open surgery group (OS) (p > 0.05).Bony consolidation was noticed after 6 weeks (OS, double threaded screw) or 12 weeks (MI, crossing K-wires).Three deep infections occurred in the OS group after Lapidus arthrodesis and two deep infections were registered in the MI group after MICA. All patients required revision with removal of implants. Pseudarthrosis did not occur in any group. Conclusion: Perforation of the lateral corticalis did not cause negative effects on bone healing or IPA. Minimally invasive Akin osteotomy provides equivalent correction of IPA compared to open surgery with a slightly prolonged radiological bony consolidation. The fixation technique had no influence on IPA correction.
The Trans-Syndesmotic Axis in Relation to the Distal Anterior Medial Tibial Cortex
Authors: Schlatterer Daniel R. , Deal James , Krautmann Kurt M. 
Published: November 2020

Category: Ankle Introduction/Purpose: Gardner et al. (2006) reported that over 50% of operative syndesmoses are malreduced. The functional consequence of syndesmotic malreduction at two years was reported in 2012. Miller et al. in 2013, found that the 15° and 30°clamp positions caused fibula external rotation and over compression of the syndesmosis joint. The 0° medial clamp position which was in line with the trans-syndesmotic axis (TSA) did not negatively impact fibular reduction as did the other two posterior clamp positions. The purpose of this study is to identify the medial exit point of the TSA on the tibia. We hypothesized that the TSA on the medial side of the ankle would be a constant distance from the medial anterior tibial cortex. Methods: Fifty consecutive CT scans of uninjured ankles were reviewed from our image archive system. On an axial 2- dimensional reformatted image proximal to the ankle joint that included the entire incisura a line was drawn connecting the anterior and posterior limits of the incisura of the tibia. A second line was then drawn at 90 degrees at the midpoint of the first line and extended medially. Results: The average distance of the medial TSA exit point from the anterior edge of the distal medial tibia was 2.9 mm (Range 0- 9 mm, standard deviation 2.03 mm). The average anterior to posterior length of the medial distal tibia was 23.6 mm (Range 16-30, standard deviation 3.01 mm). Conclusion: Syndesmosis reduction clamp placement may first involve identifying the TSA based upon the anterior edge of the distal medial tibia. This region may be used to locate the TSA for optimal medial clamp placement. This study provides a foundation for future clamp placement investigations.
Trends in Sport Related Foot and Ankle Injuries in Adults 65 and Over Presenting to US Emergency Rooms from 2009-2018: A Descriptive Epidemiology Study
Authors: Scott Devon , Canton Stephen P. , Hogan MaCalus V. , LaBaze Dukens 
Published: November 2020

Category: Sports Introduction/Purpose: The percentage of the U.S population that is age 65 and older is expected to rise to 19.3% by the year 2030, up from 13% in 2010. Only 39% of seniors get the recommended amount of weekly exercise. This has led to Medicare sponsored fitness plans to increase of the number of older adults being active. For this percentage it is important that they are aware of safety precautions and ways to prevent injuries. One study showed that in elderly men still active in sports 75% of injuries were located in the lower extremity. The purpose of this study is to trend sports related foot and ankle (SFA) injuries in patients 65 and over that presented emergency departments from 2009 to 2018. Methods: Data was obtained from the National Electronic Injury Surveillance System (NEISS). Injury data is obtained daily from the emergency departments of approximately 100 hospitals across the United States and its territories. This serves as a probability sample of over 5000 hospitals across the country. Each case recorded is given a statistical weight based on the study design. CPSC analysis has the ability to make adjustments to more accurately represent the entire United States population. Hospitals are group in five strata mostly based on hospital size and number of ED visits they receive per year. The database was set with query inputs of patients aged 65 and over that presented with sports related injuries of the lower leg, ankle, foot and toes from 2009 - 2018. Results: An approximate total of 216,334 SFA injuries presented to emergency rooms in persons age 65 and over. Contusions/abrasions accounted for 11.7% of total injuries; lacerations (12.4%); fractures (20.9%); sprains and fractures (22.7%). Other types of injuries accounted for 32.3 %. There was an approximate total of 1,654,666 sports related injuries. Upper extremity had the highest percentage at 24.6%. Ages 65-69 accounted for 38.8 %. The trend for the SFA injuries increased 39.9% from 2009 to 2018, while the trend for overall sports injuries rose 83%. The percentage of SFA out of all sports injuries has decreased 23.6% from 14.81% of total sport injuries in 2009 to 11.32% in 2018. Conclusion: As the population ages, more seniors are remaining active and more are participating in sports. Thus, the increase in the number of sport related injuries. This increase however has outpaced the number of foot and ankle specific sport injuries. Over the time span of the study there has been an increase in percentage of hand, wrist and knee injuries. Further research is needed to delineated which specific sports and activities cause the most SFA injuries. This information can then be used to educate this population on injury prevention.
Safety and Outcomes of Early Fixation in Patients who Suffered an Ankle Fracture
Authors: Shah Ashish , Hawkins Jacob , Alexander Bradley , Agarwal Abhinav , Cage Benjamin B. , Greco Elise M. , Barranco Hannah M. , Patel Akshar 
Published: November 2020

