bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Survival Analysis of Total Ankle Arthroplasty and Patient Risk Factor for Failure
Authors: Kim Sung-Jae , Kang Hwa-Jun , Kim Ki Chun 
Published: November 2020

Category: Ankle; Ankle Arthritis Introduction/Purpose: The aim of current study is to perform long-term survival analysis for TAA of 5619 cases, and identify patient risk for failure of TAA. Methods: Total of 7516 cases of TAA were identified from national insurance claim data of South Korea during 2007 to 2018. After exclusion of bilateral cases and cases performed on 2018, total 5619 cases of primary TAA cases were included. TAA failure was defined as case with revision arthroplasty or case with TAA implant removal and arthrodesis after primary TAA. Patient age, hospital size, comorbidities were included for survival analysis. Kaplan-Meier survival analysis was performed during study period, and Multivariable Cox regression analysis were performed. Results: During study period, five-year survival rate was 95.4%, and 10-year survival rate was 91.1%, and mean survival duration was 9.6 years. Regression analysis revealed that younger age (< 65, adjusted hazard ration (AHR), 1.812; p< 0.001), chronic pulmonary disease (AHR, 1.476; p= 0.013), diabetes (AHR, 1.443; p= 0.014), alcohol consumption (AHR, 1.524; p= 0.032) showed significant high odds ratio for TAA failure. Conclusion: Current study was performed with largest cohort with TAA procedures in literature. 10-year survival rate was 91.4%, young age and some comorbidities revealed as significant predictor for TAA failure.
Return to Play after Arthroscopic Microfracture for Osteochondral Lesions of the Talus in Young Elite Athletes
Authors: Kim Sung-Jae , Lee Kyung-tai 
Published: November 2020

Category: Ankle; Arthroscopy Introduction/Purpose: The current scientific evidence for the clinical and sports-related outcomes of the surgical treatment of osteochondral lesions of the talus (OLTs) with arthroscopic microfracture (MF) in elite athletes is scarce. The purpose of curretn study is to evaluate the clinical outcomes and return to sports activity after arthroscopic MF for OLTs in elite athletes. Methods: The files of 41 elite athletes (mean age 19.34 +- 3.76 years) who had undergone arthroscopic MF for OLTs at our institution between January 2011 and September 2015 were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot and visual analog pain (VAS) score, time and rate of ‘return-to-competition’ (RTC, defined as return to an official match for at least one minute after treatment), and rate of ‘return- to-play’ (RTP, defined as participation in at least two entire seasons after treatment) were used to evaluate the outcomes. We compared athletes who were able to RTP (RTP-group) with those who were not (No-RTP group). Results: The mean follow-up was 54.9 +- 13.72 months. All five subscales of preoperative FAOS were significantly improved at the final follow-up. The mean preoperative AOFAS hindfoot score of 74.46 +- 8.10 improved to 91.62 +- 2.99 (P < 0.001) at the final follow-up. The mean preoperative VAS score of 5.44 +- 1.57 improved to 2.66 +- 1.04 (P < 0.001). All patients achieved RTC (100%) at mean time of 5.45 +- 3.18 months, and 74.4% of patients were able to RTP. The RTP-group showed significantly smaller lesions compared to the No-RTP group (71.52 +- 43.29 vs. 107.00 +- 45.28 mm2, P = 0.009). The cut-off OLT size for predicting RTP was 84.0 mm2, with a sensitivity of 90.0% and specificity of 75.9%. Conclusion: All athletes were able to RTC at average of 5.45 months after MF for OLTs, and 74.4% were able to RTP. The only prognostic variable for RTP was lesion size, and its predictive cut-off was 84 mm2.
Hypoalbuminemia is an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures
Authors: Kukowski Nathan , Wilson Jacob M. , Bariteau Jason T. , Staley Christopher A. 
Published: November 2020

