bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous Chevron Akin (PECA) Correction of Hallux Valgus Deformity: Analysis of the Learning Curve
Authors: Robinson Peter W. , Ray Robbie , Dearden Paul M. , Goff Thomas A. , Whitehouse Michael R. , Lam Peter , Dracopoulos George 
Published: November 2020

Category: Bunion Introduction/Purpose: Percutaneous hallux valgus correction is increasing in popularity, with good correction of deformity and improvement in outcomes. The learning curve is reported as steep, based on arbitrary analysis. Methods: We performed a prospective study of a single surgeon series on the 1st 58 feet in 53 patients undergoing PECA hallux valgus correction, following cadaveric training and surgical observation. Pre- & post-operative (6 month) hallux valgus angles (HVA) & 1-2 intermetatarsal angles (IMA) were measured on weight bearing radiographs. Tourniquet time & number of fluoroscopy images were recorded. Complications were analysed. Parametric data was described with mean+-SD & non- parametric data with median+-interquartile range. Unpaired 2-tailed t tests were used to compare continuous data. The learning curve was calculated by plotting the tourniquet time against case number using a smoothed cubic spline with straight lines fitted to the slope. This was used to define a learning phase & a plateau phase. Results: Median age was 62 (IQR 56-66). The mean HVA improved from 32°+-4.7 to 9°--+-5.9 (p<0.0001). Mean IMA improved from 16°+-3.1 to 8°+-2.3 (p<0.0001). There were 6 re-operations (ostectomy & screw removal). The learning curve inflection point was between case 38 & 39. 38 were analysed in the learning phase & the remaining 20 in the plateau phase. No significant difference between the learning and plateau phases were seen for age, pre- & post-operative HMA or IMA, difference from normal angles or return to theatre. Pearson correlation revealed that only tourniquet time (p=0.001) & number of fluoroscopy shots (p=0.019) were significantly correlated with the learning or plateau phase. Conclusion: The learning curve for the PECA hallux valgus technique is around 40 cases, reflected by tourniquet time and number of fluoroscopy shots. It does not affect radiological correction or complications, showing that if taught properly this technique is reproducible and reliable.
Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons
Authors: Rogero Ryan G. , Illical Emmanuel M. , Corr Daniel , Raikin Steven M. , Krieg James , Tsai Justin 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management. Methods: An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management. Results: One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025). Conclusion: Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.
Early Outcomes with the CADENCE Total Ankle Prosthesis
Authors: Rushing Calvin J. , Berlet Gregory C. , Hyer Christopher F. 
Published: November 2020

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: A number of two-component, 4th generation total ankle arthroplasty (TAA) prostheses have been introduced to the market within the past few years. The purpose of the present study was to assess early outcomes for the CADENCE total ankle prosthesis. Methods: All patients who underwent primary TAA with CADENCE between August 2016 and June 2018 at a single institution and who were at least 1 year postoperative were included. A total of 32 ankles with a mean follow up of 19 (range, 12-33) months met the criteria. Weightbearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperative, and at the most recent follow-up. Medical records and charts were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook at el., respectively. Results: Survivorship for the CADENCE prosthesis was 93.7%. Coronal and sagittal tibiotalar alignment significantly improved after surgery (p< 0.001, p< 0.005), and was maintained at the latest follow-up (p=0.44, p=0.30). Overall, two ankles (6.3%) underwent early revision for aseptic loosening; while 6 (18.8%) underwent a non-revisional reoperation. Nine ankles (28.1%) presented a total of 13 complications (4 high grade, 2 intermediate, and 7 low) according to the Glazebrook classification system. The most common was intraoperative periprosthetic medial malleolar fracture (5 ankles, 15.6%), a low-grade complication. Conclusion: Satisfactory outcomes were observed at short-term follow-up for the CADENCE prosthesis. Additional studies with longer follow-up are warranted.
Risk Factors for Early Failure of 4th Generation Total Ankle Arthroplasty Prostheses
Authors: Rushing Calvin J. , Hyer Christopher F. , Berlet Gregory C. 
Published: November 2020

