bluuebunny/crossref_metadata_2025_split huggingface dataset:
Return to Play Following High-Grade Turf Toe Injuries in National Football League Athletes
Authors: Lindsey Benjamin B. , Bakshi Neil K. , Walton David M. , Holmes James R. , Talusan Paul G. 
Published: November 2020

Category: Sports; Midfoot/Forefoot; Trauma Introduction/Purpose: Return-to-play (RTP) rates of National Football League (NFL) athletes following surgical intervention for numerous foot and ankle injuries has been reported. To our knowledge, no studies have reported on RTP rates of NFL athletes after non-operative and operative treatment of high-grade turf toe injuries. The purpose of this study was to evaluate the RTP rates in NFL athletes who sustained high-grade turf to injuries. We hypothesized that NFL athletes requiring operative intervention for high-grade turf toe injuries would have lower RTP rates and longer recoveries than athletes treated non- operatively. Additionally, we hypothesized that regardless of treatment, NFL athletes would demonstrate equal productivity following RTP. Methods: Publicly available NFL injury data was reviewed to identify athletes who sustained high-grade turf toe injuries, as indicated by surgical intervention or missed playing time of 2 weeks or more. Athletes were excluded if RTP was prevented for reasons unrelated to the injury. Demographic and performance data was obtained including a player’s injury, date of injury, date of surgery, RTP, time to RTP, number and percentage of games played, and performance. Results: 53 NFL athletes were identified with high-grade turf toe injuries that met inclusion criteria. 28 of these athletes were treated non-operatively and 25 were treated with surgery. The overall RTP rate was 91%. Athletes who were treated non- operatively had a RTP rate of 100% while athletes who underwent surgery had a RTP rate of 80% (P = 0.011). The mean time to RTP for all athletes was 140.9+-111.9 days. The mean time to RTP for non-operatively treated patients was 75.8+-99.0 days, compared with 221.4+-81.6 days for operatively treated athletes (P = 0.002). In skill position athletes who achieved RTP, 78% treated non-operatively were able to return to their prior level of performance compared to only 27% for athletes treated surgically (P = 0.032). Conclusion: There is a significant difference in return to play following surgical versus non-operative management of high-grade turf toe injuries, with only 80% of athletes achieving return to play after surgery. No athletes were able to return the same season as surgery and the mean time to RTP following initiation of treatment was significantly shorter for players who underwent non- operative management. Postoperative performance was also significantly worse in players who underwent surgical intervention compared to non-operative management. This study provides important prognostic information to high level athletes in regards to recovery following high-grade turf toe injuries
Correlation Between Three-Dimensional Biometric Weightbearing CT Assessment of Hindfoot Alignment and Conventional Measurements of Adult Acquired Flatfoot
Authors: Mansur Nacime S. , Netto Cesar de Cesar , Bang Katrina E. , Cychosz Chris , Garfinkel Jonathan H. , Lintz Francois , Bernasconi Alessio , Deland Jonathan T. , Ellis Scott J. 
Published: November 2020

Category: Hindfoot; Ankle; Other Introduction/Purpose: Semi-automatic three-dimensional (3D) biometric weightbearing CT (WBCT) tools have been shown to accurately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the Foot and Ankle Offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD. Methods: In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20 to 86) years. Three-dimensional coordinates (X, Y and Z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were harvested by two blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse plane were manually measured. Results: We found overall good to excellent intra (range, 0.84-0.99) and interobserver reliability (range, 0.71-0.96) for manual AAFD measurements. FAO semi-automatic measurements demonstrated excellent intra (0.99) and interobserver reliabilities (0.98). Hindfoot moment arm (p<0.00001), subtalar horizontal angle (p<0.00001), talonavicular uncoverage angle (p=0.00004) and forefoot arch angle (p=0.0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R-squared value of 0.79. A value of hindfoot moment arm of 19.8mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8mm and 14.6 when the HMA was equal or higher than 19.8mm. Conclusion: We found that 3D WBCT semi-automatic measurements of Foot and Ankle Offset (FAO) significantly correlated with traditional markers of pronounced AAFD. HMA, subtalar horizontal angle, talonavicular uncoverage angle and forefoot arch angle were found to explain 79% of the variations in FAO measurements. FAO Measurements were also found to be more reliable than the manual measurements. The FAO offers a more complete biomechanical and multiplanar assessment of the AAFD, that that accounts for relative positioning of the foot tripod and the center of the ankle joint, representing in a single measurement the three-dimensional components of the deformity.
Contamination Profile of the Mini C-Arm Fluoroscopy Unit in Orthopedic Surgery
Authors: Momenzadeh Kaveh , Williams Caroline , Czerwonka Natalia , Alemi Mohammad Mehdi , Kwon John Y. , Nazarian Ara , Miller Christopher P. 
Published: November 2020

