bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of Over the Counter Analgesics Post-Operatively in Foot and Ankle Surgery
Authors: Khan Shamis , Lam Kenrick , Acebo Joshua , Jain Rishabh , Panchbhavi Vinod 
Published: October 2019

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Managing post-operative pain in patients has become a growing concern given the increasing focus on controlling opioid use. Over the counter (OTC) analgesics such as tylenol and ibuprofen have been shown to be useful adjuncts to post-operative pain regimens and may decrease opioid use. However utilization of these adjuncts may be limited by patient education especially if they are not formally prescribed by the physcian. In this work we aim to identify how often post-operative patients utilize OTC analgesics to supplement their pain control and what are the barriers to usage. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18 and not incarcerated. Bony procedures included any osteotomy, fracture fixation, or arthrodesis. This subset of patients were then called and surveyed about their post-operative pain. 114 patients met inclusion criteria. Results: 42 patients responded to the survey. 27 (64%) of patients did not supplement their pain control with OTC analgesics. The most common reason why (13/27 patients) OTC meds were not used was because pain control on narcotics alone was sufficient. Other reasons included dislike of polypharmacy, not believing they would be efficacious, and not knowing that it is was safe to take them. Total narcotic use between the two groups was higher in the OTC group however (760 mg morphine equivalent in the no OTC group and 1073 mg morphine equivalent in the OTC group, p = 0.25). Conclusion: This study highlights the misconception of patients in regards to optimal pain control. The higher absolute narcotic usage in the OTC group may reflect that patients who feel the need to supplement their pain regimen have lower pain tolerance to begin with.
Are Sicker Patients Less Likely to Improve after Ankle Fusion?
Authors: Kohring Jessica M. , Houck Jeffrey R. , Flemister Sam , Ketz John P. , Oh Irvin , Baumhauer Judith F. 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: The influence of pre-existing medical conditions on post-operative patient reported outcomes are important to consider when selecting and preparing a patient for surgery. The purpose of this study was to determine the impact of medical comorbidities on post-operative physical function and pain in patients undergoing ankle arthrodesis. Methods: This was a Global IRB approved retrospective review of 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS PF and PI computerized adaptive test. A chart review was performed to determine the Charlson Comorbidities Index (CCI), ASA scores, and demographic data. A multivariate analysis predicting pre- and post-operative PROMIS PF based on PI, ASA score, and CCI was performed. Spearman correlations for CCI, ASA, pre- and post-operative PROMIS T- scores for PF and PI were calculated. Results: The ASA score and CCI were not associated with pre-operative PI, although the CCI was predictive of pre-operative physical function (p=0.06), indicating that patients with a higher CCI had lower pre-operative PF. Pre-operative PF and ASA were the best individual predictors of physical function at 6 months post-operatively (r=0.51). At 6 months after undergoing ankle arthrodesis, there was no correlation between CCI and post-operative PROMIS PF and PI outcome T-scores (r=0.02, r=-0.06, respectively), this continued at 1 year post-operatively (r=-0.17, r=0.04, respectively). Demographic data, ASA, CCI, and mean PROMIS T-scores are included in Table 1. Conclusion: Sicker patients (ASA score=3) and those with lower pre-operative function recovered more slowly as indicated by lower physical function at 6 months and obtained less physical function benefit from ankle fusion than healthier patients at one year. The results of this study can assist surgeons with risk stratification and educating patients about surgical expectations as pre- operative physical function and ASA score appear to influence post-operative physical function after undergoing ankle arthrodesis.
