bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of Turf Toe Injuries in NFL Players
Authors: Parekh Selene G. , Parekh Tejas J. 
Published: October 2019

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: “Turf toe” is an injury to the great toe’s metatarsophalangeal joint capsule. The increase in artificial turf in the 1970’s was thought to have contributed to increased incidence of this injury in players of the National Football League (NFL). To our knowledge, there are no publications that have critically analyzed the impact of this injury on player performance. The goal of this study was to quantify the impact a turf toe injury has on NFL players, specifically in time to return to competition and their performance post-injury compared to pre-injury. Methods: This is a retrospective review of NFL players who sustained a turf toe injury between the 2011-2014 seasons. Online resources including NFL injury reports, player registries, game summary sites, NFL news articles, fantasy football sites and NFL blogs were used to identify players with this injury. Additionally, an injury database from theFantasyDoctors.com was used to further identify injured players. Recorded variables included player age, position, games missed, and type of playing surface on which the injury occurred. The performance of each offensive skill player was analyzed separately by calculating their power rating (total yards divided by 10 plus touchdowns multiplied by 6) for the 3 seasons prior to injury, the injury season (index season) and the 2 seasons immediately following. Injured offensive skill players were then compared to a control group consisting of all running backs and wide receivers without a turf toe injury who competed in the 2012 season. Results: 71 turf toe injuries in 67 players were identified. Players’ average age was 26.4 years old. Injury by playing surface: 29 grass, 29 turf and 13 unidentified. The average time missed was 3.2 games. 9 players were placed on injured reserve and 8 required surgery. 16 offensive skill players were at or above 200 total points during the 6 observed seasons. The average power rating prior to injury was 105.7 per season (7.3 per game), 87.3 (6.9 per game) during the injury season and 115.5 (8.1 per game) for post-injury seasons. The power rating per season (p=0.53) and per game (p=0.4) was not significantly different after a turf toe injury compared to before. Power ratings were not significantly different from uninjured control players (p=0.24, p=0.27). Conclusion: ”Turf toe” is a term used for an injury that has a wide spectrum of consequence depending on injury severity. A mild sprain of the great toe should respond well to conservative treatment with rest, taping and possibly an orthotic while a complete tear of the metatarsophalangeal joint capsule typically is season-ending and requires surgical repair. We were unable to show a statistically significant difference in NFL players’ performances after turf toe injury based on power ratings.
Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures
Authors: Pate Matthew , Hall Jacob , Anderson John , Bohay Donald , Maskill John , Padley Michelle , Behrend Lindsey , Yaldo Omar 
Published: October 2019

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.
Structures at Risk in the Arthroscopic Brostrom-Gould Procedure: A Cadaver Study
Authors: Pitts Charles C. , McKissack Haley M. , Anderson Matthew C. , Buddemeyer Katherine M. , Jha Aaradhana J. , Wilson John T. , He Jun Kit , Naranje Sameer M. 
Published: October 2019

Category: Ankle, Arthroscopy, Basic Sciences/Biologics, Sports Introduction/Purpose: The Broström Gould procedure is the gold standard for repair of lateral ankle ligament injury and ankle instability. This procedure has demonstrated excellent short- and long-term outcomes in the orthopaedic literature. Arthroscopic Broström Gould techniques have become increasingly popular among some foot and ankle orthopaedic surgeons. Typically, this technique requires standard medial and lateral portals along with an accessory lateral working portal. The exact location of this portal is variable within the available described surgical techniques. The objective of this cadaveric study is to establish a standard entry point for and to assess the safety of the accessory lateral portal with respect to nearby anatomical structures. Methods: Ten fresh-frozen below-knee cadaver specimens were used. The location of the accessory portal was created 1.5 cm anterior to the distal tip of the fibula. A small vertical incision was made at this point, followed by insertion of a Kirschner wire into the joint. The wire was then gently impacted into the fibula. Superficial dissection was subsequently carried out around the entry point to identify the peroneal tendons, superficial peroneal nerve branches, and sural nerve branches. Structures were marked with colored push pins, and distance was measured between the nearest edge of the Kirschner wire and each of the three anatomic structures listed. Any instances of structural contact or damage were documented. Results: The average distance from the Kirschner wire to the peroneal tendon was 16.1 (±4.41) mm. The average distance from the wire to the superficial peroneal nerve and sural nerve was 13.11 (±6.79) mm and 12.33 (±4.08) mm, respectively. There were no instances of injury to any of the studied structures. However, there was a notable amount of variability in the proximity of structures in question for each cadaver. A branch of the superficial peroneal nerve was measured as close as 2 mm and as far as 24 mm in separate cadaver specimens. Conclusion: Arthroscopic Broström Gould procedures are a safe and effective method for lateral ankle ligamentous repair but are not without risk. Accessory lateral portal placement is relatively safe but should be meticulously executed to avoid damage to nearby anatomical structures.
