bluuebunny/crossref_metadata_2025_split huggingface dataset:
Degenerative Pathology of the Ankle, Hindfoot, and Midfoot is as Limiting to Patient Mobility as Congestive Heart Failure
Authors: Erwood Amalie , Kurkis Gregory , Maidman Samuel David , Cole Robert , Tenenbaum Shay Ariel , Bariteau Jason Tyler 
Published: October 2019

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Degenerative conditions of the ankle, hindfoot, and midfoot can markedly limit mobility. The Life-Space Assessment (LSA) is a questionnaire quantifying how patients mobilize after a medical event as they return to their previous daily settings. Current outcome measures do not accurately assess mobility in the geriatric foot and ankle population. In contrast, the effect of congestive heart failure (CHF) on patient mobility is routinely assessed via the New York Heart Association (NYHA) functional classification. The NYHA classification is stratified by limitation of physical activity: I (no limitation), II (some limitation), III (marked limitation), and IV (unable to carry out without discomfort). We hypothesized that degenerative conditions of the foot and ankle would be as mobility limiting as CHF. Methods: Patients over the age of 50 were included in this study. LSA data was prospectively collected from patients with degenerative ankle, hindfoot, and midfoot diagnoses at their preoperative visit and NYHA-classified CHF patients at a cardiology clinic. The degenerative foot and ankle cohort included Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and comorbidities were recorded from the electronic medical record. Mean LSA data was analyzed and compared using a Student’s t-test. Results: 28 degenerative foot and ankle patients and 44 CHF patients met inclusion criteria for the study. Patient demographics, including age, gender, and BMI, were not significantly different between the two groups. The foot and ankle cohort had a mean LSA score of 68. Mobility of the foot and ankle group was significantly less compared to NYHA class I patients, who had a LSA score of 103 (p=0.008). There was no significant difference in mobility compared to class II or III congestive heart failure patients, who recorded a mean LSA score of 62 (p=0.60). There was insufficient data available on NYHA class IV patients to make comparisons to this group. Conclusion: Degenerative ankle, hindfoot, and midfoot pathology is associated with similar mobility limitation to that of NYHA class II and III congestive heart failure.
Gender-Related Reporting Within Foot and Ankle Subspecialty Orthopaedic Literature is Lacking
Authors: Gianakos Arianna L. , George Nicole , Merklein Meghan , Chambers Lori , Daniel Joseph , DiGiovanni Christopher , Kennedy John G 
Published: October 2019

Category: Ankle, Arthroscopy, Hindfoot, Midfoot/Forefoot, Trauma Introduction/Purpose: Differences in the prevalence of foot and ankle injuries between men and women have been established within the orthopedic literature, but reporting of these differences in treatment outcomes is lacking. The purpose of this study was to determine the trends in reporting of gender-specific outcomes in major orthopaedic foot and ankle related journals over the last 8 years. Methods: The five highest impact orthopaedic foot and ankle and sports specialty journals were selected for review. These included: Foot and Ankle International (FAI), Foot and Ankle Surgery (FAS), American Journal of Sports Medicine (AJSM), Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). All published issues in 2011 and 2016 were evaluated for the presence of gender-specific analyses by two independent reviewers. Studies were included if they met the following criteria: clinical randomized control studies, prospective studies, and retrospective studies. Case series, review articles, cadaveric studies, biomechanical studies, and animal studies were excluded. Journal article, percentage of female patients, body part evaluated, type of gender-specific analysis, and results of the analysis were recorded and analyzed. Results: A total of 529 studies evaluating a total of 103,099 patients were included in this review (Table 1). In all included studies, an average of 44.7% (46,116 patients) of the population were female. Only 13.6% (72/529) of studies included gender as variable in a multifactorial statistical model. 229 studies were included from 2011 and 300 studies were included from 2016 with only 10.4% (24/229) and 16.0% (48/300) of studies reporting gender specific statistical analysis, respectively (Table 2). There were no journals that demonstrated significant improvements in gender-reported rates from 2011 to 2016 (p=0.07). Twenty-four percent of the studies that performed gender-based statistical analysis demonstrated significant differences between male and female outcomes with the most common difference reported following management of ankle fractures (Table 3). Conclusion: The reporting of gender-specific differences in foot and ankle literature is lacking. Only 13.6% of studies analyzed for gender-specific differences. Within these studies, there has been significant differences in outcomes reported. Understanding these differences is important in order to more effectively manage and treat the male and female populations.