Matching Patient Expectations after Ankle Fusion Based on Patient Reported Outcome Measures
Authors: Kohring Jessica M. , Houck Jeffrey R. , Flemister Sam , Ketz John P. , Oh Irvin , Baumhauer Judith F. 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: Much research on outcomes after ankle fusion focuses on gait changes, progression of adjacent joint arthritis, and other clinical measures, but little has been reported on the patient’s perspective. The purpose of this study was to determine the change in physical function and pain after undergoing ankle arthrodesis as determined by patient reported outcomes (PROs). Methods: This was a retrospective review of prospectively collected patient reported outcomes data in 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS computerized adaptive test at 6 months and 1 year post- operatively. Descriptive data and Spearman correlations were determined for PF and pain at 6 months and 1 year. Results: The mean pre-operative PF T-score was 37, less than the pre-determined threshold value of 42, indicating that this cohort was impaired physically and would respond positively to surgical intervention. The mean pre-operative PI T-score was 63 indicating moderate to high baseline pain and greater than the threshold value of 60, indicating that this patient cohort would have decreased pain after surgical intervention. The meaningful clinically important difference (MCID) was achieved for PI at 6 months and 1 year post-operatively (T-score of 4 and 6, respectively). At 6 months and 1 year, there was a moderate inverse correlation between PF and PI (r=-0.49, r=-0.61 respectively) suggesting less pain and more function. Demographic data, mean follow-up time, and mean PROMIS T-scores are seen in Table 1. Conclusion: The results of this study indicate that patients can expect to have a clinically meaningful improvement in pain after undergoing ankle fusion. Although patients do improve marginally in physical function, it is most likely the improvement in pain that is the greatest benefit to these patients at one year after ankle arthrodesis. This information is important to share with patients to align patient expectations with surgical results.
Biomechanical Comparison of Hintermann and Evans Osteotomy for Lateral Column Lengthening
Authors: Koury Kimberly , Grasu Beatrice , Stein Benjamin , Abassi Pooyan , Parks Brent , Schon Lew , Guyton Gregory 
Published: October 2019

Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Both Evans and Hintermann procedures are opening wedge calcaneal osteotomies used for lateral column lengthening in flatfoot reconstruction. Risks of lateral column lengthening include lateral forefoot overload and increased calcaneocuboid (CC) joint pressure. The Evans osteotomy is preformed closer to the CC joint increasing the theoretical risk of higher CC pressures. The Hintermann technique is a more posteriorly located osteotomy developed to avoid destabilization of the anterior calcaneal fragment and subsequent CC joint incongruency. The purpose of this study is to biomechanically compare the Evans and Hintermann osteotomies through analysis of CC joint pressures and forefoot plantar pressures after sequential lengthening of the lateral column. Methods: A flatfoot model with radiographic confirmation was created in 10 matched cadaveric specimens which were then randomly selected to undergo either the Evans or Hintermann osteotomy. Specimens were physiologically loaded and the peak pressure of the CC joint and forefoot plantar pressures were measured under the following conditions: (1) intact foot, (2) flatfoot, and (3) sequential lengthening of the lateral column from 6 mm to 14 mm, in 2 mm increments. Results: Lateral column lengthening lead to significantly increased pressure across the CC joint in both the Evans and Hintermann specimens. With increasing lateral column length, mean peak CC pressures ranged from 2.9–4.0 and 1.2–2.2 times intact CC pressure for the Evans and Hintermann group, respectively. Normalized mean and normalized peak CC pressures were significantly higher in the Evans osteotomy group compared to the Hintermann group at every level of distraction (see figure). The CC pressures under each testing condition were normalized with respect to the intact foot. Forefoot lateral plantar pressures were significantly increased in specimens corrected with Evans osteotomy at 10 mm and 12 mm of distraction compared to the intact foot. Conclusion: The Evans osteotomy lead to significantly higher CC pressures than the Hintermann osteotomy. This data suggests the Hintermann osteotomy for flatfoot reconstruction minimizes increase in CC joint pressures and could reduce the risk of subsequent CC osteoarthritis.
