bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Zone II and III Fifth Metatarsal Fractures Using a Novel Fixation Technique
Authors: Eble Stephanie K. , Hansen Oliver B. , O’Malley Martin J. , Drakos Mark C. 
Published: November 2020

Category: Sports; Lesser Toes Introduction/Purpose: Zone II and III 5th metatarsal fractures are common injuries which can be addressed surgically with percutaneous fixation following anatomic reduction. Limited vascular supply and the specific anatomy of the 5th metatarsal causes concern for non-union of these fractures. This study evaluated a novel screw designed to optimize 5th metatarsal fixation. The titanium alloy headless screw (Jones Union System, Extremity Medical, Parsippany, NJ) provides compression across the fracture site using variable angle pitch and is designed to minimize the occurrence of painful hardware. In addition, we use an intramedullary reamer to create local autologous bone grafting in conjunction with an osteoplasty of the cuboid to obtain ideal positioning. This study represents the first to evaluate clinical outcomes following fixation with this system. Methods: Patients treated for a 5th metatarsal fracture between 2018 and 2019 by two surgeons fellowship-trained in foot and ankle orthopedics were identified. Operative notes were reviewed to ensure that patients were treated with the headless compression screw. 21 patients (22 fractures) were identified. Postoperative x-rays were reviewed to evaluate osseous bridging and time to union was determined. Retrospective chart review was performed to determine time to return to sport. Postoperative complications, including non-unions, need for revision, and need for hardware removal, were also evaluated. Results: Of the 22 total fractures, 16 were Zone II fractures and 6 were Zone III fractures. Average time to clinical follow-up was 13.60 months (range, 3.91-25.07). Average age at time of surgery was 28.82 years (range, 16 to 66). 16 males and 5 females were represented with average BMI of 27.41 kg/m2. Average time to union was 6.78 weeks (range, 5.13-12.12), and average time to return to sport was 11.38 weeks (range, 5.87-15.12). No patients experienced a non-union or painful hardware, and no other postoperative complications were observed. Conclusion: Fixation of Jones fractures using the Jones Union System produced excellent postoperative outcomes. This system, designed to address the challenges of 5th metatarsal anatomy, demonstrated effectiveness with expeditious times to union and return to sport. Union rates were high, and our cohort did not experience any postoperative complications. Although follow-up in some cases is short, no patient has experienced painful hardware. Our results suggest that this system is an effective approach for fixation of Zone II and III 5th metatarsal fractures.
The Percutaneous Technique for the Treatment of Metatarsalgia with Metatarsophalangeal Dislocation of the Lesser Toes: Preliminary Results
Authors: Ferraz Gabriel F. , Santos Tatiana F. , Oksman Daniel , Filho Miguel V. Pereira 
Published: November 2020

Category: Lesser Toes Introduction/Purpose: Minimally invasive surgery through percutaneous technique has developed significantly in recent years, increasing its indication for correction of foot deformities, especially in the forefoot region. The treatment of severe metatarsalgia remains a challenge for surgeons, especially in techniques requiring larger incisions. Methods: We prospectively evaluated 16 patients diagnosed with metatarsalgia with plantar keratosis associated with metatarsophalangeal dislocation of the lesser toes submitted to surgical correction by the distal metatarsal metaphyseal osteotomy (DMMO) technique. Clinical (AOFAS, FFI and VAS) and radiographic scores were used, as well as personal satisfaction criteria. Statistical analysis was performed using the Mann-Whitney U test and Fisher’s Exact Test with the R software ‘Stats’ package. Results: One participant was lost to follow-up, totaling a sample of 15 patients and 16 feet (a bilateral case). The mean follow-up was 14 months (6 - 23) and the mean age of the sample was 73.53 (62 - 85). There was a significant reduction in postoperative status with a reduction in VAS of 5.47 (p <0.001) and a difference in metatarsalgia after the procedure, ranging from 100% of cases to 13% (p <0.001). All patients stated that they would do the procedure again if necessary and most (73%) defined it as satisfied with the procedure (Coughlin Score). Conclusion: The DMMO technique for the treatment of metatarsalgia in patients with metatarsophalangeal dislocation of the lesser toes has shown good results, reducing pain and high satisfaction index, demonstrated by preliminary results.
A Comparison of First Ray Length and Dorsiflexion after Arthrodesis, Osteotomy and Suture Button Procedures for Hallux Valgus Deformity
Authors: Foran Ian , Mehraban Nasima , Jacobsen Stephen K. , Bohl Daniel D. , Lin Johnny L. , Lee Simon , Holmes George B. , Hamid Kamran S. 
Published: November 2020

