bluuebunny/crossref_metadata_2025_split huggingface dataset:
Union of Foot/Ankle Arthrodesis: A Registry Study of Low-Intensity Pulsed Ultrasound (LIPUS)
Authors: White Neil J. , Lau Johnny T. , Ong Kevin , Kurtz Steven M. , Lin Sheldon S. 
Published: November 2020

Category: Ankle; Hindfoot; Midfoot/Forefoot; Trauma. Introduction/Purpose: To aid in healing and avoid costly revision surgery, bone grafts, growth factors, and bone stimulation devices are used as adjuncts to foot/ankle arthrodesis. This study evaluated the union rates of LIPUS as an adjunct to foot/ankle arthrodesis and the corresponding factors associated with improved healing. Methods: Foot/ankle arthrodesis patients were identified retrospectively from a prospective post-market arthrodesis/fracture registry for EXOGEN (Bioventus LLC, Durham, NC). Inclusion criteria were males or non-pregnant females 18 years of age or older at time of enrollment, known date of fracture, known start and end dates of LIPUS treatment, and known treatment success outcome. Treatment success was defined by both clinical (solid and pain-free on manual stress) and radiological (at least 3 of 4 cortices bridged on x-rays) criteria. Association between union rates and surgical treatments, comorbidities, and medications was tested with Chi-square tests. Results: A total of 235 primary and 16 revision foot/ankle arthrodesis patients used EXOGEN. 41.4% used EXOGEN within 90 days of the fracture/arthrodesis. Overall union rate was 86.9% (primary: 86.4%; revision: 93.8%). Having the comorbidity of diabetes, obesity, or current smoker was not associated with a higher non-union rate (p=0.779). Other comorbidities were also not associated with increased non-union rates (e.g., Charcot disease p=0.614, NSAID p=0.862, steroids p=0.647). EXOGEN use within 90 days of the fracture/procedure date was associated with improved union rates for the overall (p=0.004, odds ratio (OR) 3.7 (95% CI: 1.5-9.3)) and primary (p=0.007, OR 3.4 (95% CI: 1.3-8.6)) groups. For the overall group, union rates were 94.2% (EXOGEN use <=90 days post-fracture/procedure), 80.6% (91 to 365 days), and 84.6% (>365 days). Conclusion: Union rates for foot/ankle arthrodesis with adjunctive LIPUS were comparable to other therapies with and without other adjuncts (Table 1). Known risk factors for non-union, such as smoking and Charcot disease, were not found to be associated with healing for the LIPUS patients. This suggests the possibility that LIPUS was able to mitigate potential patient risk factors and may offer a low risk post-operative adjunct in difficult healing scenarios. [Table: see text]
Quality and Readability of Online Information on Ankle Instability
Authors: Willegger Madeleine , Schwarz Gilbert M. , Lisy Marcus 
Published: November 2020

Category: Ankle; Sports; Trauma Introduction/Purpose: Ankle sprains are among the most common sports injuries and up to 60% of patients experience long- term ankle disability or develop chronic ankle instability. Proper patient information is essential in both conservative and surgical treatment. The rising role of the internet has revolutionized the way patients acquire health-related information. Nevertheless, inaccurate or outdated online resources could lead to misinformation about the nature of ankle instability and the treatment options. Aim of this study was to evaluate the quality, accuracy and readability of free available online resources regarding ankle instability. Methods: Three search terms (‘ankle instability’, ‘ankle instability treatment’, ‘ankle laxity’) were searched using the three biggest search engines (Google, Bing, Yahoo). Quality and accuracy of online patient information was evaluated by using the EQIP36 and a custom 25-item list based on recommendations of the AOFAS. Readability was assessed by evaluating the Flesch-Kincaid score. Results: A total of 102 online resources were included in this study. The mean 25-item-score was 9.45 (range 1-22) and the mean EQIP 36-score was 40.72 (range 17.65-65.71). The average Flesch-Kincaid score reached 110.60 (range 10-176) and 97% of evaluated websites exceeded the recommended 8th grade reading level for patient information. Quality was significantly higher with reading levels of college graduates (p<0.001). There was no difference regarding search terms or search engines. Conclusion: Available online information on ankle instability showed huge differences regarding the quality, readability and accuracy. Inappropriate advanced reading levels of high-quality websites could be incomprehensible to patients. Foot and ankle specialists should be aware of the low quality and readability of the majority of online resources and provide patients with adequate website-links.