The Difference of In-Shoe Plantar Pressure Between Level Walking and Stair Walking
Authors: Kyung Min Gyu , Lee Chungho , Lee Jae Hee , Cho Yoon Jae , Linying Cao , Lee Dong Yeon 
Published: October 2019

Category: Basic Sciences/Biologics Introduction/Purpose: Stair walking is one of common activities of daily living. It is more demanding than level walking and can aggravate discomfort of the foot, such as Morton’s neuroma, plantar fasciitis, Achilles tendinitis, pressure related-ulcer, and etc. Therefore, analysis of increased pressure in specific plantar area at stair walking can be used as a risk assessment of foot discomfort and basic data in the clinical field. The purpose of this study is to analyze plantar pressure distribution and pressure patterns during gait cycle at stair walking compared to level walking. Methods: Fourty healthy male adults were recruited. Radiologic measurements and gait analysis were performed to check participants’ normality, and 35 healthy males with 20-28 years old were included. They performed level walking (18 meters walkway), stair (26 steps stair, height:16.7 cm, depth:29.8 cm) ascending, and descending in same type of running shoes. Measurements of in-shoe plantar pressure including peak pressure, pressure-time integral (PTI) were done by Pedar-X system. Only measurements of right steps were used to exclude the effect of the dominant foot. The sole was masked in 7 segments (hallux, 2nd-5th toes, medial forefoot, central forefoot, lateral forefoot, midfoot, heel region) to analyze properly. Percentages were assigned in relation to the size for each mask segment. Statistical analysis was performed using repeated measure ANOVA, and Bonferroni post hoc test was done. Results: Mean peak pressures in all regions except for the midfoot were higher during level walking than stair walking. During stair descent, mean peak pressures in all the regions except for the midfoot were generally lower than other types of walking, but it was the highest in the midfoot region. Pressure time integral (PTI) in the medial and central forefoot was higher during stair descent than level walking. PTI in the central and lateral forefoot, and the midfoot was higher when stair ascending than level walking. Pressure time integral (PTI) in the heel region was the highest during level walking, followed by stair ascent, stair descent. Conclusion: The risk of aggravation of discomfort in the midfoot area increases when stair descending. The medial region of forefoot bear high pressure load during stair descent, and the lateral region of forefoot and the midfoot region bear high pressure load during stair ascent. This is the first study to show plantar pressure patterns during level and stair walking in the large healthy gender-controlled population. We recommend that patients with pressure related foot lesions in the forefoot or midfoot avoid stair walking.
Individuals with Recurrent Ankle Sprain Demonstrate Postural Instability and Neuromuscular Control Deficits in Unaffected Side
Authors: Lee Jin Hyuck , Choi Gi Won , Jang Woo Young 
Published: October 2019

Category: Ankle, Sports Introduction/Purpose: To compare proprioception, postural stability, and neuromuscular control between patients with mechanical laxity and recurrent ankle sprain. Methods: Among 86 patients with ankle instability, 45 patients had mechanical laxity (mean age 27.2 ± 7.0 years) and 41 had recurrent ankle sprain (mean age 25.1 ± 9.2 years). Both the affected and unaffected ankles of each patient were evalu- ated. Proprioception and neuromuscular control tests were conducted using an isokinetic machine, and postural stability was tested using a postural stabilometry system. Results: Proprioception was not significantly different between the unaffected or affected ankles of the mechanical laxity group compared with those of the recurrent ankle sprain group (n.s). Static and dynamic postural stability and neuromus- cular control were similar in the affected ankles between the two groups (n.s). However, postural stability (static, overall: p = 0.009, anterior– posterior: p = 0.028, medial–lateral: p = 0.022; dynamic, overall: p = 0.012, anterior–posterior: p = 0.004, medial–lateral: p = 0.001) and neuromuscular control (inversion: p = 0.031, eversion: p = 0.039, dorsiflexion: p = 0.029, plantarflexion: p = 0.035) were significantly decreased in the unaffected ankles of the recurrent ankle sprain group compared with those of the mechanical laxity group. Conclusion: The unaffected ankles of the recurrent ankle sprain group showed significant decreases in both postural stability and neuromuscular control compared with the mechanical laxity group. Clinicians and therapists should consider unaffected ankle rehabilitation in patients with recurrent ankle sprain to prevent future sprain events.
