bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Complications Following Ankle Fractures in the Geriatric Population: A Case Series
Authors: Anderson Matthew , Jha Aaradhana J. , Naranje Sameer M. , Viner Gean C. , McKissack Haley , Hsu Alan , Chinnakkannu Karthikeyan , McGwin Gerald , Shah Ashish B. , Moraes Leonardo V. M. 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are among the most common orthopedic injuries. While open reduction and internal fixation (ORIF) is the standard treatment for displaced ankle fractures in younger patients, there is controversy regarding the optimal management of these injuries among geriatric patients due to the high prevalence of comorbidities. Closed manipulation leads to poor long-term functional outcomes, with high rates of malunion and non-union in all populations as well as higher mortality in patients over 65 years of age. However, surgical management in the elderly carries rates of complications as high as 20-40%. The purpose of this study was to investigate risk factors for healing complications following ORIF of ankle fractures in patients greater than 75 years of age. Methods: All patients 75 years of age and older undergoing open reduction and internal fixation of ankle fractures at a single institution from 2008 to 2018 were identified. Patients with polytrauma and/or pilon fractures were excluded. Patient medical records were reviewed to obtain information regarding details about the injury, surgery, and follow-up as well as patient demographics and comorbidities. Radiographs from post-operative clinic visits were examined by a foot and ankle certified orthopedic fellow for each patient and the time for complete union was recorded as well as any delayed union or malunion. Fisher’s exact tests were used to compare post-operative complications (wound infection, wound dehiscence, sepsis, deep vein thrombosis, revision surgery, and malunion/nonunion) among those with and without specific comorbidities. Results: Patients with other comorbidities had a statistically significant increased risk of revision surgery (p<0.0001). Additionally, those who used illicit drugs had statistically significant increased risk of sepsis (0.0213). Revision surgeries included syndesmotic screw removal, a standard procedure which does not necessarily imply presence of complication. Conclusion: Elderly patients are susceptible to various postoperative complications. Substance abuse is associated with revision surgery, while the presence of other comorbidities collectively is associated with sepsis. To optimize postoperative management, surgeons should be aware of patient comorbidities and exceptionally attentive at follow-up examinations for these patients.
Posterior Talofibular Ligament: The Relationship between its Length and Talar Morphometric Profiles
Authors: Angthong Chayanin , Rajbhandari Prasit 
Published: October 2019

Category: Ankle, Sports Introduction/Purpose: Posterior talofibular ligament is one of the lateral ligamentous complex of the ankle. However, little is known about its anatomic profile especially on the relationship between its length and the morphometric profiles of talus. The present was to analyze the correlations between PTFL length and the talar morphometric profiles in the cadaveric specimens. The PTFL variation was also reported in this study. Methods: A total of twenty four cadaveric ankles as twelve matched pairs of ankle were collected in this study. All ankles were measured with a Vernier caliper which provided the data for further analysis regarding the PTFL length and the talar morphometric profiles. The data was calculated to demonstrate the relationship between PTFL length and the morphometric profiles of talus. There was a cadaveric ankle which was not used in the study due to its absence of PTFL. Results: An average length of PTFL was 23.9+/-6.9 mm. In overall, an average talar length (TaL) was 53.5 millimeters (mm). An average talar dome height (TaH) was 31.2 mm. An average talar body width (TaW) was 41.3 mm. The average anterior trochlear width (TrAW), middle trochlear width (TrMW), posterior trochlear width (TrPW), and trochlear length (TrL) were 31.8, 31.2, 28.3, and 30.7 mm. Based on twenty three ankles, the paired samples T-test showed the significantly negative correlations between PTFL length and TrL (Pearson’s r correlation coefficient: -0.432; P-value: 0.039). Other correlations were in negative values but P-values > 0.05. There were 16 ankles (84.2%) with 1 PTFL band and 3 ankles (15.8%) with 2 bands from 19 ankles with complete data. Conclusion: The present study may be a first study which delineates the relationship between PTFL length and the morphometric profiles of talus. The PTFL length was negatively correlated with talar size especially on the trochlear length of talus.