Category: Ankle Introduction/Purpose: Ankle fractures are a common injury in the United States leading to increased ER visits and healthcare costs. Additionally, these injuries normally lead to prolonged immobilization that can make it difficult for patients to return to work and normal activities. By optimizing fracture healing and decreasing the amount of time to union patients can avoid the frustration of prolonged immobilization and return to daily activities more quickly. It is believed that early surgical fixation of ankle fractures can lead to wound complications while late fixation can lead to issues with reduction during surgical intervention. This study was undertaken to determine if there is a difference in wound complication and time to union between early and late fracture fixation. Methods: From July of 2008 to June of 2018, a retrospective chart review of 321 patients who underwent ankle fracture corrected with ORIF was performed at a single institution. Patients with pilon fractures, poly trauma, open fractures, or less than 3 months of follow up time were excluded from our study. After exclusion were made there was 232 patients remaining. All patients were then stratified by time to surgery after injury and injury classification. The cohorts were surgery within 2 days with 31 patients, surgery within 7 days with 69 patients, and patients that had surgery after 8 days (132). The patients were also stratified according to the Lauge-Hansen classification. The cohorts were PA, PER, SA, and SER. Results: The average time to union for patients who were operated on within 2 days of injury was 108.48 days, 106.52 days for patients operated on between 3-7 days, and 97.59 days for patients operated on after 7 days. Wound complications were highest in the cohort operated on within 2 days at 9.6%. Patients operated on between 3 and 7 days had the lowest rate of wound complications at 2.8%/. Patients with an SER Lauge-Hansen classification has the fastest time to union at 94.04 days and individuals with an SA had the longest at 139.30 days. Wound frequency for patients with a classification of PA had the highest wound complications at 20%. Conclusion: There has been little research done on how time to surgery affects wound complications and healing time in ankle fracture fixation. Patients that received surgery after 7 days achieved union the fastest. We saw that wound complication rate was greatest in the cohort that had surgery within 2 days of injury. Injury classification did factor into union time and wound complications. Overall, there was not a significant difference in wound complication between early fixation and delayed fixation. [Table: see text]
No Progression of Radiological Adjacent Joint Arthritis Noted in Patients with Type II DM undergoing Total Ankle Replacement: A 5 Year Follow Up Study
Authors: Shahid Zuhaib , Hutt Nicholas , Allport Jack , Ramaskandhan Jayasree Ramas , Refiae Ramsay , Siddique Malik S. 
Published: November 2020