Incidence of Chondral and Osteochondral Lesions in Ankle Fracture Patients Identified with Ankle Arthroscopy Following Rotational Ankle Fracture
Authors: Williamson Emilie , Rosas Kevin , Dankert John , Toale James P. , Hurley Eoghan T. , Egol Kenneth , Kennedy John G. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: It is controversial whether routine arthroscopy is beneficial at the time of ankle fracture fixation. This may be, in part, due to sparse information regarding the incidence of chondral injury in the setting of ankle fractures.The purpose of this study is to systematically review the incidence of chondral injures in patients with ankle fractures and to further characterize intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following an ankle fracture. Methods: The literature search was performed based on the PRISMA guidelines. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures were included. The incidence of intraarticular chondral lesions was recorded, as well as location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. All statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL, USA). Multiple comparisons were used to compare incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < 0.05 was considered statistically significant. Results: Fifteen studies with 1,355 ankle fractures were included. Of those ankles, 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Overall, 648 ankles had chondral lesions on the talus (47.8%), 207 ankles had lesions on the tibial plafond (15.3%), 165 has lesions of the lateral malleolus (12.2%), and 133 had lesions of the medial malleolus (9.8%). Weber C group had significantly higher incidence than Weber A group (p=0.015). Trimalleolar and isolated lateral malleolar fracture groups had significantly higher incidence of chondral injury than bimalleolar and isolated medial malleolar fracture groups (p<0.001). A significant difference was found in occurrence rate of chondral injury among Lauge-Hansen classification, with supination-adduction having the lowest incidence (p=0.001). Conclusion: Our study found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy, with more than half of all patients having a chondral lesion. Talar lesions were most common. This study may help direct greater attention to the Talus as a source of chondral injury particularly in higher grade fracture patterns.
Outcomes Following Microfracture for Osteochondral Lesions of the Talus in Female Patients
Authors: Williamson Emilie , Gianakos Arianna L. , Hurley Eoghan T. , Kennedy John G. 
Published: November 2020

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: Microfracture (Mfx) is typically indicated for patients who have symptomatic osteochondral lesions of the talus (OLT) which are smaller in size. However, there is scant literature focusing exclusively on female patients, who may require specific consideration as compared to male counterparts. The purpose of this study was to evaluate the outcomes of Mfx in the treatment of OLT in the females population. Methods: A retrospective analysis comparing patients treated with Mfx for OLT was performed, to include all patients treated between 2007 and 2015. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Results: Thirty-one females were included. The mean patient age was 39.6 +- 17.2 years with mean follow-up of 48.4 +- 24.8 months. The mean preoperative and postoperative FAOS score was 53.3 +- 22.9 and 73.2 +- 18.2 (p < 0.001), and the mean preoperative and postoperative SF-12 score was 40.6 +- 11.1 and 56 +- 15.1 (p < 0.001). The final MOCART score was 59.3 +-24.5. Overall, 6 (19.4%) patients required a further surgery, 4 patients (12.9%) were considered failures, 2 (6.5%) patients required a distraction arthroplasty and 2 patients (6.5%) required a repeat bone marrow stimulation. Conclusion: The outcomes following Mfx for OLT in females were good at mid term follow up. However, the final MOCART scores were poor, indicating poor cartilage repair tissue and a poor harbinger for long term outcomes.
Preoperative Depression Influences Outcomes Following Total Ankle Arthroplasty
Authors: Wilson Jacob M. , Schwartz Andrew M. , Farley Kevin X. , Bariteau Jason T. 