Category: Bunion; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Shortening and dorsiflexion of the first metatarsal are a known side effect of metatarsal osteotomies for hallux valgus (HV) deformity with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 123 feet in 115 patients. The average age was 54. There were 106 females. Eighty-four feet had a Lapidus procedure, 14 had a PLCWO, and 24 had intermetatarsal suture button fixation. Digital radiographic measurements were made for pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups (p>0.05 for each). Similar corrections of HVA (30.1 to 12.3 degrees) and IMA (14.7 to 7.0 degrees) were achieved in all three groups (p>0.05). There were significant differences in absolute first-cuneiform-metatarsal length (FCML) between Lapidus (-1.5mm), PLCWO (-2.5mm), and intermetatarsal suture button fixation (+1.1mm) (p<0.05). There were also significant differences in relative 1st metatarsal shortening between Lapidus (0.32mm relative lengthening), PLCWO (1.05mm relative shortening), and intermetatarsal suture button fixation (1.24mm lengthening) (p<0.05). Average dorsiflexion differed between the Lapidus (1.95 degrees) and PLCWO groups (0.49 degrees) (p<0.05). Conclusion: The use of the intermetatarsal suture button fixation relatively lengthens the first ray, whereas the Lapidus and PLCWO shorten it. Dorsiflexion may be higher with Lapidus and osteotomy procedures. These findings may be helpful to explain postoperative symptoms of metatarsalgia and for the surgeon’s selection of the appropriate surgical technique for preoperative planning. [Table: see text]
A Retrospective Analysis of Results and Outcomes after Cadence Total Ankle Arthroplasty Implanted through the End of 2017
Authors: Fram Brianna R. , Rogero Ryan G. , Corr Daniel , Pedowitz David I. , Tsai Justin 
Published: November 2020

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is an increasingly popular operative treatment of ankle arthritis, due to its ability to decrease adjacent joint degeneration and preserve gait mechanics compared to ankle arthrodesis. However, ankle arthroplasty components have a shorter mean longevity then their hip, knee, or shoulder counterparts. The Cadence TAA entered clinical use in 2016 and was designed to address common failure modes of prior systems. We report here on radiographic and clinical outcomes and early complications of the Cadence TAA system at a minimum of 2 years follow-up. Methods: Patients who underwent primary Cadence TAA from 2016 through 2017 by one fellowship-trained foot and ankle surgeon were eligible. Exclusion criteria included prior ipsilateral ankle arthrodesis or arthroplasty and lack of followup. Chart review was performed for eligible patients to identify complications and reoperations. Patients were contacted to obtain Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sport subscores, SF-12 Mental (MCS) and Physical Health (PCS) subscores, and Visual Analog Scale (VAS) pain levels (rated 0-100). Scores were analyzed with 2-sided repeated measures T- tests, with P<0.05 as significant. A second, blinded, fellowship-trained foot and ankle surgeon evaluated followup 5-view radiographs of each ankle to measure range of motion (ROM), alignment, peri-implant osteolysis, and component loosening or subsidence. Subsidence or loosening were defined, respectively, as >2mm or >2⁰ change in position for the tibial component and >5mm or >5⁰ change for the talar component. Results: Sixty patients were included with mean age 64 and mean BMI 32.0. Thirty patients (50%) had concurrent other procedure(s). FAAM-ADL, FAAM-Sports, SF-12 PCS, and VAS pain scores all improved significantly at mean 2.24 years post-op (Table 1). Ten patients (6.7%) had operative complications requiring 15 surgeries (mean 265 days to first reoperation). Three patients (5%) required removal of one or both components, for 2-year implant survival of 95.0%. Two revisions were for infection and one for osteolysis. This produced a mechanical failure rate of 1/60 (1.7%). Radiographic analysis revealed average coronal alignment improved from 7.4⁰ from neutral preoperatively to 2.2⁰ postoperatively. Average ROM was 36.5⁰ total arc of motion. One of 38 (2.6%) had signs of peri-implant osteolysis, with no cases demonstrating loosening or subsidence. Conclusion: Two-year follow-up of the Cadence TAA system demonstrates mechanically stable implants resulting in improved patient function and preserved ankle range of motion. Outcomes compare favorably to those of other TAA systems at 2-year follow-up. Further radiographic and clinical follow-up are needed to evaluate implant longevity and long-term patient functional outcomes. [Table: see text]
Readability and Suitability of Patient-Reported Outcome Measures in Foot and Ankle Surgery: A Health Literacy Assessment
Authors: Freibott Christina , Shoap Seth C. , Vosseller J. Turner 
Published: November 2020