Category: Basic Sciences/Biologics; Trauma; Other Introduction/Purpose: Malnutrition is known to be negatively associated with outcomes after multiple orthopedic procedures. We hypothesized that admission albumin levels, as a maker for malnutrition, would correlate with postoperative outcomes. The purpose of this study is to investigate this relationship following surgery for ankle fracture. Methods: This is a retrospective cohort study of the ACS-NSQIP database. Patients undergoing operative fixation of an ankle fracture were identified. 6,138 patients with albumin available for analysis were identified. Baseline patient information, preoperative serum albumin levels, 30-day postoperative complications, readmission, reoperation, and length of stay data were then collected. Poisson regression with robust error variance was performed to assess the effect of preoperative serum albumin level on postoperative outcomes. Results: 6,138 patients with albumin available for analysis were identified in the database. The mean albumin level was 3.86 g/dl and 20.3% of patients with available albumin levels were hypoalbuminemic. Multivariate analysis revealed that albumin level <3.5 g/dl is an independent risk factor for complication (RR 1.42, 95% CI 1.13-1.78, p=0.002) and readmission (RR 1.54, 95% CI 1.13- 2.08, p =0.006). Additionally, when analyzed as a continuous variable, albumin level was negatively correlated with risk of mortality (RR 0.37, 95% CI 0.19-0.72, p=0.003). Patients with hypoalbuminemia also had significantly longer length of stays (4.5 v. 2.1 days, p<0.001). Conclusion: While complication rates after fixation of ankle fractures remain low, hypoalbuminemia is a predictor of postoperative course. Malnutrition, therefore, may help inform the decision between surgical and conservative management of patients with ankle fractures potentially amenable to non-operative management. Additionally, hypoalbuminemia should trigger heightened awareness and prophylactic therapy where appropriate.
Novel Measurement Technique for Talar Height Assessment in Total Ankle Arthroplasty
Authors: Kulwin Robert , Haddad Steven L. 
Published: November 2020

Category: Ankle Arthritis; Other Introduction/Purpose: Talar and calcaneal height have been identified as important not only to the biomechanics of ankle joint function but of the adjacent joints of the hindfoot as well. Many proposed measurement systems have been introduced to the literature to assess talar height in ankle arthroplasty, but have significant shortcomings. The malleoli frequently develop osteophytes after total ankle arthroplasty. If the subtalar joint is fused or arthritic, methods relying on landmarks such as the angle of Gissane are similarly unreliable. Lastly, subsidence is often asymmetrical. Measuring from the highest point of the talar component may not be reflective of functional talar height. We propose using adjusted talocalcaneal height to assess the functional restoration of talar height. Methods: Pre and post-operative radiographs and weight bearing computed tomography (WBCT) were reviewed for 40 cases of failed total ankle arthroplasty undergoing revision. Bony landmarks were assessed for consistency over a time course of two to four years post operatively. Talocalcaneal height was measured along from the center of the tibial component of ankle arthroplasty on weight bearing lateral radiographs and on sagittal and coronal reconstructions on WBCT (fig 1). Measurements on radiographs and WBCT were compared for agreement. For implants where lateral radiographs could not be used (AgilityTM, Depuy), sagittal and coronal WBCT was used. Results: Average adjusted talocalcaneal height as measured on lateral radiographs, sagittal WBCT, coronal WBCT, and averaged values from sagittal and coronal WBCT was 68mm, 67.4mm, 68.5mm, and 68mm respectively. There was not a significant difference between the lateral radiographs and WBCT measurement methods (p= 0.30, 0.37, 0.46), and correlation was 0.99 for all methods. Measurements did not vary in cases of angular subsidence or subtalar fusion. Conclusion: Adjusted talocalcaneal height is a reproducible and reliable measurement to assess talar height. It accommodates procedures frequently performed in tandem with total ankle arthroplasty such as calcaneal osteotomy and subtalar fusion. It relies on a single, static bony landmark, and remains valid in cases of asymmetric subsidence. Lastly, it incorporates calcaneal height, which affects not only ankle joint mechanics but adjacent joint mechanics as well.
A Comparison of Arch Index, Foot Posture Index and Surgeon Observation for Foot Type Classification
Authors: LaBaze Dukens , Gabrielli Alexandra , Anderst William , Hogan MaCalus V. 
Published: November 2020