Minimum 2 Year Outcomes of a Fixed Bearing Total Ankle Replacement in the United Kingdom
Authors: Reeve William JE , Dearden Paul , Drake Benjamin , Kakwani Rajeshkumar , Aradhyula Murty N , Talbot Nicholas , Hughes Adrian M , Townshend David , Sharpe Ian T 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: The Infinity (Wright medical) total ankle replacement (TAR) has become the most implanted ankle replacement in the UK with a 30.1% share in the most recent 2016 England and Wales NJR 14th report. It is a fixed bearing implant utilising an anterior approach and radiological guidance to aid alignment, and is approved for use in the UK as an uncemented implant. Methods: Since introducing the Infinity TAR in June 2014, all implants from two centres in the UK; The Royal Devon and Exeter Hospital NHS Foundation Trust and Northumbria NHS Healthcare Trust, have been followed up prospectively. 113 implants are included with 2 year minimum follow-up, average follow-up being 33 months (24-52). Pre- and post-operative demographic, radiographic and functional outcomes were collected including Visual Analogue Score (VAS), Manchester Oxford foot questionnaire (MOxFQ, UK validated patient reported outcome score) EQ5D (validated quality of life score). Complexity was assessed using COFAS pre-operative grade. Results: Implant survivorship was 93.8% at 2 years minimum. Median age was 68 (42-92), male: female 72:41. Mean MOxFQ improved by 28, mean EQ5D by 1.4 and mean VAS by 7. 16 cases had planned additional procedures, 5 required intra-operative medial malleolar fixation. There have been 2 revisions for deep infection, 2 for implant subsidence, 1 for instability and 2 for unexplained pain (6.2%). 5 patients have required further surgery to the ankle and hindfoot with implant retention (4.4%). 3 patients have asymptomatic tibial cysts (3.4%) and 1 patient has an asymptomatic talar cyst (0.9%) - there is no evidence of progression or loosening. Conclusion: We report favourable early functional, radiographic and survivorship outcomes of this implant in the UK population.
Retained Missile to the Foot and Ankle: When Should They Come Out?