A New ‘Approach’ to Reduce Wound Complications Following Ankle Arthroplasty
Authors: Halai Mansur , Pinsker Ellie , Khan Ryan , Daniels Timothy R. 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: Despite advancements with instrumentation and implant design, total ankle arthroplasty (TAA) is still associated with a high rate of wound complications, which can lead to poorer outcomes. The aim of this study was to evaluate all wound complications following TAA and to determine any demographic or operative associations. Methods: A retrospective review of 660 consecutive TAAs was performed between November 2001 and May 2017. Data was collected on wound complications and potential risk variables, including age, sex, body-mass index, diabetes, smoking, and inflammatory arthritis. All wounds were seen at the clinic by the surgical team and a wound specialist nurse who independently recorded any issues. Major wound complications were those that required consultation with plastic surgeons, debridement by the nurse specialist, use of negative pressure therapy, or return to the operating room. All major complications were treated initially with oral antibiotics. Minor wound complications included any mention of discoloration, swelling, or clinical concern that merited the patient returning for further review. Minor wound complications were not treated with oral antibiotics. Operative notes were also reviewed to collect data on the surgical approach and additional incisions. Results: Fifty-nine patients (8.9%) had wound healing issues: 19 major (2.9%) and 40 minor (6.1%). All issues became evident <21 days postoperatively. Major wound complications were associated with a history of inflammatory arthritis, smoking, or coronary heart disease. Four patients were treated with negative pressure therapy, four with debridement in the operating room, and two were eventually converted to fusions. Fourteen (83%) patients with major complications had an ancillary procedure to balance the TAA through a separate incision. From 2001 to 2010, the standard surgical approach for TAA was performed anteriorly. All TAA patients with major wound complications were operated via an anterior surgical approach as their primary incision. No major wound complications were reported among the 22 anteromedial approaches. Conclusion: Potential TAA patients with a history of smoking, heart disease, or inflammatory arthritis should be considered with caution. A multidisciplinary team is valuable for evaluating wounds, as the majority of wound complications can be managed in the outpatient clinic with debridement, bespoke dressings, or negative pressure therapy from a specialist nurse. The anteromedial approach (see attached figure), which we have previously described, has great potential for patients who have a higher risk of developing a wound complication. Further investigation is necessary to evaluate its role in reducing the incidence of wound complications.
Iatrogenic Avascular Necrosis of the Talus Following Subchondroplasty
Authors: Hanselman Andrew , Cody Elizabeth , Easley Mark , Adams Samuel , Parekh Selene 
Published: October 2019

Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Subchondroplasty® (SCP®) (Zimmer Holdings, Inc, Warsaw, IN) is a relatively new procedure that was developed in 2007 for the treatment of bone-marrow lesions (BMLs). It involves the injection of flowable nanocrystalline calcium phosphate (CaP) synthetic bone substitute into the BML using fluoroscopic-guidance, in order to promote healing and reinforce the effected region. Although a newer technique, SCP has been shown promising results in the knee through several different small case-series. The foot and ankle literature is sparser, with only a few documented case-reports or case-series. As a result, we wanted to report our small case-series of patients who underwent talar SCP and went on to develop avascular necrosis (AVN). Methods: A retrospective review was conducted of patients who underwent SCP for a talar BML at our facility or were referred to our facility after undergoing SCP at an outside institution. Patients who developed iatrogenic talar AVN postoperatively were included in the study. Patient characteristics, comorbidities, imaging, and need for further surgery was analyzed. Results: Four patients were identified who had previously undergone talar SCP and went on to develop iatrogenic talar AVN. Two patients had their original SCP performed at our facility, whereas the other two patients were referred from outside institutions. All four patients were symptomatic from their AVN. Two patients have undergone revision surgical intervention, while the other two patients are pending surgical intervention. Conclusion: This case-series is the first study, to our knowledge, to report iatrogenic talar AVN after undergoing SCP for talar BMLs. Although early studies in the Foot and Ankle literature are promising for use of this technology, these studies have been small and surgeons should be aware of this potential complication.