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: A number of two-component, 4th generation total ankle arthroplasty (TAA) prostheses have been introduced to the market in the past few years, as the popularity and indications for TAA have continued to expand. The purpose of the present study was to identify independent risk factors for the early failure of 4th generation TAA prostheses. Methods: A total of 97 ankles underwent TAA with a 4th generation prostheses (INFINITY, CADENCE) between August 2015 and June 2018 at a single institution and were at least 6 months postoperative (mean 18.3 months, range 6-43). The primary outcome assessed was the need for revision surgery, defined as removal of 1 or both metal components for any reason, excluding infection. Baseline patient demographics, characteristics, radiographic alignment parameters, and distal tibia cortical bone thickness (CBT) were assessed. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook et el., respectively. Univariate and multivariate analyses were performed. Results: Three ankles (3.1%) underwent revision surgery for aseptic loosening at a mean of 24.3 (range, 16-31) months; all had a CBT <4mm. Independent predictors for reoperation were a CBT < 4mm, the presence of diabetes, and ipsilateral hindfoot fusion (p=0.04). No associations were identified for purported risk factors (age, BMI, and coronal deformity). Conclusion: The present study is the first to suggest a potential relationship between CBT of the distal tibia and TAA failure. Additional studies are warranted to better understand the role of bone density in TAA survivorship.
Shortening of the First Ray After First Tarsometatarsal Joint Fusion: A Cadaveric Comparison Between Curettage Versus Planal Resection
Authors: Rushing Calvin J. , McKenna Bryon J. , Langan Travis M. , Bull Patrick E. , Hyer Christopher F. , Berlet Gregory C. 
Published: November 2020

Category: Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Potential shortening of the first ray is an important consideration when performing a first tarsometatarsal (TMTJ) fusion. However, no previous study has sought to directly quantify the resultant shortening after TMTJ fusion. The purpose of the present anatomic study was to directly assess and compare shortening of the first ray using two joint preparation techniques (curettage, planal resection) for first TMTJ fusion. Methods: Ten pairs of matched lower extremity cadaver specimens were divided into two groups. Preoperative length assessments were performed at the first TMTJ dorsally and plantarly using a digital caliper. In Group 1, joint preparation for first TMTJ fusion was performed with curettage, whereas specimens in Group 2 underwent planal resection. Post-operative length assessments were repeated. All data was analyzed using two-tailed Students t-tests. Results: Mean shortening of the first ray following curettage was 1.1 (range, 0.3 to 2.0) mm dorsally and 1.6 (range, 0.6 to 3.7) mm plantarly; while mean shortening following planal resection was 4.5 (range, 2.7 to 7.9) mm dorsally and 4.6 (range, 2.4 to 8.9) mm plantarly. The measured differences were statistically significant (p <0.001, p=0.001). Conclusion: Both curettage and planal resection resulted in shortening of the first ray after first TMTJ fusion. Planal resection resulted in significantly more shortening, which was also more variable. Surgeons performing first TMTJ fusions may consider curettage over planal resection to mitigate the risk of painful postoperative transfer metatarsalgia.
The INFINITY Total Ankle Prosthesis: Outcomes at Short Term Follow-up
Authors: Rushing Calvin J. , Hyer Christopher F. , Berlet Gregory C. 
Published: November 2020

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: The INFINITY total ankle prosthesis remains the most widely used 4th generation total ankle arthroplasty (TAA) system in the United States. The purpose of the present study was to assess outcomes for the INFINITY prosthesis at short-term follow-up. Methods: All patients who underwent primary TAA with INFINITY between August 2015 and June 2018 at a single institution and who were at least 1 year postoperative were included. A total of 55 ankles with a mean follow up 22 (range, 12-43) months met the criteria. Weightbearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6- 8 weeks postoperatively, and at the most recent follow-up. Medical records and charts were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook at el., respectively. Results: Overall survivorship for the INFINITY prosthesis was 98.2%. Coronal and sagittal tibiotalar alignment improved after surgery (p<.001, p=0.09), and was maintained during the latest follow-up (p=0.62, p=0.47). One ankle (1.8%) required early component revision; while 5 (9.1%) required non-implant related revision. Postoperative periprosthetic lucency’s were observed in nineteen ankles (34.5%); most of which were non-progressive (17 ankles, 89.5%). Thirteen complications (3 high grade, 3 intermediate, and 7 low) in 11 ankles (20%) were recorded according to the Glazebrook classification system. Conclusion: INFINITY survivorship was 98.2% at a mean of 1.8 years of follow-up, with only 1 ankle requiring prosthetic revision. Additional studies with longer follow-up are warranted for 4th generation TAA prostheses.
Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement
Authors: Salem-Saqer Hatem , Raglan Martin , Dhar Sunil 
Published: November 2020