Can Weightbearing CT Scans Be Used to Diagnose Subtalar Joint Instability? A Cadaver Study
Authors: Barg Alexej , Weinberg Maxwell W. , Davidson Nathan P. , Burssens Arne , Hintermann Beat , Saltzman Charles L. , Krähenbühl Nicola 
Published: October 2019

Category: Hindfoot, Trauma Introduction/Purpose: Accurate assessment of subtalar joint stability is difficult. Weightbearing CT (WBCT) scans have increased in popularity among foot and ankle surgeons as it offers an accurate representation of hindfoot joint alignment under weightbearing conditions. However, the clinical utility of this imaging modality to diagnose subtalar joint instability has yet to be investigated. The purpose of this study was to assess the impact of load and torque application on the assessment of subtalar joint instability when using WBCT scans. We hypothesized that load and torque application would improve the ability to identify subtalar joint instability. Methods: Fourteen paired male cadavers (tibial plateau to toe-tip) were included. A radiolucent frame held specimens in a plantigrade position while non-weightbearing and weightbearing CT scans (with and without torque application) were taken. First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent interosseous talo-calcaneal ligament (ITCL) transection (Condition 1A), while the contralateral underwent calcaneo-fibular ligament (CFL) transection (Condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact ITCL or CFL was transected (Condition 2). Finally, the deltoid ligament was transected in all ankles (Condition 3). Two radiographic measurements were performed on the level of the ankle joint (talar tilt [TT], anterior talar translation [ATT]), while the subtalar tilt (STT) was measured at the anterior, middle, and posterior plane of the subtalar joint. Inter- and intra-observer agreement calculations were additionally performed. Results: Weight did not impact most measurements, while the majority of measurements differed significantly within each condition after torque application. Measurements performed at the level of the subtalar joint were more reliable and better predictors for subtalar joint instability compared to measurements performed at the level of the ankle joint. Discrete ITFL, combined ITFL/ CFL, and combined ITFL/ CFL/ deltoid ligament injuries had significantly different STT values than native ankles (Figure 1). Conclusion: Measurements to assess the stability of the subtalar joint should primarily be performed at the level of the subtalar joint rather than at the level of the ankle joint when using WBCT scans. Torque application is crucial for identifying subtalar joint instability, while the application of load should be avoided. Future clinical studies will therefore face substantial technical challenges should they attempt to determine the clinical utility of WBCT scans for assessment of subtalar joint instability.
Flexible Fixation for Ligamentous Lisfranc Injuries
Authors: Briceño Jorge , Stupay Kristen L. , Moura Bruno , Velasco Brian , Kwon John Y. 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Surgical outcomes of Lisfranc injuries depend on achieving an anatomical and stable reduction. Severity of injury defines the best treatment option and surgical techniques vary from internal fixation to arthrodesis. While effective, limitations of commonly used metal implants include iatrogenic articular cartilage damage, implant breakage and need for implant removal. Additionally, these surgical techniques do not preserve tarsometatarsal (TMT) joint motion. This report demonstrates a novel, easy and inexpensive surgical technique to stabilize TMT joint instability utilizing “flexible fixation” utilized in a case series of 8 patients. Methods: A dorsal approach over the second metatarsal is performed in a standard fashion, after careful dissection and direct visualization of the joint, the TMT joint is anatomically reduced and stabilized with k-wires avoiding damage of the cartilage. Two 2.7 or 3.5 screws with washers are placed from dorsal to plantar in the base of the metatarsal and in the respective tarsal bone to serve as posts. A non-absorbable #2 FiberWire (Arthrex, Naples, Florida) is looped 3 to 5 times in a Figure-of-8 fashion around the screws beneath the washers, tensioned, knotted and secured by tightening the screws. Repeat fluoroscopic stress views are performed to ensure stability of the TMT joint. Results: N/A Conclusion: For selected patients with Lisfranc injuries demonstrating no significant comminution or gross instability, flexible fixation using sutures is a promising technique due its potential benefits over trans-articular screws or bridge-plating techniques. This technique is inexpensive, avoids iatrogenic cartilage damage and subsequent removal of hardware.
Regional Genetic Responses of Porcine Talar Articular Cartilage to Impact Injury
Authors: Bryant Evan (Hank) , Mansour Kailey , Huang C.Y. Charles , Kaplan Jonathan R. , Aiyer Amiethab A. 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: The ankle is at greatest risk for post-traumatic osteoarthritis (PTOA) in comparison to the hip or knee. Adaptive changes to the cartilaginous topography may be a marker for where cartilage damage poses the greatest risk of development of osteoarthritis. The objective of this study was to elucidate the mechanism of PTOA by analyzing the changes in regional genetic expression of inflammatory markers after impact injury in an ex-vivo porcine model. Methods: Talus bones were recovered from 5 porcine ankles. A drop tower was used to induce injury by dropping a 1000 g weight from a height of 15 cm on the talus. Following the injury the bone was cultured for 24 hours. Four 6-mm cartilage plugs were harvested from the inferior aspect of each talus bone and a small slice of each plug was used for cell imaging. The remaining cartilage plugs were flash frozen with liquid nitrogen and stored at -80°C for ribonucleic acid (RNA) extraction and analysis of gene expression. Expression of inflammatory and catabolic genes (IL1-ß, TNF-a, ADAMTS-5, ADAMTS-4, MMP-3 and MMP-13) was compared among the samples obtained from the non-impacted and impacted sites of the anterior and posterior regions. Student t-test was performed to examine the differences between the control (non-impact) and impacted samples from each region and between the control samples from the anterior and posterior regions. Results: The current porcine impact model demonstrated significant up-regulation of several inflammatory cytokines and metalloproteinases by impact force. Among the genes tested, TNF-a, ADAMTS-4, and MMP-3 showed increased expression at impact sites (p<0.05) compared to non-impact sites in the posterior region (Figure 1) whereas no differences were found in the anterior region. Interestingly, the non-impacted samples in the anterior region exhibited significantly higher expression of TNF-a, ADAMTS-4, MMP-3 and ADAMTS-5 than those of the posterior region (p<0.05). Conclusion: The results of the current ex-vivo porcine impact study demonstrate significant up-regulation of inflammatory and catabolic genes 24 hours after porcine talus bone impaction. These findings highlight the relevance of regional differences in post- traumatic ankle inflammation; the posterior region of porcine talar articular cartilage demonstrated increased sensitivity in response to injury. The anterior region illustrated greater resistance to injury, showing less gene up-regulation compared to the posterior region of the same ankle. These findings suggest that location of cartilage injury may play a crucial role in the development of inflammatory response, chondrocyte apoptosis, and subsequent osteoarthritis of the ankle.
Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States
Authors: Cassinelli Spenser J. , Chen Stephanie , Charlton Timothy P. , Thordarson David B. 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: The aim of this study was to determine the outcomes and early complications following the implantation of a novel hydrogel synthetic cartilage implant (SCI) for the treatment of hallux rigidus by a single surgeon. This implant was FDA approved for implantation for the treatment of hallux rigidus in the United States in July 2016. Methods: A retrospective chart review of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and June 2018 by a single surgeon was performed. Demographic information, radiographic assessment, and concomitant surgical procedures performed were evaluated for all patients. Post operatively, PROMIS physical function and pain scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Seventy SCI were implanted in 65 patients. Follow up averaged 16.3 months (Range 6-27 months). Results: 16% (11/67) of patients were very satisfied, 31% (21/67) were satisfied, 22% (15/67) were neutral, 6% (4/67) were dissatisfied, and 24% (16/67) were very dissatisfied with their outcome. PROMIS physical function scores averaged 43, indicating mild dysfunction compared to population norms. PROMIS pain interference scores averaged 59, indicating mild pain compared to population norms. 50% (35/70) required a corticosteroid injection post-operatively. 24% (17/70) required advanced imaging with MRI post-operatively. There was a 13% reoperation rate for all-cause reoperation, and a 2.9% rate of conversion to arthrodesis. Subgroup analysis showed that patients undergoing Moberg osteotomy at time of SCI performed better than patients undergoing SCI alone. Conclusion: Synthetic cartilage implantation yielded modest patient satisfaction, mild dysfunction in physical measures, and a large proportion requiring further treatment and workup post operatively. We believe patient selection and counseling on the potential for continued pain and dysfunction in the early postoperative period following this procedure are important before proceeding with synthetic cartilage implantation for hallux rigidus.
Peripheral Vascular Disease is Associated with Increased Risk of Acute Postoperative Infection and Failure of Total Ankle Replacements
Authors: Conti Matthew S. , Savenkov Oleksandr , Ellis Scott J. 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: Peripheral vascular disease (PVD) is often cited as a contraindication for total ankle replacement (TAR); however, there are no studies looking at its impact on postoperative complications. The primary purpose of our study was to identify whether preoperative PVD increased the rate of infection, postoperative irrigation and debridement, or failure of the implant in patients undergoing total ankle arthroplasty using a large dataset. Methods: The PearlDiver Database was used to identify Medicare patients who underwent a TAR from 2005 to 2014 using ICD- 9 and CPT codes. The cohort was queried for postoperative infections within 90 days, subsequent irrigation and debridement, and failure of TAR. Failure of TAR was defined was a revision, conversion to tibiotalar arthrodesis, lower extremity amputation, or implant removal. A diagnosis of preoperative PVD only included those patients who had PVD as an ICD-9 diagnosis code and underwent a preoperative lower extremity angiogram prior to TAR. Preoperative co-morbidities including prior corticosteroid injections, diabetes mellitus, smoking, rheumatoid arthritis, congestive heart failure, hypertension, obesity, and end-stage renal disease requiring dialysis were taken into consideration. Three multivariable logistic regression models were then developed in order to identify risk factors associated with postoperative infections and failure after TAR. Results: 10,698 Medicare patients who underwent a primary TAR were identified. 334 patients had a postoperative infection within 90 days of their TAR and 95 of those patients required an irrigation and debridement. Patients with a preoperative diagnosis of PVD had the highest acute infection rate at 10.5% as well as the highest incidence of failure at 12.3%. Multivariable logistic regression modeling demonstrated that patients with PVD had the greatest risk of developing a postoperative infection within 90 days (OR 2.85, 95% CI 1.45-5.13, P<0.01). Preoperative PVD was the most important risk factor for requiring an irrigation and debridement postoperatively (OR 4.87, 95% CI 1.94–10.6, P<0.001) (Table 1) and placed patients at the highest risk of TAR failure (OR 2.67, 95% CI 1.43–4.63, P<0.001). Conclusion: Our study suggests that a preoperative diagnosis of PVD has significant negative effects on outcomes following TAR. Preoperative PVD is an independent risk factor for an acute postoperative infection, postoperative irrigation and debridement, and failure of the implant.