Category: Ankle; Ankle Arthritis; Diabetes Introduction/Purpose: Total Ankle Arthroplasty [TAR] is a recognized treatment for end stage osteoarthritis. Many of these patients also have Type 2 Diabetes. There is a lack of literature of patients undergoing TAR surgery who belong to this cohort and any available literature has shown negative outcomes in such surgery. We aim to study whether the radiological outcomes of such patients undergoing TAR is different to their non diabetic counterparts performed at our Tertiary center. Methods: We conducted a retrospective study of patients undergoing Total Ankle Replacements between 2006 and 2014. Both patients with Type 2 Diabetes and non-diabetic patients were included. Type 1 Diabetics were excluded. Pre-operative screening of patients included thorough clinical assessment including swelling, warmth, erythema and neurovascular assessment including proprioception, vibration and neuro-filament testing. True AP, lateral X-Ray weight bearing views were obtained. MRI or CT scan was carried out on all patients pre-operatively. Patients were reviewed with X-Ray at 3, 6, and 12 month post operatively. Any radiolucency was defined as gap >2mm between the implant and the bone which was not seen at 3 month post op x-ray. Painful ankle replacement implants were investigated by SPECT CT scan. Results: 9(3.9%) of the 230 patients were diabetic. Pre-operative radiographs revealed disease confined to OA, MRI and CT scans showed no evidence of bone debris, fragmentation of articular surfaces, translation of Talus or symptomatic OA in the Subtalar or Talo-navicular joint requiring treatment. Radiological analysis at 5 years demonstrated no evidence of loosening, implant subsidence, migration or periprosthetic cysts. No x-ray progression of arthritis was noted in the Subtalar, Talo-navicular or midfoot joints in Diabetic patient group. At the latest follow up, no radiological features of Charcot arthropathy was noted in the peri-prosthetic area. Conclusion: Our radiological outcome study has demonstrated that at minimum of 5 years, patients with diabetes who underwent TAR did not show any progression of arthritis in adjacent joints. Our study highlights that in the absence of diabetic neuropathy, it is safe to offer TAR in patients with Type II DM.
Outcomes following Subchondroplasty in the First Metatarsal Head
Authors: Sharma Akhil , Akoh Craig C. , Parekh Selene G. 
Published: November 2020

Category: Midfoot/Forefoot; Other Introduction/Purpose: Patients with subchondral bone marrow lesions often present with arthritic symptoms causing severe discomfort. Recently, subchondroplasty has been offered to treat such patients who suffer from symptoms of bone marrow edema. Calcium phosphate is percutaneously injected into these edematous regions to stabilize damaged bone and aid in healing. Subchondroplasty has been used successfully in the knee for femoral and tibial plateau injuries. However, its use in foot and ankle orthopaedics is relatively limited. This procedure has shown short-term success in patients with painful edema of the talus, as well as patients with early stage avascular necrosis (AVN) in the second MTP joint and the cuboid. Here, we report outcomes of two patients who developed AVN as a result of subchondroplasty in foot and ankle surgery. Methods: A retrospective review of patients was performed in those patients who underwent subchondroplasty in their first metatarsal heads between January 2017 and April 2017. Exclusion criteria included patients lost to follow up. Following implementation of inclusion and exclusion criteria, two patient charts were reviewed. Patients were treated by a single surgeon at the same institution. Data collected included patient demographics (age, laterality, BMI, ASA class, comorbidities), preoperative and postoperative VAS scores, FAOS scores, and imaging. Patients were followed up in clinic for two years following the procedure. Data was then analyzed via mean, standard deviation, median, and range for continuous variables and counts with percentages for categorical data. Results: In both patients, VAS scores increased, and physical exam showed greater tenderness over the affected region. The corresponding MRIs showed development of avascular necrosis in the region of the first metatarsal joint where the subchondroplasty had occurred. Both patients consequently had to undergo revascularization procedures and required further operations to correct the condition. Conclusion: Ultimately, subchondroplasty over the first metatarsal head failed in our patients. Exposure to calcium phosphate exacerbated their condition, resulting in symptomatic AVN. Although literature for subchondroplasty in foot and ankle orthopaedics is limited, preliminary results are unfavorable for use in the first metatarsal joint. Therefore, more long term data needs to be gathered this area before implementing the procedure more widely in foot and ankle surgeries.
Three-Spike Insole Can Substitute the Total Contact Insole (TCI) in Refractory Plantar Fasciitis: Randomized Control Trial
Authors: Shim Dong Woo 
Published: November 2020

