bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications Associated with Lisfranc Injury Open Reduction Internal Fixation versus Primary Arthrodesis: A Matched Cohort Study
Authors: Probasco William V. , Stein Benjamin E. , Fassihi Cyrus , Hossain Nazia 
Published: November 2020

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries are complex injuries of the midfoot in which the optimal course of treatment remains controversial. The objective of this study was to identify whether open reduction and internal fixation (ORIF) was associated with greater risk for surgical complications and/or greater financial burden in comparison to a primary arthrodesis (PA). Methods: A retrospective database review was conducted using the PearlDiver database to identify all Medicare patients who underwent a Lisfranc ORIF or PA in an inpatient setting from 2006-2013. Exclusion criteria included age >85 years and a prior history of foot or ankle trauma/infection/malignancy within 5 years of index surgery. Patients were matched in a 1:1 statistical manner to precisely control for potential influence of comorbidities and demographics, resulting in two cohorts with 2746 patients in each. Perioperative complications (within 30 days) were compared between the cohorts, in addition to the respective costs associated with each procedure. Complications were broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) or minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Results: No significant differences in major perioperative complications were noted between the two procedures. Significant differences were however noted in the incidence of minor perioperative complications, including higher rates of hardware failure (OR 0.26 (CI 95%, 0.07-0.752, P=0.021) and transfusion (OR 0.37 (CI 95%, 0.13-0.94, P=0.045) in the ORIF cohort. There was additionally a higher incidence of 30 day readmission (OR 0.35 (CI 95%, 0.24-0.51, P<0.001) with ORIF. Length of hospital stay (LOS) was shorter in the PA cohort (x̅; = 2.59 days) compared to the ORIF cohort (x̅; = 5.58 days, p < 0.001). Higher mean total hospital costs were noted for ORIF (x̅ = $66,342.56) compared to PA (x̅ = $40,761.65, p < 0.001). Conclusion: Within our study population, ORIF has a significantly higher rate of hardware failure and transfusion, and 2.5 times the risk of readmission within 30 days. When comparing the total cost of care, there was a significantly greater cost with ORIF. LOS was also significantly longer in the ORIF group. One weakness of this study was the ability to account for patients <65, as these were pooled into a single age group by the database. While revealing with regard to the aforementioned variables, further research still needs to be conducted on the functional outcomes of these procedures. [Table: see text][Table: see text][Table: see text]
Predictors of Spring Ligament Degeneration and Outcomes of Reconstruction during Correction of Adult Acquired Flatfoot Deformity
Authors: Raikin Steven M. , Rogero Ryan G. , Raikin Jared , Corr Daniel , Tsai Justin 
Published: November 2020