Category: Basic Sciences/Biologics Introduction/Purpose: Foot morphology is a key aspect of patient evaluation. Individuals with Pes planus usually have medial foot pain; those with Pes Cavus commonly have pain over lateral foot. Foot Posture Index (FPI) is a qualitative measure that uses six specific physical exam parameters. Arch index (AI) is a quantitative measure in which the footprint is photographed and measured. Radiographs allow for visualization of the bone and used to directly measure parameters of foot morphology such as calcaneal pitch (CP). The purpose of this study was to determine the sensitivity and specificity of surgeon observation, FPI, and AI in determining foot type, with CP serving as the reference standard. Our hypothesis is that surgeon observation will be more sensitive and specific than FPI and AI for identifying foot type. Methods: Following institutional review board approval and informed consent, we examined 41 adults (82 Feet) (average age 37.8+-17.6 yrs.; range: 20 to 68 years old; 20F/21M) without history of prior foot or ankle injury. Subject evaluation included bilateral FPI exam, lateral and hindfoot standing radiographs, pedographs, and weightbearing photographs. Three authors were trained to perform standardized FPI assessments. The radiographs and photographs were presented in a randomized order to a board-certified foot and ankle orthopaedic surgeon to classify a foot as either planus, cavus or normal (Figure 1). Calcaneal pitch was measured for each foot by finding the angle between the inferior surface of the calcaneus and the supporting surface, with normal classified as 18°-32°, planus <18° and, and cavus>32°[2,3]. Arch index was calculated for each foot from pedograph, with normal classified as 0.21 to 0.28, planus < 0.21 and cavus >0.28. Results: The gold standard calcaneal pitch measurements identified 12 planus, 57 normal, and 13 cavus feet. Surgeon observation was the most sensitive for identifying planus feet and most specific for identifying cavus feet (Table 1). Arch index was the most sensitive for identifying cavus feet and most specific for identifying both planus and normal feet. FPI was most sensitive for identifying normal feet. The correlation between raw scores on the FPI and AI to CP were weak to moderate, -0.387 and -0.526, respectively (p<0.01). Conclusion: Surgeon observation is the only method that had a sensitivity over 0.50 for two different foot morphologies. FPI does not have the highest specificity for any particular foot type; however, a specificity of 0.844 and 0.971 for planus and cavus feet demonstrates that FPI is a suitable modality for evaluating pathologic morphology. Our specificity is close to a prior reported 0.932. These similarities in statistics reassure us that our methods are consistent with prior studies. Limitations of the study include small sample size and a single surgeon reviewing imaging. [Table: see text]
Efficacy of Ultrasonography for MIPO in Distal Tibia Fractures
Authors: Lee Gi-Soo , Song Jaehwang , Kang Chan 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Restoration of normal anatomic alignment is most important aspect of the minimally invasive plate osteosynthesis (MIPO) for tibia fracture. The purpose of this study was to verify the usefulness of ultrasonography of MIPO in tibia fractures. Methods: Of the tibia fracture patients were admitted to the emergency department patients who plan to MIPO surgery were enrolled. We measured maximum angular formation in posteromedial and anterior edge of tibia using ultrasonography (US). And then, we measured maximum angular formation using mobile C-arm images after closed reduction in operating room. The accuracy was measured and compared using 3-dimensional computed tomography (3D-CT). Results: There was no significant difference in accuracy between C-arm and US. However, the use of C-arm during surgery was reduced by using US. By using US, we could determine that the reduction is adequate without the lateral and oblique C-arm images. Conclusion: The use of US is useful in reduction for tibia fracture. It seems that US is effective for confirmation of reduction state and considered safe and non-invasive because it can reduce the radiation exposure by using C-arm.
Comparison of Clinical Outcomes after Arthroscopic Anterior Talofibular Ligament Repair with or without Inferior Extensor Retinaculum Augmentation
Authors: Lee Sung Hyun 
Published: November 2020