Published: November 2020

Category: Ankle; Ankle Arthritis; Other Introduction/Purpose: Total ankle arthroplasty (TAA) is a successful procedure and its incidence is increasing. While a diagnosis of depression is known to effect outcomes following other procedures, its effect on outcomes following TAA are unknown. Therefore, the purpose of this study was to assess the contribution of depression to outcomes following TAA. We hypothesized depression would lead to increased rates of 90-day complications. Methods: This is a retrospective cohort study. Data was collected from the Nationwide Readmission Database (NRD) for all patients undergoing TAA. Patients were screened for a documented preoperative diagnosis of depression. Two cohorts (those with and without depression) were created. Logistic regression was then performed to assess the contribution of a pre-operative diagnosis of depression on rates of 90-day complications, while controlling for patient demographic and comorbid data. Results: Overall 8,047 patients underwent TAA during the study period. Of these, 11.4% (918) had a pre-operative diagnosis of depression. Compared to patients without depression, patients with depression had a 1.61 (95% Confidence Interval [CI]: 1.31- 1.98) times increased odds of non-home discharge and a 34% increased odds (Odds ratio [OR] 1.34, 95%CI 1.15-1.57) of extended LOS (>2 days). In addition, patients were at increased risk of prosthetic complication (OR 1.39, 95%CI 1.10-1.74), wound complication (OR 1.59, 95%CI 1.11-2.29), prosthetic joint infection (OR 1.82, 95%CI 1.06-3.15), superficial surgical site infection (OR 1.62, 95%CI 1.02-2.58), and occurrence of at least one medical complication (OR 1.32, 95%CI 1.03-1.68). Conclusion: Depression in patients undergoing TAA is common and should be recognized by providers. Furthermore, it is associated with increased healthcare utilization and complications following surgery. Further research should be performed to determine if depression is a modifiable risk factor.
Prevalence and Related Factors of Flexible Flatfoot in School-Aged Children: A Cross-Sectional Study
Authors: Xiaojun Liang , Hong-Mou Zhao 
Published: November 2020

Category: Other; Midfoot/Forefoot Introduction/Purpose: There is a greater prevalence of flexible flatfoot (FFF) among children; however, most of them are physiological, and the associated factors are still in debate. The purpose of current cross-sectional study was to investigate the FFF prevalence of 6 to 13 years Han nationality children in Northwest China; and to investigate the potential relative factors correlated with FFF. Methods: A total of 1,059 children aged from 6 to 13 years were included. Dynamic footprints according to FootScan system were collected from both feet. The relationship of FFF with age, gender, side, body mass index (BMI), foot length-width ratio (LWR), and contact area were investigated. Results: The percentage of FFF decreased from 39.5% at 6 years to 11.8% at 12 years, and reached a platform at 12 to 13 years. Overweight (OR 1.35, 95%CI 1.03-1.77) and obese (OR 2.43, 95%CI 1.81-3.26) showed positive correlation with percentage of FFF children; but only obese (OR 3.25, 95%CI 2.19-4.82) showed positive correlation in small age group (6 to 9 years). The mean LWR was larger in healthy children, and still larger in small and large age groups (P < 0.01). The mean midfoot contact area percentage was larger in FFF than healthy foot (P < 0.01). No correlation was found between FFF prevalence and gender or side. Conclusion: The prevalence of FFF decreases with age, and reached a platform at 12 to 13 years. The prevalence of FFF is positively correlated with increased BMI, especially in small aged children; and the prevalence of FFF is positively correlated with decreased LWR.