Authors: Reilly Megan , Luginbuhl Joshua , Thoder Joseph 
Published: October 2019

Category: Trauma Introduction/Purpose: Gunshot wounds are common injuries encountered by orthopaedists in urban settings. Retained missiles can lead to significant morbidity and functional impairment. Despite the potential for adverse sequelae, controversy remains regarding the role of routine bullet removal. Suggested indications for bullet removal include those leading to infection and lead toxicity. Bullets located in the palm of the hand, sole of the foot, or intraarticularly are commonly removed as well. Given the unlikeliness of a retained missile sparing the many joints or sole of the foot, we question the indications for conservative management. The purpose of this case series of is to further develop indications for bullet removal from the foot. Methods: A medical record search was performed at a single one trauma institution, with high volume of patients with ballistic injury, for patients who underwent bulletectomy from 2008 until 2018. Of the 169 patients originally obtained, 17 patients underwent bulletectomy, with associated irrigation and debridement, of the foot and ankle. The record of each patient in this retrospective case series was individually reviewed for location of retained missile, indications for removal, whether the procedure was performed at the bedside or in the operating room, concomitant injuries or surgeries, and follow up. Results: Of the 17 patients with retained bullets removed from the foot and ankle, four (23.5%) were removed at the bedside versus the operating room. Indications for removal were painful palpable subcutaneous position of the bullet (11 or 64.7%), periarticular or intraarticular bullet (five or 29.4%), and infected wound with removal of foreign body to optimize healing (one or 5.9%). The location of the palpable missiles included three on the plantar foot, four on the dorsal foot, and four located in subcutaneous tissues adjacent to the ankle joint. Nine out of seventeen (52.9%) had fractures associated with the retained missile. Of the patients with OR procedure (13), the majority of them (nine or 69.2%) were in the operating room for another procedure as well. Conclusion: The indications for bulletectomy of the foot and ankle are not definite, however, it is recommended that bullets located in the weightbearing plantar foot or intraarticularly be removed. After analysis of a seventeen patient retrospective case series, we support these indications but also advocate for the removal of any painful subcutaneous or periarticular bullet, whether under local anesthesia or in the operating room. In our experience, the prominent foot and ankle bullet is often removed during a procedure for another anatomic site. Bulletectomy of the foot and ankle in a stable polytrauma patient should be considered.
Total Joint Replacement of the First Metatarsophalangeal Joint with Roto-Glide as Alternative to Arthrodesis
Authors: Richter Martinus , Zech Stefan , Meissner Stefan , Naef Issam 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of TJR (Roto- Glide) and A of MTP1. Methods: All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2018 were included in the study. Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies (WBCT) were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at first metatarsal head/first toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered and compared pre-operatively and follow-up. From November 24, 2011 until October 31, 2016, 25 TJR and 49 A were performed that completed follow-up. Results: Parameters (average values if not stated otherwise) for TJR/A were preoperatively: age 59/60 years; 7(28%)/14(29%) male; height 168/169 cm; weight 71/72 kg; degree degenerative changes 3.3/3.1; ROM 19.4/0/9.8°//20.3/0/9.2°; percentage force first metatarsal/first toe 7.9/14.6//8.5/15.3; VAS FA 45.9/46.2. Six wound healing delays were registered (TJR 2, A 4) as only complications. Follow-up time on average 45.7/46.2 and range 25.0-80.3/24.1-81.1 months. VAS FA at follow-up was 73.4/70.2.; percentage force first metatarsal/first toe 15.8/5.8//12.3/10.8; ROM 35.6/0/10.5°//10.5/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage first toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05). Conclusion: TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and VAS FA. TJR and A improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.
Ankle Range of Motion after Total Ankle Replacement with and without Heel Cord Lengthening