Category: Sports; Arthroscopy Introduction/Purpose: Though several arthroscopic surgical techniques for the treatment of lateral instability of the ankle have been introduced recently; the effect for the inferior extensor retinaculum augmentation is remained unclear. The purpose of this study was to compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair with or without additional retinaculum augmentation. Methods: We performed a retrospective review between 2017 and 2018 of 61 consecutive patients who underwent arthroscopic ATFL repair surgery for chronic ankle lateral instability. The exclusion criteria were previous surgery on affected ankle and combined medial ligament instability. Demographic data were evaluated including age, gender, smoking, Body mass index, generalized hyperlaxity and concomitant lesions. Patients were divided into two groups according to whether retinaculum repair or not. Clinical results were analysed to compare groups A and R preoperatively and at minimum follow-up of 1 years by using the Visual Analogue Scale, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome score (FAOS), and Karlsson Ankle Functional Score. Radiologic outcome evaluations were performed preoperatively and at 2 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: A total of 62 patients were included in this study. Patients were divided into two groups: group A consisted of 29 patients who underwent only arthroscopic ATFL repair and group R consisted of 32 patients who underwent arthroscopic ATFL repair and additional retinaculum augmentation. There was no difference statistically between two group in demographics (Table 1). All clinical scores were improved after surgery in both groups. (P<0.001) There were no differences were found in VAS, AOFAS score, total FAOS and Karlsson score between two groups. However, sports activity unit in FAOS, there were significant differences between group A (71.4 +- 8.1) and group R (83.4 +- 8.6) (Table 2). (p=0.032) Radiographic data also showed no differences (Table 3). Conclusion: Arthroscopic ATFL repair achieved improved outcomes postoperatively with or without retinaculum augmentation. However, among physically active patients with chronic ankle lateral instability, arthroscopic ATFL repair with retinaculum augmentation results in better sports activity unit in FAOS as compare with arthroscopic ATFL repair alone.
Prospective Evaluation of Opioid Consumption in Multimodal Analgesia Following Isolated Hallux Valgus Correction or First MTP Joint Arthrodesis
Authors: Lee Wonyong , Prat Dan , Farber Daniel C. , Wapner Keith L. , Chao Wen 
Published: November 2020

Category: Other; Bunion; Midfoot/Forefoot Introduction/Purpose: There is no standard guideline for prescription opioids for postoperative pain management following outpatient foot and ankle surgery. Multiple previous studies demonstrated that opioids were overprescribed. The purpose of this study was to prospectively investigate opioid consumption using multimodal analgesia regimen after two of the most common forefoot surgeries: isolated hallux valgus correction or 1st metatarsophalangeal (MTP) joint arthrodesis. Methods: We prospectively investigated opioid prescription and consumption of total 21 patients who underwent isolated hallux valgus correction with distal soft tissue procedure and proximal first metatarsal crescentic osteotomy or 1st MTP joint arthrodesis. Postoperative pain was managed using multimodal analgesia including oxycodone, ibuprofen, acetaminophen, and regional ankle block. Patients were instructed to take 5mg of oxycodone every 4 hours as needed, and 600 mg of ibuprofen as well as 1,000 mg of acetaminophen every 8 hours regularly. The number of pills patients consumed for oxycodone was recorded at postoperative follow-up at 1-week, 2-week, 4-week, 8-week, and 12-week. Subgroup analysis was performed to evaluate opioid consumption according to the prescription type: Only oxycodone was prescribed in group A while oxycodone as well as prescription strength ibuprofen and acetaminophen were prescribed in group B. Another subgroup analysis in opioid consumption was performed based on the quantity of opioid prescription and procedure type. Results: The overall mean opioid consumption in 12 weeks of the postoperative period was 16.2 pills per patient with an average of 37.3 pills prescribed. Lower opioid consumption was noted in group B when prescription ibuprofen and acetaminophen were prescribed compared to group A when patients took over-the-counter (OTC) ibuprofen and acetaminophen: 9.0 pills vs 24.1 pills, respectively (P = 0.036). There was a trend showing higher opioid consumption in patients prescribed greater than 30 pills of oxycodone compared to less than or equal to 30 pills: 22.0 pills vs 9.8 pills, respectively (P = 0.099). No significant difference was found in opioid consumption according to the procedure type: 15.8 pills in hallux valgus correction vs 16.5 pills in 1st MTP joint arthrodesis (P = 0.750). Conclusion: This study showed that on the average, patients took 16.2 pills out of 37.3 pills of the prescribed oxycodone after isolated hallux valgus correction or 1st MTP joint arthrodesis using our multimodal analgesia regimen. Patients who were prescribed prescription strength ibuprofen and acetaminophen consumed opioid significantly less than those who took the OTC strength. No significant difference was noted in opioid consumption between isolated hallux valgus correction and 1st MTP joint arthrodesis.
Ortho-Plastic Approach in Management of Open Pilon Fractures
Authors: Lim Jiang An , Thahir Azeem , Krkovic Matija 
Published: November 2020

