bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of Staged Treatment with External Fixation for High Energy Calcaneus Fractures
Authors: Kohring Jessica M. , Neumaier Mackenzie A. , Ketz John P. 
Published: November 2020

Category: Trauma; Hindfoot Introduction/Purpose: High energy calcaneus fractures have significant soft tissue compromise and typically poor outcomes. The purpose of this study was to describe patient complications and outcomes, after undergoing staged treatment for high energy calcaneus fractures, including initial treatment with medial calcaneal external fixation followed by definitive reconstruction. Methods: A retrospective chart review with prospective data was performed from April 2013 to February 2019. Inclusion criteria for the study included: patients >18 years of age, closed Sanders III and IV fractures or open fractures of the calcaneus. Patients were initially treated with placement of a medial based external fixator with closed reduction. Once the soft tissue envelope had improved, definitive fixation was performed, either ORIF or ORIF with primary subtalar fusion. Results: There were a total of 15 patients that met inclusion criteria for the study. 9 of the fractures were open and 6 were closed. The medial calcaneal external fixation (ex-fix) was placed at a mean of 2.0 (0-12) days after initial injury. The definitive procedure occurred at a mean of 23.6 (12-42) days after ex-fix placement. 11 of the patients underwent calcaneus fracture ORIF with primary subtalar (ST) fusion and 4 patients were treated with calcaneus fracture ORIF alone. 14 (93%) of the patients showed radiographic union at an average of 6.7 months. Mean PROMIS scores showed improvement in physical function, mood, and a decrease in pain at an average of 19 (5-72) months after initial injury. The average VAS pain score was 3.5 (0-7). Conclusion: A staged protocol for high-energy and open calcaneal fractures is an effective tool in treating these difficult injuries. It allows the soft tissues to improve while maintaining length and alignment of the fracture for definitive fixation and minimizing complications. There were improvements in physical function, mood, and a decrease in pain at final follow-up of almost 2 years. [Table: see text]
Ankle Joint Pressure in Supination-External Rotation Injuries: A Dynamic Biomechanic Cadaveric Study
Authors: Krause Fabian , Zderic Ivan , Seidel Angela , Gueorguiev Boyko , Attinger Marc C. , Foesel Andreas 
Published: November 2020

Category: Ankle; Basic Sciences/Biologics; Trauma Introduction/Purpose: In isolated lateral malleolar fractures of the supination-external rotation (SER) type and competent medial stabilizers (type II and III), non-operative treatment has yielded excellent outcome. With complete rupture of the deltoid ligament (SER type IV) fracture instability increases substantially. The rationale for operative treatment of SER type IV fractures is based upon good clinical results and previous biomechanical studies. A significant reduction of the ankle contact area that however is caused by an artificially forced lateralization of the talus in the ankle mortise has been demonstrated. Presumed resultant elevated joint contact stresses are thought to lead to ankle arthritis in the longterm. Methods: In 12 lower leg specimen SER type injuries were simulated by gradual bony and ligamentous destabilization of the ankle from lateral to medial according to the mechanism of injury as described by Lauge and Hansen. High-resolution pressure sensors placed in the ankle joint recorded tibio-talar pressure changes at physiologic weightbearing (700N) in three positions (plantigrade, 10° dorsiflexion and 20° plantarflexion). Results: With increasing instability changes of the ankle kinematics were seen in SER II and III fractures with the same trend also in SER IV lesions. In the plantigrade position, the medial clear space (MCS) increased significantly from an average of 2.5+-0.4mm (no fracture) to 3.9+-1.1mm (SER type IV fracture). However, the corresponding peak pressure increased only slightly from 2.6+- 0.5 mPa to 3.0+-1.4 mPa on average, and the contact area decreased slightly from 810+-42 mm2 to 735+-27mm2 on average representing a non-significant reduction of only 9% of the contact area (p=0.08) after the deep deltoid ligament was completely dissected.The comparison of the results in plantigrade and plantarflexed position revealed substantial differences for MCS, contact area and center of force. Conclusion: Under physiologic load SER type IV isolated lateral malleolar fracture with completely disrupted deep deltoid ligament led to a significant increase of the MCS, but neither to a significant decrease of the of the joint contact area nor significant increase of peak pressure. Clinical Relevance: The findings of this biomechanical study support the recently reported good clinical results of non-operative treatment of SER type II to IV fractures.
Compression Wrapping for Calcaneal Fractures after Extensile Lateral Approach: Results of a Retrospective Study
Authors: Kulwin Robert , Shah Sapan , Haddad Steven L. , Weatherford Brian M. 
Published: November 2020