Category: Other; Ankle Introduction/Purpose: Fluoroscopy is critical for orthopaedic surgery. The mini C-arm is popular among foot and ankle surgeons owing ease of easy, maneuverability, and cost effectiveness. However, there are concerns that the mini C-arm may represent a potential source of contamination and increasing the risk of postoperative infection. Evaluation of large c-arm drapes have shown high rates of contamination. However, the mini C-arm may be even more concerning due to how it is handled. The mini c-arm is continuously manipulated by the surgical team who then return to the surgical field carrying with them any potential cross-contamination.Objective: We hypothesize that there is significant contamination of the drape, and that specific locations of the drape are at higher risk. Methods: 50 foot and ankle surgery cases which required the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were chosen for sampling. Locations were defined based on commonly touched areas on the drape by the surgical team, and their proximity to the non-sterile field. Negative controls were obtained by separately sampling an additional 20 mini C-arm drapes after draping c-arm and waiting for average surgery time. Positive controls were obtained by sampling non- sterile surfaces within the OR.Culture Q-swabs were used for sampling defined locations, using an established semiquantitative technique. Plates were incubated at 37 °C for 48 hours. Based on the number of quadrants on plate where colony growth was observed, bacterial growth was graded on a scale of 0, 1+, 2+, 3+, or 4+. Contamination threshold was defined as any growth pattern of 1+ or higher. Results: Figure 1 shows the contamination rates of the sampled areas of the c-arm drape. Contamination was noted in 70% of the cases for at least one area, and in two or more areas in 38% of cases.Contamination rates were significantly higher on defined locations in comparison with their relative negative control, except for locations 4 and 5. (P<0.05)The most frequently contaminated location was location #2 (30%) followed by Location 1 (26%), and then location 8 (22%). (P<0.05) Conclusion: Bacterial contamination of the drape was found to be common (70% of cases) after foot and ankle surgery. Contamination was more common on the superior and inferior aspects of the mini c-arm. This correlates to the area that is most commonly manipulated by the surgical team to position the arms of the c-arm. This information can be utilized by surgeons to identify and avoid high risk areas and, in high risk cases, they may consider changing gloves or re-draping the mini c-arm part way through the case.
Relationship Of Press Ganey® Satisfaction and Promis Function and Pain in Foot and Ankle Patients
Authors: Nixon Devon C. , Zhang Chong , Weinberg Maxwell , Presson Angela , Nickisch Florian 
Published: November 2020

Category: Other Introduction/Purpose: Patient satisfaction has garnered interest as a tool to measure healthcare quality. The Press Ganey (PG) instrument was designed to assess outpatient patient satisfaction by probing multiple domains of the patient experience including clinic wait-times and overall assessment of the provider practice. However, orthopaedic studies in total joint arthroplasty, spine, and hand patients have offered conflicting relationships between PG satisfaction metrics and patient-reported outcome (PRO) measures. No prior study has assessed the relationship between PG and PROs in foot and ankle patients. Here, we tested if there was an association between PROMIS outcomes and PG satisfaction scores. Methods: Between 2015 and 2017, new patient visits to orthopedic foot and ankle clinics at a single academic center were retrospectively analyzed. Patients that completed PG satisfaction surveys were included for study. All patients who completed PG surveys had completed either one or both of the PROMIS physical function (PF) or pain interference (PI) metrics administered by computerized adaptive testing. Negative binomial regressions were used to compare PRO scores to PG overall satisfaction and PG satisfaction with care provider, adjusting for patient characteristics. Results were reported as dissatisfaction score ratios along with 95% confidence intervals (CIs) and P-values. Results: Out of 3,984 new patient visits, only 441 completed the PG survey (11.3% response rate). Ceiling effects were seen with PG data as 64% of our patients reported perfect satisfaction with care provider and 27% had perfect overall satisfaction. Higher function on the PROMIS PF was weakly associated with increased overall satisfaction (Ratio=0.82, 95% CI: 0.68-0.99, P=0.039) and increased satisfaction with care provider (Ratio=0.60, 95% CI: 0.40-0.92, P=0.019). However, pain (PROMIS PI) was not associated with overall satisfaction or with satisfaction with care provider. Conclusion: Patient satisfaction was weakly related to patient-reported function but not pain among new foot and ankle clinic patients. It appears from our data that PG and PROMIS measure differing components of patient care. Further, our findings showcase the limitations of the PG tool including low response rates and notable ceiling effects. Until we achieve a broader understanding of the relationship between patient satisfaction and clinical and surgical outcomes, we would caution against the use of PG data in the assessment of quality of care and reimbursement for orthopaedic foot and ankle surgery. [Table: see text]
The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
Authors: Reb Christopher W. , Haupt Edward T. , Berlet Gregory C. 
Published: November 2020