Risk Factors of Arthropathy Change of the Lateral Side of Subtalar Joint After Calcaneal Fracture Surgery
Authors: Hio Naohiro , Hasegawa Atsushi , Monden Satoshi , Taki Masanori , Tsunoda Kazuhiko , Omae Hiroaki 
Published: October 2019

Category: Hindfoot, Trauma Introduction/Purpose: As a result of arthropathy change on the lateral side of subtalar joint after intra-articular calcaneal fracture, the secondary disorders such as pain or restricted range of motion occasionally occur. The purpose of this study is to examine factors that cause such arthropathy change. Methods: We divided 23 joints into two groups according to arthropathy change of the lateral side of subtalar joint: the existence of such arthropathy (O) group included 8 joints, the absence of arthropathy (N) group included 15 joints. The patients’ mean age at the time of surgery were 49.1 years and 54.9 years respectively, and the mean follow-up period were 16.1 months and 12.4 months respectively. The anterolateral approach or the sinus tarsi approach was used for both groups, and the medial approach was combined as needed. The fixing materials were a plate or screws, and in some cases, staples and Kirschner wires were used in combination. We assessed Sanders classification, postoperative clinical evaluation using Creighton-Nebraska scale, and the width, height and dislocation of subtalar joint surface of calcaneus. Results: The breakdown of the Sanders classification is as follows: N group consists of 3 joints of type 2A, 7 of type 2B, 3 of type 2C, 1 of type 3BC, 1 of type 4. O group consists of 5 joints of type 2A, 2 of type 2B, 1 of type 2C. The proportion occupied by Sanders classification type 2A in O group was larger than in N group. The average of the postoperative clinical evaluation was 94.9points in N group, 86.9points in O group. In postoperative image evaluation, the mean width in the was 106.2% in N group, 117.1% in O group, the mean dislocation of the subtalar joint surface was 0.4 mm in N group and 1.1 mm in O group. Conclusion: It was suggested that Sanders type 2A and the residual dislocation of the subtalar joint surface may be a cause of arthropathy change on the lateral side of subtalar joint.
Tarsal Coalition of the Cuneiforms in an Elite Athlete: A Case Report
Authors: Johnson Alexander J. , Gokcen Eric 
Published: October 2019

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Tarsal coalitions are a relatively common, often asymptomatic disorder with an incidence of 1-6% in clinical studies and 11-13% in cadaver studies. Calcaneonavicular, followed by talonavicular, are the most common forms of coalitions, but a variety of other coalitions have been described in radiographic, anatomic, and clinical literature. Despite the varied research that has focused on the topic in recent decades, there are no identified reports of cuneiform to cuneiform coalition in the literature. Methods: The authors present the unique case of medial and intermediate cuneiform coalition in a young female track athlete. A 19 year old female Division 1 hurdler presented with 1 year of atraumatic midfoot pain limiting her ability to compete. Despite evaluation by multiple orthopedic surgeons, the etiology of the pain was undetermined, and she had failed multiple conservative treatment options. Her exam revealed diffuse midfoot tenderness and increased midfoot pain with twisting motion. MRI and CT evaluation showed coalition between medial and intermediate cuneiforms with early degenerative changes. Ultrasound guided injection in this area resulted in relief of symptoms, confirming the diagnosis. The patient underwent coalition release and medial- intermediate cuneiform arthrodesis. Results: Postoperatively the patient underwent a period of nonweightbearing then progressed back to activity. CT scan confirmed solid arthrodesis and she was cleared to return to track competition. She successfully returned to competitive collegiate hurdling 11 months after surgery while noting only occasional discomfort in the foot. Conclusion: With no previous reports identified in the literature, cuneiform to cuneiform coalitions are a rare clinical entity. It is likely that the patient in the current case experienced symptoms related to this pathology because of her high level athletic participation. After failing conservative management, the patient experienced a good outcome after coalition release and arthrodesis. Although it is likely that patients with similar pathology who fail conservative management may expect similarly positive outcomes, review of future cases will help further define the optimal treatment for this condition.