Category: Trauma Introduction/Purpose: Displaced intraarticular calcaneus fractures comprise the majority of all calcaneus fractures. Many are indicated for open reduction and internal fixation (ORIF) through an extensile lateral approach (ELA). Unfortunately, this approach has reported complication rates of up to 32%. Improved edema management may reduce the incidence of complications. While compression wrapping has been shown to reduce wound complications in ankle arthroplasty, it has not been well studied in lower extremity trauma. This study aimed to evaluate the benefit of compression wrapping in calcaneus fractures treated surgically with an ELA. Methods: This study included 19 patients from 2015-2018 who underwent ORIF of closed intra-articular calcaneal fractures via an ELA by two surgeons. Demographics, comorbidities, fracture characteristics, and time to surgery were recorded. Following surgery, the extremity was initially immobilized in a short leg splint with transition to serial compression wrappings on postoperative day two. Wrappings involved application of multi-layered cotton cast padding and short stretch elastic bandages to the extremity in a distal to proximal fashion. Wraps were replaced every three days by trained physiotherapists until the two- week postoperative visit. The primary outcome was development of a wound complication. A minor complication was defined as wound appearance prompting initiation of oral or IV antibiotics or local wound care. A major complication was defined as development of flap necrosis or return to the OR for debridement. Results: Mean age was 47.7 years. 3 patients (15.7%) were diabetic, and 7 patients (36.8%) were smokers. Mean BMI was 26.9 kg/m2 (SD 4.4). Mean time to surgery was 11.4 days from injury (SD 6.93). The rate of minor soft tissue complication was 4/19 (26.3%); 2 patients required oral antibiotics only, 1 local wound care only, and 1 both antibiotics and local wound care. The rate of major complication was 2/19 (10.5%), with 1 patient requiring a return to OR and another requiring both a return to the OR and IV antibiotics. Of those patients, 1 was noncompliant with the protocol. All patients progressed to eventual soft tissue healing. Statistical analysis identified diabetes as a risk factor for any complication (p=0.02, relative risk 5.3). Conclusion: Compression wrapping resulted in a low incidence of major soft tissue complications in calcaneus fractures treated with an extensile lateral approach. Compression wrapping is an effective method of post-operative soft tissue management for calcaneal fractures, and may have further applications for similar high energy foot and ankle fractures. Further studies are warranted to determine whether this novel wound care technique is superior to standard post-operative wound care.
Restoration of Talar Height, Alignment, and Implant Survival after Revision Total Ankle Arthroplasty with Minimum 2-Year Follow-up
Authors: Kulwin Robert , Haddad Steven L. 
Published: November 2020