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: It is currently unclear how injury to the spring ligament (SL) affects the preoperative presentation of adult acquired flatfoot deformity (AAFD). The purposes of this study were to retrospectively identify shared factors that could be used to preoperatively predict SL damage in patients undergoing AAFD correction as well as compare outcomes of patients undergoing SL reconstruction to those not undergoing reconstruction during AAFD correction. Methods: All patients undergoing operative correction of grade 2B AAFD secondary to tibialis posterior tendon dysfunction by a single fellowship-trained foot and ankle orthopaedic surgeon from 2011 to 2017 were reviewed. Operative reports were reviewed for the surgeon’s evaluation of the competency of the SL and to determine whether SL reconstruction was performed. Patient charts were reviewed for demographic information, preoperative Visual Analog Scale (VAS) pain level, and their Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and -Sports subscales. Preoperative radiographic parameters were assessed by a surgeon blinded to the intraoperative findings. Patient outcomes of VAS pain, FAAM-ADL, and FAAM-Sports were collected at a minimum of 24 months postoperatively. Multiple logistic regression analysis was performed to determine significant independent predictors of spring ligament tears. Results: The study included 115 feet undergoing corrective reconstruction, with 47 feet having a spring ligament tear (40.9%). Patients with tears were significantly older (p<0.001), with higher preoperative reported pain (p=0.01), and lower preoperative FAAM-ADL (p=0.04) and -Sports (p=0.006) scores than those without SL tears. Patients with a SLT demonstrated significant differences in AP talo-1st MT angle (p=.003), talonavicular uncoverage percentage (p<0.001), talonavicular angle (p=0.017), and Meary`s talo-1st MT angle (p=0.001). Based on multiple logistical regression analysis (odds ratio [95% confidence interval]), patient age (1.10 [1.03, 1.18]; p=0.003), talonavicular uncoverage percentage (1.35 [1.13, 1.60]; p<0.001), and talonavicular angle (0.82 [0.71, 0.96]; p=0.0133) were independently predictive of ligament degeneration. Patients undergoing SL reconstruction did not differ significantly in functional score improvements compared to those without reconstruction. Conclusion: Our findings suggest that a SLT is associated with more advanced flexible pes planovalgus, measured both by radiographic parameters as well as its impact on patient function. Increasing patient age, increasing talonavicular uncoverage percentage, and decreasing talonavicular angle are all independently associated with increased likelihood of patients with AAFD having a SLT. AAFD correction with concomitant SL reconstruction does not appear to influence absolute or changes in patient pain and function. [Table: see text]
Comparison of Topical Skin Adhesive and Simple Interrupted Nylon Sutures for Wound Closure in Forefoot Surgery: A Prospective Randomised Trial
Authors: Ray Robbie , Goff Thomas A. , Dearden Paul M. , Robinson Peter W. , Lam Peter , Wines Andrew P. , Lewis Thomas L. 
Published: November 2020

Category: Bunion Introduction/Purpose: There are many options for wound closure in forefoot surgery. The purpose of this study was to compare topical skin adhesive (2-Octyl-cyanoacrylate) to standard simple interrupted nylon sutures with attention to the quality of wound healing and the acceptability to the patient. Methods: Patients undergoing elective 1st ray forefoot surgery utilising a medial incision, either Hallux Valgus correction or 1st Metotarsophalangeal joint arthrodesis, were recruited to this study. Patients were randomly allocated during surgery to final layer wound closure with either the intervention topical skin adhesive (TSA) or the control interrupted nylon sutures (INS). Practicality was assessed by time taken for wound closure and subsequent time to perform wound care at 2 weeks postoperatively, wound care pain (VAS) and quality of wound healing was assessed at this point with a dedicated scoring tool, patient satisfaction and acceptability was assessed at 6 weeks postoperative. Results: 70 patients (18 bilateral) were recruited, resulting 42 feet in each study group (after 4 exclusions for incomplete data set). Mean age 61 (29-83). There were no statistical differences in the demographics or surgery performed between groups. Wound closure time was significantly slower for TSA (272 secs (SD 72.2) vs 229 secs (SD 58.8), p=0.0038). At 2 weeks postoperative wound care time was significantly faster for TSA (71 secs (SD 50.8) vs 120 Secs (SD 47.8), p<0.0001), and patient reported pain was significantly less with TSA (VAS 0 vs 2, p=0.025). Significantly more inflammation and wound edge separation was recorded with TSA (17 vs 5 cases, p=0.006) and (12 vs 3 cases, p=0.02) respectively. High satisfaction was reported in both groups with no signifcant difference. Conclusion: Topical skin adhesive and interrupted nylon sutures are both acceptable closure methods for forefoot surgery with high satisfaction rates, low pain scores and low complications. However, the observation of significantly more inflammation and areas of wound separation at the early post-operative period with topical skin adhesive is sufficient to recommend routine use of sutures.
The Use of Single-Photon-Emission Computed Tomography (SPECT) for the Evaluation of Painful Ankle Arthroplasties
Authors: Refaie Ramsay , Shahid Zuhaib , Ramaskandhan Jayasree Ramas , Siddique Malik S. 
Published: November 2020