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly used for treatment of end stage arthritis of the ankle; improvements continue to evolve in implant design and instrumentation. We present our experience of the Infinity Total Ankle Arthroplasty (Wright Medical), a fixed bearing 4th generation implant with improved instrumentation Methods: This is a retrospective review of prospectively collected data. From October 2016 to July 2019, we identified 92 (52M/40F) who had the infinity Total Ankle Replacement. This review is of 70 patients with a minimum of 1 year follow up (33M,37F). The mean age was 67.5 years (33-87); 32 right side and 38 left no bilaterals. The indication for surgery was end stage Osteoarthritis in 52, post traumatic arthritis 12, inflammatory arthritis 4, conversion of fusion to TAR 2. The preoperative deformity was graded according to the COFAS classification. All patients had follow up at 6 weeks, 3,6 and 12 months and then annually, with MOXFQ questionnaire and weight bearing radiographs. Results: TAA was performed with the use of fluoroscopy. 77% (54/70) had concomitant procedures as listed in Table.5% (4/70) had complications consisting of, 1 DVT, 1 intra operative medial malleolus fracture, 1 EHL tendon laceration and 1 wound break down. There were no deep or superficial infections. Improvement in clinical outcome and PROMS data was noted on follow up. The MOXFQ for Pain improved from 72 pre-op to 25 at 1year (p<0.001). The outcome for Walking improved from 83 pre-op to 30 at one year (p<0.001). Radiological alignment was maintained asymptomatic posterior heterotopic ossification was noted in 23(16%) patients, lucent lines under the tibial implant were noted in 4 ankles and 1 fibula erosion. 2 TAA (3%) needed to be revised due to malpositioning. Conclusion: Our results show significant improvement in patient outcomes, a short recovery time and marked improvement in mobility post operatively with a very low complication rate, we had no deep infection to date. Two implants were revised which we attribute to the learning curve at the start of practice. This implant is fluoroscopically navigated allowing precise implantation with dedicated instrumentation and we feel this attributed to the low complication rate and good results in our short-term study [Table: see text]
Fixation of Hammertoes with a Permanent Intramedullary K-Wire: A Low-Cost Alternative for a Common Procedure
Authors: Sammarco V. James , Sammarco Josika A. , Delman Allegra L. 
Published: November 2020

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Traditional K-Wire fixation of the proximal interphalangeal joint during correction of hammertoes is associated with various complications including loss of fixation, recurrence of deformity, pin tract infection and patient dissatisfaction due to the pin. At least 20 devices designed expressly for the purpose of fusing the interphalangeal joint of the lesser toes exist. Cost of the implants can range from $450 to $2000 per implant (when disposable instruments are included in the cost.) We hypothesized that a permanent intraosseous K-Wire bridging the proximal and middle phalanx would perform in an equivalent manner to many commercially available implants with a large potential for cost savings. Methods: A modified DuVries hammertoe correction procedure through a dorsal approach including resection of both joint surfaces. A 2mm or 1.6mm K-wire is then cut and placed into the intramedullary canals of the phalanges bridging the PIP joint (IP). A snug extensor mechanism repair affords compression and rotational control. External pins (EP) were used if the diaphyseal canal was less than 1.6mm. A retrospective review of medical records and radiographs of all patients undergoing hammertoe correction over three years by a single surgeon. 50 patients (28 Women, 12 Men) and 53 feet (2 bilateral) with mean age 66 (range 34 – 84) who had a minimum 6-month follow-up were available for study. 112 toes were corrected. Osseous union or stable fibrous union were the desired results with non-union, deformity recurrence and/or the need for revision being noted as failure. Average follow-up was 21.7 months (6 – 54). Results: Results: Of the 93 IP fixations, there were 68 fusions, 22 stable fibrous unions, and 3 non-unions. Of the 19 External pins there were, 11 fusions, 3 stable fibrous unions and 5 non-unions. 5 Patients required revision which was done by bone grafting and compression with an intramedullary screw. Success was noted in 96% of IP fixation and 74% of external pin fixations. Conclusion: Permanent internal K-Wire fixation for hammertoe correction is a viable option for fixation of hammertoe deformity outperforming traditional temporary K-wire fixation and resulting in good clinical results comparable to other commercially available implants. Given the negligible cost of this implant, the potential cost savings to the medical system is great. K-Wires are readily available worldwide and this technique may useful in countries where resources do not allow use of expensive implants.
What is the Effect of Lateral Ankle Ligament Injury on Syndesmotic Stability? Arthroscopic evaluation
Authors: Sato Go , Saengsin Jirawat , Bhimani Rohan , Hagemeijer Noortje , Lubberts Bart , Guss Daniel , Waryasz Gregory R. , DiGiovanni Christopher W. 
Published: November 2020