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: With the introduction of improved implants and long-term outcome data, total ankle arthroplasty (TAA) is becoming an increasingly common surgical treatment for end-stage ankle osteoarthritis. However, the treatment of a failed primary TAA remains a significant challenge. Ankle arthrodesis as a salvage procedure results in high rates of non-union and collapse. Revision arthroplasty is an alternative to arthrodesis, but there is little published data on the outcomes of revision total ankle arthroplasty (RTAA). This study presents 2-year outcomes after RTAA using a modular prosthesis and metal/cement augmentation to reconstitute talar height, as well as restore sagittal and coronal alignment. Methods: A retrospective review was performed on 23 patients who underwent RTAA after failed primary TAA. Demographic data, talar height, coronal and sagittal alignment, and range of motion pre-revision and at most recent follow up were recorded. Failure was defined as need for revision surgery during the follow up period. Radiographic measurements were performed on weight bearing lateral and AP radiographs. For Agility implants, measurement on weight-bearing computed tomography (WBCT) was required. The measurement methodology was performed on both radiographs and WBCT for validation and measurements were consistent across all implants. Results: Patient follow-up ranged from 2 to 3.9 years, with a mean of 2.56 years. 17 of 22 RTAA did not require further revision. Of the five failures, one was due to deep infection, four to subsidence of the talar component. For the 17 successful revisions, average pre-operative coronal malalignment was 3.8◦ (range 7.4◦ varus to 15◦ valgus), and average post-operative malalignment improved to 2.6◦ (range 0◦ varus to 7.9◦ valgus), but this difference was not statistically significant (p=.09). Average pre-operative sagittal malalignment was 8.7◦ (range 20.7◦ plantarflexion to 20.1◦ dorsiflexion), and average post-operative malalignment improved to 3.6◦ (range 8.3◦ plantarflexion to 9.3◦ dorsiflexion), which was statistically significant (p=.01). Talar height improved by 3.9mm (p< 0.001), and range of motion from 16.9◦ to 25.0◦ (p,0.001). Conclusion: At a minimum of two years of follow up, revision arthroplasty shows improved alignment, talar height, and range of motion. While the failure rate remains significantly higher than primary ankle arthroplasty, it is comparable or superior to that of conversion to arthrodesis. The complexity of RTTA varies greatly due to surgical risk, soft tissue quality, and residual bone stock amongst other factors, which limits the generalizability of this patient cohort. RTAA is a viable option for the salvage of failed primary TAA, with functional and radiographic improvements shown at mid-term follow-up.
Foot Loading Symmetry is Improved after Unicompartmental Knee Arthroplasty
Authors: LaBaze Dukens , Zarei Milad , Urish Ken , Anderst William , Hogan MaCalus V. 
Published: November 2020

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: Unicompartmental Knee Arthroplasty (UKA) is a surgical option for osteoarthritis in a single compartment of the knee. Compared to Total Knee Arthroplasty (TKA), UKA is less expensive, retains the cruciate ligaments and results in lower post-operative morbidity.[1] It has been reported that about 10 percent of UKAs require revision to TKA for multiple reasons. In TKA, ankle alignment has demonstrated a significant effect on outcomes and function. [2] Plantar pressure, a measure of foot and ankle loading, changes after TKAs but has yet to be evaluated in UKAs. The purpose of this study is to evaluate the effects of medial UKA on plantar pressure which may be a variable that contributes to revisions in these patients. Methods: Following IRB approval and informed consent, we evaluated 7 adults (14 Feet) (average age 62; range: 54 to 68 years old; 4F/ 3M). All participants walked at a self-selected speed pre surgery and 7 months post-surgery. The Pedar insole pressure system (Novel), with 99 sensors per insole, was used to collect bilateral plantar pressure during gait at 100 Hz. All participants wore the same type of shoes (Nike Zoom) for the test. The insole was divided into 9 regions for analysis2 (Figure 1). The maximum pressure (MP) within each foot region was calculated for each step and averaged over all steps. Paired and unpaired t- tests were performed to identify differences in the MP from pre to post-op and between operated and contralateral sides, respectively. Results: An average of 24 steps were recorded from each patient pre and post operatively. MP became more symmetrical between feet post-operatively, with significant improvements in bilateral symmetry observed in the medial heel, medial and lateral forefoot regions (all p<0.01). The MP in the lateral midfoot region of the operative side increased during ambulation post- operatively (p<0.05). The MP in the lateral forefoot region of the non-operative side decreased post-operatively (p<0.01). Conclusion: Our results indicate that foot loading, as assessed through plantar pressure, becomes more symmetrical after unilateral UKA and may also affect non-operative foot loading. Although our sample size is small, our data is comparable with a similar study done in TKA patients which reported changes forefoot and lateral midfoot loading. [Table: see text]
Telemedicine Foot and Ankle Visits in the COVID-19 Era
Authors: Labib Sameh A. , Goel Rahul , Manz Wesley J. , Bariteau Jason T. 
Published: November 2020