Category: Trauma; Other Introduction/Purpose: Knee flexion has been demonstrated to impede popliteal venous return with large effect size among patients lying supine for surgery. Passive popliteal flow impedance has also been suggested to occur with knee scooter usage due to knee flexion. This study compared the effect of knee flexion angles on popliteal venous return between upright, crutch and knee scooter positioning when immobilized. Further, the countervailing effect of standardized hallux musculovenous pump activation was observed. Methods: This was an IRB approved study of young, healthy volunteers. Popliteal venous diameter and flow metrics were assessed with venous ultrasonography and compared between straight leg, crutch, and knee scooter positioning while wearing a walking boot and nonweightbearing. Flow was assessed with muscles at rest and with hallux musculovenous pump activation via active oscillation between hallux metatarsophalangeal joint extension and flexion at one motion per second (0.5 Hz) as paced by a metronome. Observer consistency was assessed. Paired-sample Student’s t-test and the Wilcoxon signed rank tests were used to assess within-subject differences for diameter and venous flow parameters, respectively. Knee flexion and musculovenous pump activation effects sizes were calculated. A priori sample size indicated 24 subjects were needed to achieve 80% power to detect a significant ( p < 0.006 ) difference in medial flow for any of 8 comparisons, assuming large effect sizes. Results: 16 of 24 (67%) subjects were female. Twelve limbs (50%) were right sided. The mean age was 21.9 years (SD 3.0 years) and the mean body mass index was 21.9 (SD 1.9). Observer consistencies were excellent (0.93 to 0.99). No significant differences in mean vessel diameter, time-averaged mean velocity, and total volume flow occurred. Corresponding knee flexion effect sizes were small (range -0.04 to -0.26). A significant decrease (-24%) in active median time-averaged peak velocity (TAPV) occurred between upright and crutch position (20.89 cm/s vs. 15.92 cm/s, p < 0.001) with a medium effect size (-0.51). Hallux musculovenous pump increased all flow parameters (all p< 0.001) and effect sizes were comparatively larger (>0.6) across all knee flexion positions. Conclusion: Compared to values reported for supine individuals, upright passive popliteal venous return was observed to be markedly diminished at all knee flexion angles. Knee flexion had minimal effect on diameter, a small effect in further diminishing TAMV and TVF and a medium effect on diminishing TAPV. Hallux musculovenous pump activiation had a large effect on increasing flow at all knee flexion angles. Patients may well be counseled to use toe motion to counter the negative effects of gravity, and to a lesser extent knee flexion, when using crutches and knee scooters while their ankle is immobilized.
Percutaneous Chevron Akin (Peca) Osteotomy for Treatment of Hallux Valgus Deformity: The Long- Term Results
Authors: Robinson Peter W. , Ray Robbie , Goff Thomas A. , Dearden Paul M. , Watt Clare , Smith Margaret , Lam Peter 
Published: November 2020

Category: Bunion Introduction/Purpose: Little is known about the long-term results of percutaneous hallux valgus correction, particularly the recurrence rate and factors leading to recurrence. Methods: We retrospectively reviewed a single surgeon consecutive series of percutaneous chevron and akin osteotomies (PECA) performed between 2012-14 on 127 feet in 86 patients. Mean age was 52+-13 years at surgery and mean follow up (FU) was 69+-7 months. Patient reported outcome measures (PROMs) were completed by 65 patients (MOXFQ, VAS pain (0-100)) and Likert satisfaction scale by 86 patients. Pre-operative, 6 month and final follow up weight bearing radiographs were available for 68 feet. Radiological parameters measured were the hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA). The data was normally distributed and presented as mean+-SD. Paired t-test was used to compare pre- and post-operative angles. Ordinal logistic regression was used to test for significant dependent variables on PROMs. Results: Mean MOXFQ was 10+-16 and mean VAS pain was 6+-13 out of 100 at a mean FU of 69+-7 months. 99% (85/86) patients were highly satisfied or satisfied. Mean HVA improved from 28.3+-8.1º to 8.4+-5.6º at final FU (p<0.001). No clinically relevant difference in HVA was seen between 6 months and final FU. Mean IMA improved from 12.7+-2.9º to 6.2+-2.7º at final FU (p<0.001). 2.9% (2/68) had an HVA >20º at final FU, these both started with a pre-operative HVA >40°. Pre-operative HVA >40º was significantly more likely to have an HVA >20º at final FU than those with pre-operative HVA <40º (22% vs 0%, p<0.001). There were 5 re-operations for removal of screws. 1 foot had hallux varus, but was still satisfied. Conclusion: The 5 year results for PECA hallux valgus correction show high levels of patient satisfaction, function and pain relief, with low complication and re-operation rates. Radiological correction is maintained at long term FU.
Does Lag Screw Retightening Improve Compression in Hindfoot Arthrodesis?
Authors: Rugg Amanda , Requist Melissa , Johnson Brooks , Son Michelle , Alvarez Alicia , Latt L. Daniel 
Published: November 2020