Clinical Analysis on the Treatment of Kaschin-Beck Disease of the End-Stage Ankle by Tibiotalocalcaneal Arthrodesis Using Lateral Approach With Platelet-Rich Plasma
Authors: Yi Li , Xiaojun Liang , Hong-Mou Zhao 
Published: November 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: Objective To study the effectiveness of treated Kaschin-Beck Disease of the ankle by tibiotalocalcaneal arthrodesis using lateral approach with autologous platelet-rich plasma. Methods: Retrospective analysis was conducted on the clinical effect of our department on the treatment of 23 patients (25 ankle joints) with severe Kaschin-Beck Disease from May 2014 to May 2016. All patients were treated with tibiotalocalcaneal arthrodesis by using lateral approach of fibula osteotomy with distal fibula cancellous bone combined with autologous platelet rich plasma for bone grafting and internal fixation with full thread cannulated screws or auxiliary lateral plate. Surgical time, blood loss, joint fusion time, delayed wound healing, infection, nonunion of osteotomy surface, chronic pain and other complications were recorded. VAS score and AOFAS ankle and hind foot score were compared before and at the last follow-up. Results: The mean healing time was 14.7 weeks. Postoperative wound healing was delayed in 3 patients. One patient developed superficial infection 1 week after surgery. Bone graft absorption, nonunion of osteotomy surface and loosening of internal fixation were observed in 2 patients. The bone healed at 13 weeks after surgery. 22patients were followed up for an average of 15.7 months. The postoperative AOFAS score was 76 points, and the postoperative VAS score was 2 points with statistically significant differences from the preoperative AOFAS (t=19.13, P<0.01) and VAS (t=17.27, P<0.01). In 21 cases, tibial calcaneal joint fusion was performed in the first stage, and the fusion rate was 87.5%.21 patients received the first stage of bone fusion after surgery, and the fusion rate was 87.5%. Conclusion: Ankle joint and subtalar joint can be well exposed through the lateral approach of fibular osteotomy. The distal fibula autograft with sufficient cancellous bone mass and the combination of autologous platelet rich plasma graft can promote bone healing, and the reliable internal fixation can help achieve satisfactory clinical effect of tibiotalocalcaneal arthrodesis.
Triple Osteotomy for Correction of Hallux Valgus with an Increased Distal Metatarsal Articular Angle
Authors: Yi Li , Xiaojun Liang , Hong-Mou Zhao 
Published: November 2020

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: At present, there is a wide range of surgical methods for the treatment of hallux valgus with an increased distal metatarsal articular angle, there are not many reports on the effectiveness of this method that triple osteotomy and lateral soft tissue release. To study the clinical effect of triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle. Methods: A retrospective analysis of the clinical data of 23 patients (35 feet) with an increased distal metatarsal articular angle and undergoing triple osteotomy and lateral soft tissue release between January 2010 and December 2014 in Xi’an Hong Hui Hospital was conducted including 7 male (12 feet) and 16 female (23 feet). Their average age was (45.7+-15.2) years (range: 21˜66 years). The hallux valgus angle (HVA), the intermetatarsal angle (1-2 IMA) and the distal metatarsal articular angle (DMAA) in weightbearing dorsoplantar radiographs of the foot before operation and at final follow-up visit were compared. The preoperative and the final follow-up clinical functional outcomes were evaluated by the American Orthopaedic Foot & Ankle Society Hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). Results: The average follow-up time was (19.1+-7.3) months (range: 10˜32 months). There are no such severe complications as nonunion, avascular necrosis. The pain of first metatarsophalangeal joint was apparent release after operation 6 months. The incomplete range of motion in the first metatarsophalangeal joint occured at three patient (4 feet), but the symptoms disappeared after functional exercise. The HVA, IMA and DMAA were significantly improved from preoperative (47.6+-6.4)°, (18.6+-2.1)° and (34.7+-7.2)° to the latest follow-up (16.7+-4.3)°, (8.2+-2.2)°and (9.0+-4.5)°(P<0.01). The preoperative AOFAS score was 56.6+-3.9 points, which was significantly different from 89.2+-2.1 points (P<0.01). The postoperative VAS score has declined from 6.0+-0.8 points to 0.8+-0.7 points with statistically significant differences (P<0.01). According AOFAS score, 22 feet got an excellent result, 6 good and 5 fair. The function was good and excellent in 84.8%. Conclusion: Triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle which can gain good result in respect of functional and radiological outcomes. It is important to correct the distal metatarsal articular angle and functional training of the first metatarsophalangeal joint after operation.