Ankle and Lower Leg Injuries in Professional Baseball Players
Authors: Lucasti Christopher , Dworkin Myles , Warrender William , Pedowitz David , Winters Brian , Ciccotti Michael 
Published: October 2019

Category: Ankle, Sports, Trauma Introduction/Purpose: The purpose of this study was to determine the injury characteristics of ankle and lower leg injuries in professional baseball players during the 2011-2016 seasons by utilizing the Major League Baseball (MLB) injury surveillance system. Methods: Our study is a descriptive epidemiological evaluation through a retrospective review from the MLB Health and Injury Tracking System (HITS) since its implementation in 2011. We included any professional baseball player (Major League and Minor League) who was identified as having an ankle or lower leg injury from January 1, 2011 through February 28th, 2017.Over the study period there were a total of 4,756 injuries of which 763 (16.0%) occurred in the Major League and 3,993 (84.0%) occurred in the Minor League. Results: The average number of days missed for all players was 27.8 days (+/-141.4 days) with a median of 3 days. From 2011 through 2016 it was estimated that there were 414,912 athlete exposures (AEs) in Major League Baseball and 1,796,607 AEs in the Minor Leagues. Of the 4,756 injuries recorded, 550 (11.6%) took place during the Major League regular season and 3,320 (69.8%) took place during the Minor League regular season. Major League injuries, however, were 1.7 times more likely to require surgery (p < .001). Additionally, rates of injury to the lower leg were stratified by position with infield players experiencing injuries at a 1.6 times greater rate than any other position (p < .001). Conclusion: In conclusion, the data from this study represents the only epidemiological study to focus primarily on lower leg injuries in professional baseball players utilizing an injury surveillance system developed by MLB.
The Use of Tranexamic Acid in Total Ankle Arthroplasty
Authors: Luick Laura , Ringus Vytas , Steinmetz Garrett , Falcon Spencer , Tkach Shaun , Hallem Amgad 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications. Methods: This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups. Results: 87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9). Conclusion: The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.
Psychotropic Medication Use Increases Risk for Poor Outcomes After Hammertoe Correction Surgery
Authors: Maidman Samuel D. , Erwood Amalie A. , Brodsky James , Daoud Yahya , Fantry Amanda , Tenenbaum Shay , Bariteau Jason T. 
Published: October 2019

Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are common conditions of the lesser toes, known to affect daily activities and cause pain. Following failure of conservative management, surgical correction of these deformities strives to reduce pain and improve physical function. Currently, 1 in 6 Americans are being treated with psychotropic medications. Baseline mental health issues are known to diminish self-perceived overall health and may hamper recovery following surgery. The aim of this study is to assess the impact of psychotropic medication use on the development of complications and reduction of patient reported outcomes following operative hammertoe correction. Methods: Prospectively collected data was reviewed on 116 patients who underwent operative correction of hammertoe deformity following failure of conservative management. Patient demographics, past medical history, and postsurgical complications were recorded from the electronic medical record. Patient-reported outcomes were assessed utilizing preoperative and postoperative Visual Analogue Scale (VAS) and Short Form Health Survey Physical and Mental Component Scores (SF-36 PCS and SF-36 MCS, respectively) with 1-year of follow-up. Data was examined using chi-squared, t-test, and ANOVA analyses. Results: 17.2% of patient were taking only antidepressants, 10.3% other psychotropic medications, and 8.6% both an antidepressant and another psychotropic medication. Wound infections treated with antibiotics occurred in 12.9%. Mean 1-year improvement in VAS, SF-36 PCS, and SF-36 MCS were 2.8 (SE=0.3), 10.8 (SE = 2.0), and 3.1 (SE = 1.3), respectively. A significant association was found between antidepressant use and postoperative superficial wound infection requiring antibiotics (P=0.049). Antidepressant use was also determined to be significantly associated with lower preoperative and postoperative SF-36 MCS (P=0.0023 and P=0.017, respectively). Other psychotropic medication use was significantly associated with lower preoperative SF- 36 MCS (P=0.030) and PCS (P=0.048) as well as postoperative PCS (P=0.023). However, psychotropic medication use was not associated with any reduction in improvement from pre- to postoperatively. Conclusion: Patients receiving psychotropic medications are at an increased risk for developing postoperative infection following hammertoe deformity correction. While these patients at baseline have lower mental and even possible physical component scores, their improvement following hammertoe correction surgery is equivalent to patients not on these medications. Patients treated with psychotropic medications can still benefit from hammertoe correction surgery, but clinicians should recognize the increased risk for complications and expect lower patient-reported outcomes.