Comparison of Drain Versus No-Drain for Intra-Articular Calcaneal Fixation via Sinus Tarsi Approach: Randomized Controlled Trial Study 33 Cases
Authors: Khongphaophong Methee , Kungwan Supoj 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Sinus tarsi approach for intra-articular Calcaneal fracture fixation has been popular recently and brought lower rate of would complications compared to extensile lateral approach. Post -operative drains are routinely used as precaution again hematoma and would complications, but still no study explained the importance of drains in sinus tarsi approach recently.The objectives of this study is to compare the outcome and complications between drain vs. without drain in sinus tarsi approach for intra-articular Calcaneal fixations. Methods: Prospective randomize controlled study (RCT) of 33 intra-articular calcaneal fractures treated by open reduction and internal fixation with mini-calcaneal locking plate (Normed, Florida) use sinus tarsi approach between 2014, December to 2018, March by one surgeon. 15 cases were not applied post-operative radivac drain vs. 18 cases were applied radivac drain no. 8. Operative times, post -operative maximum body temperature (degree Celsius), duration of hospital stay (day), wound complications (dehiscence, infection, hematoma), nerve injury were recorded, post-operatively. Results: Compared demographic datas for age, gender and Sander’s classifications, both groups were not significantly different. Mean operative time were 84.73 minutes in no drain group vs. 92.06 mins in drain group, p-value = 0.202. Mean post-operative maximum body temperature were 37.31 degree C. in no drain vs. 37.46 degree C. in drain group, p value =0.46. Hospital stay were 5.53 days in no drain group vs. 7.28 days in drain group, p-value = 0.224. There were 1 superficial wound complications in each groups and were cured by intravenous antibiotic, no hematoma and nerve injury in both groups. Conclusion: Post-operative radivac drain application did not bring different outcome and wound complications when compared to no radivac drain group in open reduction and internal fixation (ORIF) via sinus tarsi approach. But no drain group brought shorter mean operative time and hospital stay, although there were not significantly different (p>0.05). Continue our study for larger numbers of patient may bring different results.
Automatic Grading of Ankle Osteoarthritis Based on Takakura Staging System: A Deep Learning- Based Approach
Authors: Kim Hwiyoung , Choi Jiyun , Jang Chul-Young , Lee Jin Woo , Kim Sungjun , Han Seung Hwan 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: The Takakura staging system has been used for the stratification in ankle osteoarthritis(OA). Patient’s OA stage is determined by visual examination on the status of talar and distal tibia in anteroposterior ankle radiograph. Clinical decisions about whether to treat conservatively or to treat with operation such as supra-malleolar osteotomy or arthroplasty may depend on this grading system. However, this is not completely reproducible between examiners and it makes a debating situation about different treatment method to a same ankle radiograph. If highly reproducible measurement method may be suggested this debating may no longer need. Therefore, the purpose of this study was to suggest a deep learning-based algorithm that automatically grades ankle osteoarthritis and to present feasibility of the provided automatic grading system. Methods: 2529 AP both-ankle radiographs were collected and graded for OA by a radiologist and orthopedic surgeon. We converted Takakura staging system into 3 grades(Grade1: stageI, Grade2: II-IIIa, Grade3: IIIb-IV) according to treatment plan. To confine the region of interest(ROI), a rectangle encompassing ankle portion was automatically generated using an object detection model(YOLOv2). The data oversampling was done to overcome small data and class imbalance. Four pre-trained convolutional networks(One Inception-v3 and three ResNet models) were fine-tuned using augmented data. We tried two different ensemble methods: voting