The Lateral Drawer Test: A Novel Clinical Test to Assess Mortise Instability in Weber B Fibula Fractures
Authors: Zhao John Z. , Williams Caroline , Broughton Kimberly K. , Miller Christopher P. , Kwon John Y. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. While instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the apparent isolated Weber B fibula fracture often requires further investigations such as stress radiography. While several authors have previously demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis and swelling with instability, no previous investigation has examined the ability of a translational test to determine deltoid ligament injury. The goal of this study is to test the validity of a novel clinical test, the lateral drawer test, in determining mortise instability in a cohort of patients with Weber B fibula fractures. Methods: Patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three views of the ankle as well as gravity stress views (GSV) were obtained. Prior to examining radiographs, two foot & ankle fellowship-trained orthopaedic surgeons (JYK, CPM) performed and graded the lateral drawer test. (Grade 0: no instability/symmetric to contralateral ankle, Grade I: translation < 5mm, Grade II: translation >= 5mm) While the surgeons were made aware of the presence of a Weber B fibula fracture, radiographs were not visualized prior to conducting the drawer test. Medial clear space (MCS) was measured. VAS pain scores were obtained before and after testing. The results of the lateral drawer test results were compared with radiographic measurements of MCS. Results: The study has thus far prospectively enrolled 14 consecutive patients with Weber B ankle fractures. Six (43%) patients demonstrated radiographic instability with widening of the medial clear space >= 5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 88.9% for determining instability. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (⍴=0.82, p=0.0003). Patients tolerated the lateral drawer test well with an average increase of 1.6 on the VAS pain scale after testing. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV and NPV for detecting instability in patients presenting with Weber B fibula fractures. While further validation is required in a larger cohort of patients, the lateral drawer test may offer an adjunct tool via physical examination to predict mortise stability.
Recurrent Spontaneous Macular Hole Formation and Resolution in a Patient With Previous Vitrectomy
Authors: Massamba Nathalie , Chin Eric K. , Almeida David R.P. 
Published: November 2020

Purpose: We report a case of recurrent macular hole (MH) formation and spontaneous closure in the absence of any vitreoretinal interface abnormality. Methods: A 49-year-old man presented for his annual ocular examination with no specific ocular complaints. He had a history of retinal detachment in the left eye, which was treated years prior with vitrectomy and scleral buckle. During a routine follow-up, the patient was discovered to have a full-thickness MH. Optical coherence tomography revealed the formation of an MH with spontaneous closure after 3 months without intervention. One month later, the MH recurred but once again closed spontaneously over 4 months. Results: The patient remained asymptomatic during the entire follow-up without any symptoms, vision changes, or therapeutic intervention. Conclusions: To our knowledge, this is the first known case report of recurrent spontaneous opening and closure of an MH in the absence of any vitreoretinal interface abnormality, as revealed by macular optical coherence tomography imaging.
An experimental study on change of gas permeability depending on pore structures in three species (hinoki, Douglas fir, and hemlock) of softwood
Authors: Jang Eun-Suk , Yuk Jee-Hoon , Kang Chun-Won 
Published: November 2020

AbstractThe purpose of this study is to analyze the pore structure for the heartwood, intermediate wood, and sapwood sections in three species of softwood (hinoki, Douglas fir, and hemlock) and to investigate the correlation of gas permeability depending on pore structure. For this study, gas permeability and pore size were measured by capillary flow porometry, and classification of a novel method was performed to determine the type of pores (through pores, blind pores, and closed pores) based on International Union of Pure and Applied Chemistry (IUPAC). Gas permeability, through pore porosity, and pore size increased from heartwood to sapwood. The results of multiple regression analysis showed that through pore porosity, mean pore size, and bulk density were significant factors affecting gas permeability.