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: Non-union and delayed union are common complications following hindfoot arthrodesis. The failure to obtain and maintain compression at the arthrodesis site may be a causative factor. Partially threaded cannulated ‘lag’ screws are commonly used for fixation in hindfoot arthrodesis; however, the ability of these screws to maintain compression in the hindfoot bones has not been well-characterized. The goals of this work were to: 1) quantify the stress relaxation response of hindfoot bones when compressed with a lag screw, particularly compression change upon screw retightening, and 2) compare the results to prior studies on stress relaxation in direct bone compression. Methods: 12 pairs of calcaneus, talus and tibia bone cylinders, 25mm in diameter, were cut with a keyhole saw from fresh thawed cadaveric feet. The bone cylinders were prepared for simulated arthrodesis by removing the cartilage and flattening the subchondral surface with an oscillating saw. A Futek LTH 300 donut load cell and two metal washers were sandwiched between the two bone cylinders. An 8.0mm partially threaded cannulated lag screw (Smith and Nephew) was placed from the posterior- inferior aspect of the calcaneus cylinder to the anterior-superior aspect of the talus cylinder to simulate subtalar arthrodesis, or from the superior aspect of the tibia cylinder to the inferior aspect of the talus cylinder. Compression was recorded continuously as the screws were tightened by three-quarters of a turn and left untouched for 3 minutes. Recording continued as the screws were retightened one quarter-turn and then left untouched for 30 additional minutes. Results: Both initial and subsequent compression with a lag screw demonstrated a stress relaxation pattern, with increased maximum compression and slowed decay upon retightening. Maximum compression after three quarter-turns and retightening averaged 284 N and 351 N, respectively (n=12; t=-2.55; p=0.0136). Time to decay to 80% of maximum compression after three quarter-turns and retightening averaged 34 and 528 (n=9; t=-2.59; p=0.0159) seconds, respectively, compared to 21 seconds for direct compression. Compression loss 30 minutes after retightening averaged 25.5% (SD=8.8%), compared to 34.3% for direct compression. Conclusion: The maximum compression attained following retightening was significantly greater than the maximum compression attained after initial tightening. The time required to reach 80% of maximum compression was significantly longer after subsequent compared to initial maximum compression. These findings suggest that screw retightening before surgical wound closure may slow compression loss, which could increase the likelihood of successful arthrodesis. Lag screw compression resulted in a lower percent compression loss and loss rate compared to direct compression, which was previously used to describe bone viscoelasticity.
Revision Total Ankle Replacement using the Inbone 2 System, Nottingham Experience
Authors: Salem-Saqer Hatem , Raglan Martin , Dhar Sunil 
Published: November 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Inbone Total Ankle Replacement System (Wright) is a modular stemmed ankle replacement, it is marketed as for both primary and revision TAR, it has been in use at Nottingham since 2016 mainly for revisions, we are reporting our experience with this system and our early results. Methods: This is a retrospective study with prospective collected data. We identified 27 (18M/9F) patients who had Inbone 2 TAR for revision surgery during the period August 2016 -March 2019. The mean follow up was 21 months (7-38months). Mean age of 69 years (51-81).All ankle revisions were a single-stage revision apart from 1 patient who had a 2 stage revision as at the first stage infection was suspected, it was left with a cement spacer and when all samples came back negative the second stage was carried out.All patients had follow up appointments at 6 weeks, 3,6 and 12 months. Patients were required to fill in MOXFQ questioner and all had weight-bearing radiographs on every follow up appointment.The indication for the surgery was aseptic Loosening 23, Malalignment 1 Insert wear 2 and heterotopic ossification 1. Results: 20 patients had concurrent procedure during the surgery(Table 1). There was 1 deep wound infection that required DAIR procedure 3 weeks after the revision surgery and has gone to make full recovery, no other complication were reported.Improvement in clinical outcome and PROMS data was noted on follow up, MOXFQ for Pain improved from 70 pre op to 34 at 6 months and 32 at 1 year(p<0.001 paired t test),The outcome for Walking improved from 69 pre op to 41 at 6 months and 40 at 1 year(p<0.001 paired t test).Radiological alignment was maintained in all ankles both in the coronal and the sagittal plain, posterior heterotopic ossification was noted in 8(29%), No loosening or signs of failure at any follow up appointment Conclusion: This is one of the largest series of this implant used in revision TAR. Our early results show considerable improvement in patient outcomes with very low complications and no failures.This implant provides a good option as a revision implant and our view that it is a superior solution to ankle fusions for failed total ankle replacements [Table: see text]