Category: Ankle; Ankle Arthritis Introduction/Purpose: The evaluation of the painful ankle arthroplasty remains challenging. Clinical and radiographic examination are the mainstay of surveillance. The use of CT is also widespread. In our series using CT we were however unable to reliably differentiate between prosthetic and other causes of pain. We do not therefore recommend the use of CT in evaluating this patient group. Since 2017 we have evaluated all cases of painful ankle replacement with single-photon-emission computed tomography (SPECT). The aim of this study was to review the use of SPECT in our patient cohort. Methods: A retrospective analysis of all ankle arthroplasties evaluated by SPECT was performed. Case notes, plain radiographic imaging and SPECT imaging were reviewed and tabulated for analysis. Results: 29 painful ankle arthroplasties were identified and included in this study. Implants included 14 BOX, 11 Mobility, 3 Salto xt and 1 Zenith. The mean time from index surgery was 5 years (1 -11 years). Plain radiographs demonstrated no obvious abnormality in 18 out of 29 patients. Of these SPECT demonstrated abnormal periprosthetic uptake suggestive of loosening in 12 out of 18, in the remaining 6 no loosening / ankle pathology was identified. Of these 6 patients SPECT identified an area of extra- articular high uptake suggestive of a pain source in 3 cases (1 talonavicular joint, 1 subtalar joint and 1 syndesmosis). In the 11 patients with a demonstrable abnormality suggestive of loosening on plain imaging, SPECT confirmed the diagnosis in all 11 cases. Conclusion: SPECT is a useful tool in the evaluation of the painful ankle arthroplasty. SPECT provided confirmatory information where plain radiographs were positive but also helped elucidate potential causes of pain where plain radiographs were negative. We would no longer recommend the routine use of CT but rather would recommend the use of SPECT in the evaluation of all painful ankle arthroplasties.
Comparison Matrix-Associated Stem Cell Transplantation (MAST) with Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in Chondral Lesions at the Ankle - Matched-Patient Analysis
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam 
Published: November 2020

Category: Ankle Introduction/Purpose: 2016, the local government authorities re-categorized MAST, i.e. the included BMAC for impregnation of the matrix, as stem call manufacturing and heterologous transplantation. Consequently, MAST and all other procedures including BMAC were not ‘subject to disclosure’ as before but ‘subject to authorization’. Therefore, the authors´ institution was not authorized to perform MAST after July 16, 2016. The authors´ institution changed the treatment of chondral lesions by replacing BMAC as part of MAST to Peripheral Blood Concentrate (PBC) resulting in AMIC+PBC.The aim of the study was to compare MAST with AMIC+PBC in chondral lesions at the ankle. Methods: In a matched-patient clinical follow-up study, patients with chondral lesion at the ankle that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017, and patients that were treated with MAST from April 1, 2009 to July 15, 2016 were included and compared. Size and location of the chondral lesions and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Bone Marrow Aspirate Concentrate (BMAC) was used for MAST and Peripheral Blood Concentrate (PBC) for AMIC+PBC to impregnate a collagen I/III matrix (Chondro-Gide, Wollhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. Results: One hundred and twenty-nine patients with 136 chondral lesions were included in both groups. The chondral lesions were located as follows (MAST/AMIC+PBC, n (%)), medial talar shoulder only, 59 (43)/62 (46); lateral talar shoulder only, 44 (32)/42 (31); medial and lateral talar shoulder, 7 (10)/7 (10); tibia, 19 (14)/18 (13). The lesion size was 1.6/1.8cm2 on average and VAS FA was 46.9/45.7 (MAST/AMIC+PBC). For MAST/AMIC+PBC groups, 107 (83%)/105 (81%) with 112/110 previous chondral lesions completed the defined 2-year-follow-up after 24.4/23.8 months on average. VAS FA improved to 82.3/79.8 (MAST/AMIC+PBC). No parameter significantly differed between MAST and AMIC+PBC groups. Conclusion: MAST and AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores in 2-year-follow-up. MAST and AMIC+PBC showed similar results. No method related complications were registered.
Comparison of Clinically used Bilayer Collagen Membrane and Trilayer Collagen Prototype Fixation Stability in Chondral Defects at the Talus: An Experimental Human Specimen Study
Authors: Richter Martinus , Milstrey Alexander , Zech Stefan , Grueter Angelika , Evers Julia , Raschke Michael J. , Ochman Sabine 
Published: November 2020