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot; Trauma Introduction/Purpose: Health literacy is consistently reported as one of the best predictors of health status. This becomes even more important considering the complex medical information that is communicated to a patient during a clinical visit. Patient reported outcome measures (PROMs) are used on a standard of care basis in orthopedic surgery, and consistently included in research projects to elucidate meaningful clinical information. While there have been published assessments on the reading grade level of orthopedic PROMs in general, few address foot and ankle specific outcome measures. There have been no reports on aesthetic component of these PROMs, which have a major impact on readability. The purpose of this study is to report on the literacy, readability, and suitability of PROMs in foot and ankle surgery. Methods: A PubMed search was conducted to identify the most frequently utilized foot and ankle PROMs. Two recent systematic reviews identified 86 total PROMs in orthopedic surgery, 8 of which were foot and ankle specific. For the readability component, the Flesh-Kincaid reading grade level was assessed for each PROM. For the aesthetic component, the Suitability Assessment of Materials (SAM) was utilized to assess for content, literacy demand, graphics, layout, typography, learning stimulation, motivation and cultural appropriateness. SAM is a validated measure for analyzing print materials, and designate rankings of not suitable, adequate, or superior, based on results of the analysis. SAM scores were evaluated for all included PROMs by two investigators and averaged together for increased validity. Descriptive statistics were performed on all results. Statistical analysis was performed with SPSS Version 24.0. Results: The average Flesh-Kincaid grade for all PROMs was 6.12 (+-2.2, range 3.9-8.5). 5 of the 8 (62.5%) PROMs were at or below the AMA-recommended 6th grade reading level, with 6 of 8 (75.0%) below the NIH-recommended 8th grade reading level. The average SAM score for all included foot and ankle PROMs was ‘adequate,’ receiving a score of 1. 1 PROM was designated ‘not suitable,’ with the remaining 7 deemed ‘adequate.’ The area that scored the lowest on the SAM assessment was the ‘graphics’ section. Conclusion: The PROMs used in foot and ankle surgery perform well on the Flesh-Kincaid score in comparison to both the AMA and NIH reading grade level standards. The highest rating for the SAM score was average, indicating room for improvement in suitability. The inclusion of graphics and illustrations would make these scores more easily understood by patients, which can improve their healthcare experience and improve patient satisfaction and health outcomes.
Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?
Authors: Gianakos Arianna L. , Okedele Olasunmbo , Flynn Sean , Kennedy John G. , DiGiovanni Christopher W. 
Published: November 2020

Category: Ankle; Arthroscopy Introduction/Purpose: Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence, presentation, and outcomes following AOT. The purpose of this study is to compare these differences between male and female patients. Methods: Eighty-five consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. The mean clinical follow-up was 47.2 months, with mean MRI follow-up of 24.8 months. Results: Fifty-five (65%) males and 30 (35%) females were included. OCL defect size was significantly larger in men (112.8mm2) when compared with women (88.7mm2) (p<0.0001). Male patients had a significantly longer duration of symptoms (p<0.001) and OCLs were more likely traumatic in nature (p=0.0006) when compared with female patients. Mean FAOS improved pre- to postoperatively from 50 to 81(P < .001) with a statistically significant increase in men (p<0.0001). The mean MOCART score was 82.1 and 86.7 in male and female patients, respectively (p<0.0001). Lesion size was negatively correlated with MOCART score (r = -0.36,P = .004). No differences were found in knee donor site morbidity, complication rate, or revision surgery. Conclusion: Our study demonstrates that male patients typically present with talar OCLs that are larger in size, traumatic in nature, and with longer symptom duration when compared with female patients. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.
Outcomes Following Arthroscopy for Anterior Impingement in the Ankle Joint: Need for Gender as a Variable in Analysis
Authors: Gianakos Arianna L. , Ivander Axel , DiGiovanni Christopher W. , Kennedy John G. 
Published: November 2020