Category: Other Introduction/Purpose: The current COVID-19 pandemic has created a unique problem for orthopaedic surgeons by mandating ‘social distancing’ and limiting patient-provider interactions. Centers have reacted to this by implementing Telemedicine as a way to still provide care for patients. We have developed a Telemedicine protocol we believe allows for enough information to be gathered to provide an accurate diagnosis and with high patient satisfaction. Methods: A 12-step standardized protocol was created to be used during foot and ankle Telemedicine visits. This was coupled with pre-visit preparation by the office staff with the patient as well as recommending appropriate follow-up either in person or again via Telemedicine. After implementation of this system in April 2020, we retrospectively reviewed Press-Ganey data collected for provider rating (scale 0-10) with Telemedicine visits and traditional office visits through June 2020. Scores of 9 and 10 out of 10 were grouped together to represent an excellent experience, and all other responses were grouped together as a less than excellent experience. Fischer’s exact test was used to compare samples. Results: A total of 183 patients were surveyed during this time period, 127 from telemedicine visits and 56 from in-office visits. 106/127 (83.4%) patients surveyed after Telehealth visits and 50/56 (89.2%) after in-person visits rated their visit as a 9 or 10 (p=0.37). Conclusion: The COVID-19 pandemic has changed the way that orthopaedic surgeons have needed to deliver care to their patients. Though the transition has had its difficulties, it would be a failure in progress to not recognize and adopt the advances that have been made during this time. Though the adaption of Telemedicine was made out of necessity at our institution, the lessons learned during this trying time has enabled us to provide excellent orthopaedic care through telemedicine that can continue once restrictions have been lifted.
Biomechanical Evaluation of Suture Button Spread with and without Deltoid Repair in Combined Syndesmosis and Deltoid Injury
Authors: Lau Brian , Storaci Hunter , Tam Kaysie , Lai Cara , Salazar Brett P. , Guzman Roberto , Oji David E. , Chou Loretta B. 
Published: November 2020

Category: Sports; Basic Sciences/Biologics Introduction/Purpose: Syndesmosis injuries are common and frequently occur with deltoid injuries but optimal repair remains controversial. Prior biomechanical studies have demonstrated that 1 and 2 suture buttons are equivalent to screw fixation and that parallel or divergent suture buttons are equivalent to single suture button. Prior studies, however, created constructs with suture buttons within 1cm from each other (2-3cm from joint surface). Additionally, the role of deltoid injury and repair have not been evaluated in conjunction with syndesmosis injury and repair. The purpose of this study was to biomechanically compare a narrow vs spread 2-suture button construct with and without a deltoid repair. Methods: Four matched lower leg specimens (8 total specimens) aged mean 60.2 years (range 57-66 years; 6 females and 2 males; mean BMI 21.1) were tested. Ankle motion under cyclic loading was measured in multiple planes: first in the intact state, following simulated syndesmosis and deltoid injury, then following fixation with 1 of 2 randomly assigned constructs: 2 parallel suture buttons at 2 and 3cm from joint line (narrow); and 2 parallel suture buttons at 1 and 4cm from joint line (spread), and then finally following a deltoid repair with each construct. Each state was tested at a constant 750 N axial compressive force and 5N internal/external torque. Rotation position (degrees) and anterior-posterior displacement (mm) were collected throughout the testing to characterize relative spatial relationships of the tibiofibular articulation using 3D video capture technology. Results: Narrow and spread 2-suture button constructs improved rotation and translation compared to cut state (p<0.05) but not to intact state (p>0.05). There were no significant differences in rotation or translation between Narrow and Spread constructs (p>0.05). The addition of a deltoid repair did not improve rotation or translation compared to syndesmosis repair with either construct alone (p>0.05). Conclusion: The preliminary results of this study suggest that constructs with suture button placed close together or spread apart during fixation of combined syndesmosis and deltoid injury could improve rotation and translation equally. Additionally, in a combined syndesmosis and deltoid injury, the addition of a deltoid repair to a syndesmosis repair did not strengthen the construct. These findings suggest that repair of syndesmosis alone may be sufficient in combined syndesmosis and deltoid injuries. Additional matched samples will be tested to validate preliminary findings.
Screw Fixation of the Posterior Malleolus Fragment in Ankle Fracture
Authors: Lee Gi-Soo , Song Jaehwang 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: This study aimed to evaluate the outcomes of ankle fractures with posterior malleolus fragments (PMFs)involving <25% of the articular surface treated with or without screw fixation. Methods: Among patients with ankle fractures and PMFs who underwent surgery between March 2014 and February2017, 62 with type 1 PMFs involving <25% of the articular surface were included. Of these 62 patients, 32 underwent screw fixation for PMFs and lateral and/or medial malleolar fracture fixation (group A) and 30 underwent internal fixation for malleolar fractures without screw fixation for PMFs (group B). Ankle joint alignment and fracture healing were measured using plain radiography and computed tomography (CT). Clinical outcomes were determined using the American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire, Short Form-36, and American Orthopaedic Foot & Ankle Society Scale. Results: Nonunion was not noted in either group. However, we detected union with a step-off of 2 mm or more in2 cases from group B. With regard to ankle joint alignment, 1 case in group A and 3 cases in group B showed mild asymmetry of the medial and lateral clear spaces on CT at 12 months. Clinical outcomes at 6 and 12 months after surgery were better in group A than in group B. Conclusion: Screw fixation of PMFs was effective for fracture healing and maintaining ankle alignment. Additionally, it improved short-term clinical outcomes, which we believe was due to stabilization of ankle fractures with PMFs involving <25% of the articular surface.
Clinical Outcome of Bimalleolar Ankle Fracture in Patients with Diabetes Mellitus
Authors: Lee Hong S. , Young Kiwon , Park Tae-Hoon , Lee Hong Seop 
Published: November 2020