Category: Basic Sciences/Biologics Introduction/Purpose: The purpose of this human specimen experimental study was to compare the fixation stability of clinically used bilayer collagen membrane with fibrin glue (Chondro-Gide, Geistlich Pharma AG, Wollhusen, Switzerland) with trilayer collagen prototype without fibrin glue in chondral defects at the medial or lateral talar shoulder. Methods: Eleven human specimens were used. The membranes were implanted in standardized chondral defects at the medial and lateral talar shoulder (randomized). All tests were performed in load-control (15kg). Range of motion (ROM) of each ankle was examined individually before testing. The average ROM was 10° dorsalextension (range 0°-20°) and 30° plantarflexion (range 20°-45°). 1,000 testing cycles with the defined ROM were performed. Two independent investigators, blinded to fixation and membrane type, visually assessed the membrane fixation integrity for peripheral detachment, area of defect uncovered, membrane constitution and delamination. Results: The clinically used bilayer collagen membrane plus fibrin glue showed higher fixation stability than the trilayer prototype (all p<0.05). No significant differences occurred between medial and lateral talar shoulder location (all p>0.05). Conclusion: The fixation stability of the trilayer collagen prototype without fibrin glue is lower than of the clinically used bilayer membrane with fibrin glue in chondral defects at the medial and lateral talar shoulder in an experimental human specimen test. Clinical use of trilayer collagen prototype without fibrin glue has to be validated by clinical testing to evaluate if the lower stability of fixation is still sufficient.
Semi-automatic Software-based 3D-Angular Measurement For Weight-Bearing CT (WBCT) is 97% Faster than Measurement by Hand and Provides Similar Angles
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam 
Published: November 2020

Category: Basic Sciences/Biologics Introduction/Purpose: Weight-bearing CT (WBCT) has been proven to allow for more precise and valid measurement of bone position (angles) than conventional weight-bearing radiographs (R) and conventional CT without weight-bearing (CT)1. The measurement by hand (MBH) has demonstrated adequate inter- and intraobserver reliability but high time consumption1. Recently, a semi-automatic software-based angular measurement (SAM) has been developed (Disior Ltd, Helsinki, Finland). The purpose of this study was to compare SAM with MBH regarding angles values and time spent for the investigator. Methods: Fifteen bilateral WBCT scans (PedCAT, Curvebeam, Warrington, PA, USA) were randomly extracted from a local institutional database with more than 13,000 scans. Nineteen angles as shown in table 1 were measured with MBH as previously described and with SAM1. SAM includes software generated 3D models with semi-automatic bone specification of tibia, fibula, talus, calcaneus, navicular, cuboid, cuneiforms and metatarsals. The software automatically defines the longitudinal axes of these bones and automatically measures the angles between these axes. The time spent of the investigator for the measurements was recorded (total process MBH and specification of bones for SAM). The software calculation time for SAM was not measured or considered as investigator time spent. The angles and time spent of MBH and SAM were compared (t-test, homoscedatic). Results: Mean age of the subject was 58 years (range, 7-81), 12 (40%) were male. The pathologies were bilateral in 8 (54%), right in 4 (27%) and left in 3 (20%) subjects (23 feet in total) and were specified as follows, ankle osteoarthritis/instability in 6 (26%), Haglund deformity/Achillodynia in 4 (17%), Forefoot deformity in 7 (30%), Charcot arthropathy in 2 (9%), flatfoot in 4 (17%) feet. The angles did not differ between MBH and SAM (Table 1, each p>.05). The time spent for MBH / SAM was 780+-171s / 20+-8 s on average in total for 19 angles and 41+-9s / 1+-0.4 s per angle (p<.01). Conclusion: This is the first study comparing MBH with SAM. SAM shows similar angles as MBH and can be also considered as reliable measurement option. The investigator time spent is 97% lower for SAM (1 s per angle) than for MBH (41 s per angle). SAM is an important step forward for 3D-angle measurement of WBCT. The next desired is fully automatic software-based measurement. References1. Richter M, Seidl B, Zech S, Hahn S. PedCAT for 3D-Imaging in Standing Position Allows for More Accurate Bone Position (Angle) Measurement than Radiographs or CT. Foot Ankle Surg 2014;20:201-7. [Table: see text]
Instagram and Pilon Fractures: An Analysis of Social Media and its Relationship to Patient Injury Perception
Authors: Rizkalla James M. , Lines Tanner , Daoud Yahya , Zide Jacob R. 
Published: November 2020