Authors: Ruiz Roxa , Krähenbühl Nicola , Barg Alexej , Hintermann Beat 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Though total ankle replacement (TAR) has become a well-accepted alternative to fusion for treatment of end-stage ankle osteoarthritis (OA), controversy still exists regarding the appropriate indications. In 80% of the cases, trauma accounts for the primary cause of end-stage ankle OA. In these cases, the soft tissue conditions are often poor and the remaining ankle range of motion (ROM) limited. Additionally, performing a heel cord lengthening (HCL) should theoretically increase ankle ROM. However, it remains unclear to which extent a preoperative stiff ankle can become mobile after a TAR, with or without a HCL. The purpose of this study was to assess the gained ROM after TAR in end-stage ankle OA, and whether it is beneficial for patients who additionally underwent a HCL. Methods: Out of 605 primary TAR performed at our institution between 2006 and 2015, 288 ankles (280 patients; age 64.1 [39 – 88]; male, 151; female, 129) were identified with a neutral hindfoot alignment, no degenerative changes or previous fusions of adjacent joints, and no previous ligament reconstruction and tendon transfers at time of TAR. Medial and lateral gutter debridement as well as a complete posterior capsule resection was performed before the prosthesis was inserted. The ankle was then gradually mobilized into dorsiflexion. If a minimum of 10° dorsiflexion could not be obtained, HCL was performed (percutaneous triple hemisection). Postoperatively, the ankle was protected by a walker and weight-bearing was permitted as tolerated. ROM was determined during weight-bearing with the use of a goniometer preoperatively and 2-years postoperatively. Pearson correlation analysis and paired t-test were used for statistical analysis. Results: Out of 288 ankles, 41 (14.2%) underwent additional HCL. Preoperative ROM correlated with the ROM 2-years after TAR, independent whether a HCL was performed (p < 0.01) or not (p < 0.01). ROM for the ankles where no HCL was performed was 35° preoperatively and 34° 2-years postoperatively. For the ankles in which a HCL was performed, it was 28° preoperatively and 28° 2-years postoperatively. Pearson correlation analysis showed that patients with a low ROM preoperatively tended to get more motion after TAR, whereas patients with an extensive preoperative ROM even lost some motion after receiving a TAR system (Figure 1). Conclusion: The data suggests that a HCL procedure has little potential to ameliorate a preoperative low ROM. A TAR system however, may help increase the ROM in patients with little preoperative ROM while in patients with extensive preoperative ROM it may even cause a loss of ROM. The data further suggests that the heel cord contracture is not the only cause of limited motion in end-stage ankle OA, and that whether TAR nor TAR in combination with HCL should be performed with the goal of gaining ROM for the treatment of end-stage OA.
A Novel Elastic Wrap for Syndesmotic Reduction with Post-Operative CT Scan Analysis
Authors: Schlatterer Daniel R. , Despande Chet , Morgenstein Aaron 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification. Methods: Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification. Results: In a grossly unstable cadaver ankle model the ankle wrap achieved a perfect reduction every time it was trialed. The pressure film component of this study confirmed a uniform reduction force circumferentially at the ankle under the ankle wrap device of 5-9 pounds per square inch. Post-operative CT scans in 5 cases confirmed anatomic reduction of the syndesmosis in those cases treated surgically with the wrap and screw fixation. Conclusion: Malreduction of the syndesmosis can be avoided by using an elastic wrap instead of the standard peri-articular clamp in common clinical practice today.
Outcomes of Defect Management at Tibiotalocalcaneal Fusion Treated with Innovative ‘Bamboo Hut’ Technique
Authors: Shah Rajiv 
Published: October 2019

Category: Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) fusion is a salvage procedure for post-traumatic as well as neuropathic cases. Many of these cases are characterised by some or other form of loss of talus resulting in a defect. At TTC fusion, prevention of shortening following such a defect is a challenge. Though allografts have helped solve this issue, they may not be easily available in developing countries. A retrospective analysis of prospectively collected data of 14 cases of TTC fusion with loss of talus is presented here. Cases were managed with innovative defect bridging ‘Bamboo Hut’ technique. Methods: Cases with either preoperative or perioperative loss of talus who required bridging of defect were included in the present study. Resultant defect following excision of the talus was bridged with two or three vertically placed fibular strut grafts. Grafts were snugly tied with each other with sutures to prepare a construct like a hut supported with wooden steaks (Bamboo). Fixation was carried out with indigenous TTC nail with a built-in compression device to generate compression of grafts between tibia and calcaneus. Results: Present series comprised of 6 post-traumatic cases, 7 cases of diabetic Charcot neuroarthropathy and 1 case of neuroarthropathy following operated meningomyelocele. Cases were followed up for an average period of 36 months with the average time to union being six months. All posttraumatic cases went on to the bony union but two out of eight neuropathy cases ended up in fibrous union with collapse & loss of fixation. Wound healing issues were noticed in two cases. None of the cases required amputation. Conclusion: With non-availability of allografts, prevention of shortening at TTC fusion is a challenge. This issue can be successfully managed with innovative ‘Bamboo Hut’ grafting technique, supported with in-built compression of the fusion site with the use of an indigenous nail.