Category: Trauma; Ankle Introduction/Purpose: Diabetes is a risk factor of postoperative complication for fracture surgery. The purpose of this study was to evaluate the clinical outcome of bimalleolar ankle fracture in patients with diabetes mellitus. Methods: Twenty two patients (an average age; 69.3 years, an average HbA1C; 7.6%) with bi-malleolar ankle Fracture received open reduction and internal fixation between March 2013 and January 2019. Complications related to surgery, progression to Charcot arthropathy, presence of nonunion were used for outcome analysis. The patients were followed for an average of 12.1 months. Results: The nonunion rate was 4.5% (1 case over 22 cases). The incidence rate of Charcot arthropathy was 4.5% (1 case over 22 cases). The patient with Charcot arthropathy was conversed to the tibiotalarcalcaneal fusion with retrograde intramedullary nail. No wound infection or soft tissue complications related to surgery was reported. Conclusion: Standard open reduction and internal fixation technique showed high union rate of bimalleolar ankle fracture in patients with diabetes mellitus. The surgeon should be cautious to the Charcot arthropathy when treating ankle fracture with diabetes mellitus.
Comparison of Open Syndesmotic Repair and Trans-syndesmotic Screw Fixation: A Biomechanical Study
Authors: Lee Hong S. , Young Kiwon , Park Tae-Hoon , Lee Hong Seop 
Published: November 2020

Category: Trauma; Ankle Introduction/Purpose: We hypothesized that open syndesmotic repair for ankle syndesmotic injury would provide adequate strength. The purpose of this study was to compare the biomechanical properties of open syndesmotic repair with those of screw fixation. Methods: Ten matched pairs of human cadaver specimens were subjected to open syndesmotic repair or screw fixation. Each specimen underwent initial intact physiologic loading, consisting of 10 cycles of external torsional loading with a peak torque of 7.5 Nm at 0.05 Hz. Post-fixation cyclic loading consisted of 50 cycles of combined axial and external rotation loading with peak torques of 750 N and 7.5 Nm at a rate of 0.05 Hz. After post-fixation loading, each specimen underwent failure loading by external rotation at 0.25 degrees/second. Failure was defined as a sudden decrease in the torque-degree curve. Failure torque and failure angle were measured. The paired t-test and Wilcoxon signed-rank test were used to analyze the data. Results: Mean failure torques were 95.63 Nm in the open syndesmotic repair group and 108.61 Nm in the screw group. Mean failure angles were 34.93 degrees in the open syndesmotic repair group and 43.55 degrees in the screw group. These data were not statistically significantly different between the two groups (p = 0.7682 and 0.4133, respectively). Conclusion: Open syndesmotic repair for ankle syndesmotic injury provides similar torsional strength to that of screw fixation. Therefore, this technique can be considered as an alternative treatment option for syndesmosis injury.