Category: Trauma; Ankle Introduction/Purpose: The BOAST (British Orthopaedic Association Standards for Trauma) guidelines do advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines including relatively aggressive bone debridement. Methods: A retrospective analysis of open pilon fractures treated between 2014 and 2019 was conducted. Injuries were graded according to the Gustillo-Anderson classification and all patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot & Ankle Score (AOFAS) at 6 months after definitive surgery. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 (Range: 3-24) hours. Definitive fixation was performed when the wound was healed, with the mean time from primary surgery to definitive surgery being 24.5 (Range: 7-60) days. Results: There was a total of 20 patients. The mean age was 50.5 (Range: 16-88) years. Follow-up was for an average of 25.1 (Range: 9-36) months. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 9.3 (Range: 4-18) months. The mean AOFAS score was 64.4 (Range: 15-90). Definitive treatment via Taylor Spatial Frame was performed on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement, while 3 patients had Stimulan beads with antibiotics. There were no cases of deep infection, however a superficial wound infection was found in 9 patients (45%). Conclusion: Results of our study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with antibiotics, external fixators and patient tailored timing of definitive surgery achieves low rates of wound infection and complications for patients with open pilon fractures. We suggest treating these fractures with the availability of Orthoplastic care and with an MDT approach.
Outcomes of Tibiocalcaneal Arthrodesis in High Risk Patients: An Institutional Cohort of 18 Patients
Authors: Love Bridgette , Alexander Bradley , Halstrom Jared R. , Barranco Hannah M. , Cage Spaulding F. Solar; Benjamin B. , Greco Elise M. , Ray Jessyca , Shah Ashish 
Published: November 2020

Category: Hindfoot Introduction/Purpose: Tibiocalcaneal (TC) arthrodesis is commonly performed in patients with severe hindfoot disease. These include severe Charcot deformities, ankle malformations, chronic osteomyelitis (COM), and avascular necrosis (AVN). The talar vasculature becomes disrupted to the point that the bone can no longer be salvaged. The procedure involves performing a talectomy and fusing the tibia to the calcaneus. This helps in preserving the remaining hindfoot anatomy while allowing the patient to regain function and mobility. Our study highlights certain risk factors that influence the rate of postoperative complication after tibiocalcaneal surgery. Methods: We retrospectively reviewed the charts of 18 patients from a single institution who underwent tibiocalcaneal arthrodesis between the years of 2011 and 2019. Preoperative diagnoses, comorbidities, post-operative outcomes were noted among all patients. Then, the rates of non-union, below-knee amputations, revision surgeries, postoperative infections, and hardware failure were recorded. This data was then analyzed to determine which preoperative and perioperative factors affected postoperative outcomes for patients after tibiocalcaneal arthrodesis surgery. Results: Nonunion was the most commonly reported complication in this series. Eight of the eighteen patients were documented to have nonunion including three patients with stable pseudarthrosis. Diabetic patients had a slightly higher incidence of nonunion (4 of 7 patients) compared to those without diabetes (4 of 11 patients). Of the 9 patients diagnosed with Charcot arthropathy, 5 had nonunion. Three of five individuals with a BMI ranging from 25-30, and four of six individuals with a BMI of greater than 30 had a nonunion. Infection was a post-operative complication for four of the eighteen patients. Two of the four patients had multiple comorbidities in addition to chronic infections in the joint which were recurrent after surgery. Conclusion: In conclusion, TC arthrodesis provides a viable option for high risk patients with complicated ankle pathology who have not had successful outcomes from previous treatment. It is not without complications considering the comorbidities the patients present with before requiring this procedure. Further studies are necessary in order to validate the trends of outcomes and comorbidities of patients with TC arthrodesis. [Table: see text]