Using TSF Multi-Planar External Fixation for Overcorrection of Severe Equinus Contractures of the Ankle joint
Authors: Dabash Sherif , Potter Eric , McGarvey William 
Published: October 2019

Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Equinus deformity is a debilitating condition which interferes with the activity of daily living. Correction of the deformity ranges from conservative (heel cord stretching, orthotics) to surgical treatment (Baumann, Strayer, Achilles lengthening, soft tissue releases). Severe contractures need surgical intervention with extensive dissections to release soft tissues. This study investigated the clinical outcomes of gradual equinus contracture overcorrection using a Taylor Spatial Frame with tendo-Achilles lengthening or toe flexor tenotomy as necessary. Methods: This retrospective chart review evaluated patients with significant equinus treated with a Taylor Spatial Frame at a single large tertiary referral center. Data collected included: diagnosis; patient demographics; laterality; time in frame; additional procedures; complications. Patients were assessed preoperatively and were followed at one-week, three-week, six-week, three- month, and six-month intervals, and yearly after. Results: 24 patients (26 procedures) were treated with a Taylor Spatial Frame for equinus and had complete preoperative and eighteen-month follow-up measurements. The angle of deformity increased from a preoperative -21.5 (range, -69.0 to -1.0) degrees to a postoperative 4.9 (range, -17.0 to 17.0) degrees (z = -4.4573, p = 0.0001, N = 26, Wilcoxon signed rank test). Four complications occurred during the follow up (two pin site infections, one broken pin, and one plantar abscess). Three patients had recurrence of of equinus deformity at time of last follow-up. Conclusion: Taylor Spatial Frame is a successful method for correcting severe, fixed equinus contractures of the ankle joint with minimal soft tissue related complications. Over correction should be achieved in order to compensate for the loss of some dorsiflexion after frame removal.
Radiographic Outcomes of Lisfranc Injuries Treated with a Suture Button Device
Authors: Delman Connor , Kreulen Christopher , Shelton Trevor , Roster Brent , Boutin Robert , Giza Eric 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Controversy exists regarding the optimal treatment of Lisfranc injuries of the midfoot. There has been increasing interest in using a suture button device in lieu of traditional screw fixation. Biomechanical studies comparing screw fixation with suture button devices have demonstrated conflicting results. This study evaluates the radiographic outcomes of patients with Lisfranc injuries treated with a suture button device or a hybrid technique with supplemental fixation. Methods: Forty-three patients with a Lisfranc injury were treated operatively with either a suture button device (Tightrope, Arthrex, Naples, FL) or a hybrid technique with supplemental hardware fixation. The distances between the first and second metatarsal (M1-M2) and the medial cuneiform and second metatarsal (C1-M2) were measured on weightbearing radiographs. These measurements were used to assess the accuracy of reduction, maintenance of reduction, and magnitude of reduction. The accuracy of reduction was determined by comparing weightbearing AP radiographs of the uninjured foot with weightbearing radiographs of the operatively treated foot at 6 weeks postoperatively. The magnitude of reduction was assessed via a comparison of weightbearing AP radiographs of the injured foot preoperatively to the operatively treated foot at 6 weeks postoperatively. The maintenance of reduction was determined by comparing radiographic measurements at 6 weeks postoperatively to measurements taken at 12 weeks postoperatively. Results: An accurate reduction was obtained in both treatment groups with no significant difference in the M1-M2 and C1-M2 measurements at 6 weeks postoperatively compared to the uninjured foot. The magnitude of reduction was greater and statistically significant for the hybrid fixation group but was not maintained (Hybrid fixation M1-M2 magnitude of reduction: -1.39, p < .001; C1-M2 magnitude of reduction: -1.77, p < .001). The suture button treatment group attained a satisfactory reduction that was maintained with no statistically significant difference in the M1-M2 and C1-M2 distances at 6 weeks and 12 weeks postoperatively (Tightrope M1-M2 maintenance of reduction: 0.04, p=0.88; C1-M2 maintenance of reduction: 0.39, p=0.21). Conclusion: After open reduction of Lisfranc injuries, the suture button device appears to adequately maintain the reduction when patients have returned to full activity. Based on radiographic parameters, the suture button construct provides an effective alternative to traditional screw fixation for the treatment of Lisfranc injuries.