Category: Ankle; Arthroscopy; Sports; Trauma Introduction/Purpose: Numerous studies have shown a high incidence of associated lateral ankle and syndesmotic ligamentous injuries. It is unclear, however, if there is a direct contribution of the lateral ligaments towards stabilizing the syndesmosis. Using arthroscopy, we assessed to what extent lateral ankle ligaments contribute to syndesmotic stability in the coronal and sagittal plane. Our hypothesis was that lateral ankle ligament injury has effect on syndesmosis instability. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens were divided into two groups that underwent arthroscopic evaluation for syndesmotic stability. In both the groups, the assessment was done with all syndesmotic and ankle ligaments intact and later with sequential transection of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), the posterior talofibular ligament (PTFL), anterior inferior tibiofibular ligament (AITFL), the interosseous ligament (IOL) and the posterior inferior tibiofibular ligament (PITFL). In all scenarios, coronal and sagittal loading conditions were considered under 100N of direct force to fibula. The measurements of the distal tibiofibular coronal plane space at the anterior and posterior third of syndesmosis were performed using arthroscopic probes with increment of 0.2mm diameter. Further the sagittal translation were measured by arthroscopic scaled probe. Dunnett test was used to compare the findings of each ligamentous transection state to the intact state. A p-value < 0.05 was considered significantly defferent. Results: Compared with the intact ligamentous state, there was no difference in coronal and sagittal stability when the lateral ankle ligaments (ATFL, CFL, PTFL) and AITFL were transected (Table1 and 2, Group1). However, after subsequent transection of the IOL, or after transection of the lateral ankle ligaments (ATFL, CFL or and PTFL) alongside the AITFL and IOL, both coronal space and sagittal translation increased as compared with the intact state (p-values p<0.001 respectively) (Table1 and 2, Group2). Conclusion: Our findings suggest that lateral ankle ligaments do not directly contribute to syndesmotic stability in the coronal and sagittal plane. In concomitant acute syndesmotic and lateral ligament injury, surgeons should pay attention to whether there is combined IOL injury to determine the fixation of syndesmosis. [Table: see text][Table: see text]
Anatomical Study of Lapidus Arthrodesis using two Different Plantarplate Systems
Authors: Schilde Sebastian , Gutteck Natalia , Delank Karl-Stefan 
Published: November 2020

Category: Midfoot/Forefoot Introduction/Purpose: First tarsometatarsal arthrodesis (modified Lapidus procedure) constitutes a sufficient treatment for moderate to severe hallux valgus deformity and first ray instability. The plantar plate arthrodesis was shown to provide superior mechanical stability and less postoperative complications than screw fixation or dorsal plating. Nevertheless, the in-brought hardware may cause irritation of the tibialis anterior or peroneus longus tendon requiring explanation of the material in some cases. The purpose of this study was to investigate the potential of tendon irritation after plantar first tarsometatarsal joint arthrodesis in a cadaver study. Methods: Plantar plate arthrodesis was performed as in real surgery on twelve pairs of fresh frozen cadaveric feet. Two different plate systems were randomly allocated to each pair of feet. After plate fixation careful dissection of the feet followed to analyze potential tendon irritation and to determine a ‘safe zone’ for plantar plate placement. Results: A ‘safe zone’ between the insertion sties of tibialis anterior and peroneus longus tendon was found and proven to be sufficiently exposed using a standard medio-plantar approach. Both plates were fixed in this zone without compromising central tendon parts. Peripheral tendon parts were irritated in42% using Darco Plantar Lapidus Plating System1 (Wright Medical, Memphis, TN) and in 8% using the Plantar Lapidus Plate1 (Arthrex, Naples, FL). Bending of the anatomically preshaped plates is often necessary to ensure optimal fit on the bone surface. Conclusion: Modified Lapidus procedure with plantar plating of the first tarsometatarsal joint can be performed safely without compromising central tendon parts via standard medio-plantar approach.