Category: Ankle; Ankle Arthritis; Trauma Introduction/Purpose: Patients have begun to utilize social media networking sites to discuss their individual experiences with medical care. Social media as an adjunct tool to measure patient satisfaction, progress, and long-term rehabilitation after orthopaedic procedures may hold future promise. The purpose of this study was to investigate social media posts regarding pilon fractures and their relationship to patient injury perception. Methods: We evaluated Instagram media posts in patients who have suffered pilon fractures for the following variables: gender, tone, discussion of rehabilitation, activities of daily living (ADL) reference, incision/scar reference, pain, post of radiograph/imaging, external fixation reference, discussion of bracing/splinting, pre or post-operative swelling, and need for reoperation. In total, 241 patient posts were included for investigation and analysis of patient injury perception via social media. Results: Of all included posts, 88% of posts had a positive tone. A majority of the posts (66.8%) mentioned rehabilitation and post-operative progress. There were significant associations between positive tone and rehabilitation (p=0.0001), as well as positive tone and Activities of Daily Living (ADLs) (p=0.0361). Conclusion: Outcomes after surgical management of pilon fractures are generally poor. Nonetheless, this analysis of patients sharing their experience on social media after ORIF of pilon fractures demonstrates a mostly positive attitude toward the injury and recovery. A positive tone of the post was significantly associated with mentions of rehabilitation and ADLs.
A Retrospective Chart Review to Examine Failed Modified Brostrom Procedures for Chronic Lateral Ankle Instability
Authors: Rizzo Kaitlyn , Brandle Greggory , Cheney Nicholas A. , Clark Brian C. 
Published: November 2020

Category: Ankle; Other Introduction/Purpose: Recurrent ankle injuries can lead to chronic ankle instability requiring surgical stabilization. Since the anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments, repair is often required in cases of chronic lateral ankle instability. Damage to the calcaneofibular ligament (CFL) is less common than the ATFL, but additional repair of it in these cases may be necessary to avoid this recurrent instability. A modified Brostrom procedure has been a widely accepted surgical approach to chronic lateral ankle instability if conservative measures fail. However, cases of recurrent instability even after initial stabilization surgery can present. The purpose was to examine reasoning for and rate of revision surgeries attempting to fix chronic lateral ankle instability as it relates to the ATFL and CFL integrity. Methods: A retrospective chart review was conducted to assess outcomes of a modified Brostrom procedure to determine underlying reasoning of the need for revision surgery by utilizing results of the anterior drawer and varus tilt tests. The files of these patients were examined via electronic health records to determine the reasoning for surgery. The preoperative and postoperative results of the anterior drawer test (ADT) and varus tilt test were used to examine ATFL and CFL integrity, respectively, in addition to operative notes. Results: 172 patients met criteria having undergone a modified Brostrom dual ligament repair procedure for lateral ankle instability by a single orthopedic foot and ankle surgeon. With a 3.49% revision rate in the patient population, the only similarity found in all of the patients was the presence of a positive varus tilt test indicating the CFL was a major contributor of failed correction via the modified Brostrom procedure. One patient had a positive ADT, and one had a mildly positive ADT. These ADT and varus tests were performed at various time points in the care of the patients. The average length between surgeries was calculated to be 624.2 days. This revision rate is higher than past studies but was limited to a few years under examination. Conclusion: In conclusion, the anterior drawer and varus tilt tests are utilized to determine the integrity of the ATFL and CFL in the lateral ankle ligament complex. In failed modified Brostrom procedures examined, the positive result was consistently in the varus tilt test, indicating that the CFL is the ligament most affected in these patients requiring additional surgery. However, these physical exam tests are only one way to examine the ankle and do not take additional pathologies of the lateral ankle into account. Additional studies are needed to examine long-term outcomes of the modified Brostrom procedure and reasoning for failure.