Category: Ankle; Arthroscopy Introduction/Purpose: To provide an overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement and to determine if gender affects outcome. Methods: A systematic literature search of the Medline, Embase, and Cochrane databases was performed during June of 2019. The combination of search terms utilized included the following: ankle, impingement, syndrome, talus, compression, osteophyte, arthroscopy, surgery, procedures, and treatment. Two reviewers independently performed data extraction consisting of demographic data, intraoperative arthroscopic data, functional outcome scores, patient satisfaction, complications, return to play, and gender differences. Results: Twenty-eight articles evaluating 1,506 patients were included in this systematic review [Table 1]. Sixty percent and 14% of studies assessed anterolateral and anteromedial impingement, respectively. All studies (16/16, 100%) that evaluated functional outcome reported improvements in AOFAS, VAS, and FFI Scores [Table 2]. The average complication rate was 3.89% [Table 3]. Average return to sport was 8 months. The most common associated pathologies found during arthroscopic evaluation were synovitis, osteophytes, and meniscoid lesions. Four studies (15%) failed to report gender as a demographic variable. Only 5 (17%) studies reported gender analysis, with one demonstrating that male patients had worse outcomes at 6-year follow-up. Conclusion: Our systematic review suggests that arthroscopic treatment for anterior ankle impingement provides good to excellent functional outcomes and low complication rates in the majority of patients. However, current analyses lack outcome evaluations that compare male and female populations. Future studies should perform such assessments to determine whether gender differences play a role in outcomes following arthroscopic intervention. [Table: see text][Table: see text][Table: see text]
The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya
Authors: Gokcen Eric C. , Luginbuhl Joshua C. , Luginbuhl Joshua C. 
Published: November 2020

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.
How Obesity Affects Need for Syndesmotic Fixation in Malleolar Ankle Fractures and Ankle Fracture Severity
Authors: Goodloe Jonathan B. , Caughman Alexander , Traven Sophia A. , Slone Harris , Gross Christopher E. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Obesity affects lower extremity fracture care through increased mechanical loading and has subsequently been associated with higher complication rates following surgical management. However, the association between BMI and need for syndesmotic fixation in the setting of malleolar ankle fractures remains to be elucidated. Therefore, the primary objective of this study was to determine the risk of increased fracture severity and need for syndesmotic fixation as related to BMI. Methods: A retrospective analysis of the NSQIP database was performed for patients undergoing surgical fixation of isolated, closed ankle fractures. Patients were grouped by fracture pattern (uni-, bi- and trimalleolar ankle fractures with or without syndesmotic injury). Demographic data was collected and compared between groups and logistic regression analyses were used to assess the relationship between BMI and ankle fracture pattern. Risk factors for postoperative complications and prolonged operative time were also compared between groups. Results: A total of 15,841 patients (mean age 48.9 years) were identified for inclusion. Analyses revealed that BMI had a positive association with the incidence of open reduction and internal fixation of the ankle syndesmosis, but there was no association between BMI and malleolar fracture pattern. Conclusion: This study demonstrates that elevated BMI is associated with an increased need for syndesmotic reduction and fixation in malleolar ankle fractures. However, the data did not find conclusive evidence to suggest that obesity was associated with ankle severity when evaluating malleolar involvement. Further literature is needed to further delineate the relationship between obesity and ankle fracture pattern.
Radiographic Correction after Hallux Valgus Surgery: A Meta-analysis
Authors: Gross Christopher E. , Barg Alexej 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: There are over 100 different means by which to surgically correct hallux valgus. None have been proven to be more effective in radiographic correction over another. Frequently, recurrence is noted. There has been no large-scale meta-analysis of studies reporting radiographic outcomes of surgical treatment for hallux valgus deformity. The purpose of the meta-analysis was to pool data to see if certain osteotomies have higher complication or recurrence rates. Methods: We performed a meta-analysis of studies reporting the radiographic outcomes of surgical correction for hallux valgus deformity. We pooled the data of 287 studies since 1980 that met our inclusion criteria. We divided the surgical procedures into proximal-based osteotomies (PB, n=2047), shaft-based (SB, n=1569), and distal-based (DB, n=7835). We calculated the hallux valgus angle (HVA) and intermetatarsal angle (IMA) correction as well as metatarsal shortening, recurrence, and hallux varus after surgery. ANOVA analysis was used to compare the means among the groups. Results: A total of 287 treatment studies met the inclusion criteria. The pooled rates of HVA correction between the PB, SB, and DB were: 20.7, 20, and 16.8 degrees respectively (p=.0004). The pooled rates of IMA correction between the PB, SB, and DB were: 8.5, 7.3, and 6.0 degrees respectively (p<.0001).There was a significant difference among the groups with the development of hallux varus (p=.003) and with metatarsal shortening (p=.025). There was no difference in the rate of recurrence. Conclusion: Despite the large pooling of data, no consistent superiority of any corrective osteotomy stood out. Fortunately, there is no difference in the recurrence rate among the osteotomies. Further randomized studies could help elucidate the best surgery for each patient.