ensemble and gradient boosting. Voting ensemble adjusts the decision through selecting majority votes among trained models. Gradient boosting(XGboost model) trains new classification model to focus on the cases that previous model mis- classified. The evaluation of trained models and ensemble model were performed in terms of average classification accuracy. Gradient-class activation map(CAM) method was utilized to present CAM highlighting the location where highly affected the network for the decision. Results: A total of 3836 original ROIs were obtained and as follows: grade 1, 1382; grade 2, 1927; grade 3, 527. The number of oversampled ROIs was 16398 like follows: grade 1, 5528; grade 2, 7708; grade 3, 3162. The performance of each classifier was ranged 71.0% ˜ 77.3% in terms of average classification accuracy. Ensemble methods yielded average classification accuracies of 78.1% and 79.2% for voting ensemble and XGboost, respectively. Conclusion: Deep learning-based algorithm application for automatic grading of ankle osteoarthritis based on Takakura staging system is feasible. This approach is expected to be applied to various staging system for arthritis assessment through radiographs.
Functional and Radiographic Outcomes after the Removal of Suture-Button Fixation Device in the Treatment of Syndesmosis Diastasis
Authors: Kim Jae Young , Cho Jaeho 
Published: October 2019

Category: Trauma Introduction/Purpose: Suture-button fixation device (TightRope, Arthrex, Naples, Florida) is devised to obviate the need for second operation for removal in the treatment of syndesmosis diastasis, but considerable removal rate has been reported. Nevertheless, functional and radiographic outcomes after suture-button fixation device removal has not yet been well documented. Therefore, the purpose of this study is to investigate the functional and radiographic outcomes of syndesmosis fixation treated with suture-button device before and after device removal. Methods: The records of 30 patients with syndesmosis injury who underwent suture-button fixation and later device removal between August 2009 and September 2017 were investigated. The mean postoperative time to device removal was 11.9 months (range, 7-19). In plain radiograph, tibiofibula clear space (TFCS), tibiofibula overlap (TFO), and medial clear space (MCS) were measured at three specific follow-up period; immediate postoperative (F1), just before device removal (F2), and at least three months after device removal (F3). For subgroup of 18 patients with CT scans, the Anterior to posterior (A/P) ratio (Normal range: 0.8 -1.2) was measured to investigate malreduction of syndesmosis and they were divided into two groups according to their accuracy of reduction. Additionally, functional outcomes were recorded and compared using American Orthopedic Foot and Ankle (AOFAS) score. Repeated measurement analysis of variance was performed to statistically compare the data and statistical significance was set at P < 0.05. Results: In plain radiographs, TFCS, TFO, MCS at three specific follow-up period showed no significant differences. In CT analysis at immediate postoperative period, 6 cases (30%) revealed malreduction, but 5 of them showed spontaneous reduction at follow- up just before device removal. Malreduced patients (n = 6) had a mean A/P ratio of 1.28 (range, 0.78 -1.52) at F1, 1.08 (range, 0.81- 1.21) at F2, and 1.08 (range, 0.83 -1.22) at F3 (F1, F2: p = 0.021, F1, F3: p = 0.032, F2, F3: p > 0.05). Patients with initial adequate reduction (n = 12) continued to have a reduced syndesmosis during the follow-up period and after the device removal. The AOFAS score did not change significantly before and after removal. Conclusion: Our investigation showed that the removal of suture-button device for syndesmosis fixation at average 1-year postoperative time does not bring out reduction loss or functional changes. Thus, removal is advisable for the patients with irritation or discomfort related to device. Furthermore, malreduced syndesmosis after tightrope fixation may have possibility of spontaneous reduction during the follow-up period.