Category: Hindfoot Introduction/Purpose: Plantar fasciitis is one of the common foot complaints that is chronic and can induce dysfunction. Approximately 80% of patients improve with conservative management such as stretching exercise, ice bag massage, and splint. Refractory plantar fasciitis, unresponsive to conservative care for more than 6months, can be treated with insole, extracorporeal shockwave therapy, injection, and surgery etc. Total contact insole (TCI) is effective in reducing pain with just putting it in the shoes but quite expensive and time consuming for the custom production. Therefore, we produced alternative three-spike insole that can press about half of patient’s plantar fascia using 3-dimensional (D) printing and compared the clinical outcomes with it and TCI. Methods: A pragmatic, participant-blinded randomized trial was carried out from February 2019 to January 2020. Inclusion criteria was refractory plantar fasciitis and the duration of follow-up for each patient was 6 months. Three-dimensional printing used thermoplastic polyurethane (TPU) for the material of insole and the hardness was 58 +- 5 Shore-A. Twenty-eight patients were randomly allocated to use a three-spike insole or a TCI (Figure 1). The following assessment tools were used; visual analog scale for pain, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson- Peterson (KP) score, Medical Outcomes Study Short Form-36 (SF-36) for quality of life, and Foot Function Index (FFI). The groups were evaluated by a blinded assessor at baseline and after 6, 12, and 24 weeks. Results: The groups were homogenous for the majority of variables at baseline. Overall patient reported satisfaction showed improvement from mean 5.2 (range, 1 - 12) weeks of wearing and patient’s wearing time in a day was mean 2.4 (range, 0.5 - 3.0) hours. All the subscales except for sports in FAOS and mental component summary in SF-36 showed significant improvement from 6 weeks in both groups. There was no significant difference in all parameters between both groups at 6 weeks but AOFAS score, some of FAOS subscales, KP score, SF-36, and FFI showed significantly better outcome in three-spike insole group at 12 weeks. Those significant differences in outcome parameters tended to diminish at 24 weeks. Conclusion: We reaffirmed that insole is effective in plantar fasciitis and showed the three-spike insole restores function rapidly comparing to TCI. Three-spike design that supports not the whole longitudinal arch but about half of it was efficient enough. We can manufacture the three-spike insole for the popularization that can lower the price and producing time.
Calcaneal Stress Reaction with Distal Anchor Fixation for Mid-Substance Achilles Ruptures
Authors: Shoap Seth C. , Freibott Christina , Polzer Hans , Vosseller J. Turner 
Published: November 2020

Category: Sports; Other Introduction/Purpose: Minimally invasive Achilles rupture treatment has been purported to lead to superior outcomes relative to open treatment. Various forms of minimally invasive treatment exist. One newer technique involves the use of suture proximally that anchors into interference screws distally in the calcaneus. This treatment paradigm potentially addresses some deficiencies of other techniques. However, the authors have noted calcaneal stress reactions in some patients with this technique and here we report our experience. Methods: We conducted a retrospective chart review of patients that had minimally invasive Achilles tendon repair performed by the senior author. Patient demographics, medical history, social history, surgical details, and additional surgeries were recorded. The presence of a calcaneal stress reaction, as evidenced by pain near the calcaneal anchor insertion and confirmed via MRI was reviewed. A comparison was made between those patients that did and did not have a stress reaction. Results: Of the 30 included patients, the average age was 36.93 (+-13.17) and 63.3% were male. The mean BMI in this cohort was 28.76 (+-7.62). 66.7% injured themselves while played a sport. 4 patients (13.3%) had a stress reaction from suture anchors. When comparing those who had a stress reaction to those who did not, independent samples t-test revealed that age (p=0.168) and BMI (p=0.568) were not significantly different between the groups. Chi square noted that gender (p=0.87), ASA score (p=0.449), and mechanism of injury (p=0.486) were not significantly associated. All of the patients that sustained a stress reaction were very fit and active. Conclusion: This case series notes the presence of calcaneal stress reaction in 4/30 patients treated for an Achilles tendon rupture with distal anchor fixation. This stress reaction has not been previously reported. It should be noted that the stress reaction was self-limited in all patients. It typically became symptomatic around the 3-4 month after surgery mark and resolved by 5-6 months.