bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short Term Radiographic Analysis of the Cartiva Implant for Hallux Rigidus
Authors: Adair Christopher R. , Zide Jacob R. , Royer Christian T , Reddy Veerabhadra , Brodsky James W. 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Cartiva (Wright Medical Group N.V.) was developed as an implantable interposition device for the treatment of hallux rigidus. It is performed along with a limited cheilectomy and serves as a joint preserving alternative to arthrodesis. In some patients, we have noticed gradual decreases in the joint space after surgery with Cartiva, presumably representing subsidence of the implant. The aim of this study is to report a radiographic analysis of visible joint space in surgical cases of hallux rigidus where dorsal cheilectomy and Cartiva were used. Methods: A prospectively collected patient database was queried for CPT code 28291 and those patients in which Cartiva was implanted were determined. The pre-operative and post-operative radiographs were analyzed for hallux rigidus grade, and measurements of visible joint space prior to and after Cartiva was implanted were performed at two weeks, one month, three months, and six months post-operatively. The percentage of visible joint space increase or decrease after implantation of Cartiva was calculated for each post-operative time point. Results: A total of 79 Cartiva were implanted in 74 patients between April 2017 and Sept 2018. The procedure was performed for Grade I hallux rigidus in 11% of patients (n=9), 66% grade II (n=52), 23% grade III (n=18). Mean pre-operative visible joint space measured 1.1 mm (n=79). Visible joint space measured at two weeks post-surgery was 2.2 mm (n=74); one month, 1.6 mm (n=65); three months, 1.2 mm (n=64); six months, 1.0 mm (n=30). Implantation of Cartiva resulted in 100% increase in visible joint space compared to pre-operative measurements at two weeks post-surgery, 45% increase at one month, 9% at three months, and a 9% decrease in visible joint space at six months. Conclusion: Cartiva implantation and limited cheilectomy for patients with symptomatic hallux rigidus provided a 100% increase in visible joint space on radiographs taken two weeks post operatively. However at six months post-surgery there was an overall 9% decrease in visible joint space presumably representing a subsidence of the Cartiva implant with time.
Comparison of Beaming Screw Outcomes with and without Subtalar Arthrodesis in Midfoot Charcot Reconstruction
Authors: Ahn Junho , Wukich Dane K. , Liu George T. , Raspovic Katherine M. , VanPelt Michael D. , Lalli A. 
Published: October 2019

Category: Diabetes, Midfoot/Forefoot Introduction/Purpose: Charcot neuroarthropathy (CN) is a complication of neuropathy secondary to diabetes mellitus (DM) and may involve multiple joints of the foot, in particular the midfoot. Patients with CN deformity associated with infection, ulceration or pre-ulceration are at risk of losing their limb. In these patients, reconstruction of the foot structure through beaming arthrodesis screws for stabilization is often required. In addition to midfoot beaming, previous reports have advocated for subtalar arthrodesis. Fixation of the subtalar joint restricts motion of the hindfoot. This rigid fixation has been hypothesized to offer greater stability and fewer hardware failures. The aim of this study was to describe failure of midfoot beaming screws after midfoot reconstruction of CN with and without subtalar arthrodesis. Methods: We retrospectively reviewed patients with DM diagnosed with CN. Patient radiographs were evaluated for type of midfoot Charcot reconstruction and hardware failure. Patients included in the study had follow up of 3 months or more. The main outcome variable of interest was hardware breakage. Results: Eighteen patients who underwent midfoot reconstruction for CN were included. The average age was 52.7 years (±8.4 years), 10 (55.6%) were male, and the average body-mass index (BMI) was 35.8 kg/m2 (±10.3 kg/m2). The average follow-up time was 6.5 months (±3.7 months). In the current series, thirteen out of 18 (72.2%) patients underwent subtalar fusion along with midfoot fusion. Screw breakage occurred in two patients, one at the 1st tarsometarsal joint and 2nd-4th tarsometarsal screws in another patient at 9 and 6 months respectively. Both patients with screw breakage had subtalar fusion. A third patient who had subtalar fusion subsequently developed collapse of their talus leading to subtalar screw removal 3 months after initial surgery. Patients without subtalar fusion did not experience screw breakage. Conclusion: An extended medial column fixation with subtalar arthrodesis has been previously proposed to provide better fixation after midfoot CN reconstruction with beaming screws as it restricts motion of the hindfoot. However, little to no evidence has been reported in favor of this technique. Our findings suggest that subtalar arthrodesis may result in fixation that is too rigid, which may place the beaming screws at higher risk of breakage. However, the number of observations is a limitation of our study, and further investigation comparing these techniques is needed to fully evaluate the effect of subtalar arthrodesis on midfoot beaming outcomes.
Talar Prosthesis Template: A Cadaveric Study of the Size Discrepancy between Right and Left Tali
Authors: Angthong Chayanin , Rajbhandari Prasit , Piyapanee Attaporn , Stufkens Sjoerd Antoine Sebastian 
Published: October 2019

Category: Ankle Introduction/Purpose: Nowadays, the talar prosthesis has been designed for its size and shape based on the data of its contralateral talus. However, little is known about the discrepancy of the sizes between right and left tali. The present study was to demonstrate the difference between right and left talar sizes in the matched pairs of cadaveric specimens. Methods: A total of twenty four tali as twelve matched pairs of tali were collected in this study. All tali were measured with a Vernier caliper which provided the data for further analyzed regarding the talar size. The data was calculated to demonstrate the difference between right and left talar sizes in a matched pair method included the general size of talus. There was a talus which was not used in the data calculation due to its crystal deposition from an underlying disease of a cadaver. Results: 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 eleven matched pairs of tali, the paired T-test showed the significant difference of TaH (P-value: 0.019), TrMW (P-value: 0.027), and TrPW (P-value: 0.016) between right and left tali. Conclusion: The present study demonstrated the discrepancy of right and left talar sizes about three important parameters in the matched pairs of tali. Talar prosthesis template may be necessary to use other method to determine its size for the prosthesis manufacturing in addition to the utilization of measured profiles from the contralateral talus.
Syntethic Neoligamentplasty with FiberTape has the Same Rigididy than Transarticular Screws in Lisfranc Subtle Lesions
Authors: Baumfeld Daniel , Nery Caio , Baumfeld Tiago , Wagner Pablo , Prado Marcelo , Wagner Emilio 
Published: October 2019

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Lisfranc joint injuries occur due to direct or indirect trauma, where a twisting or axial force is transmitted to the foot. Recently, new treatment options are being sought in order to use methods that allow a more physiologic fixation of this joint. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a synthetic neoligamentplasty in comparison to the traditional trans-articular screw fixation. Methods: 24 fresh frozen lower leg cadaveric specimens were utilized. The medial (C1) and intermediate (C2) cuneiforms, first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (Group 1), and between C1-C2, C1-M2, C1-M1 and C2-M2 in 12 matched specimens (Group 2). The groups were further divided in fixation with screws (G1 Screws and G2 Screws) and with Tape (G1 Tape and G2 Tape). The tape fixation group used a fixation technique described by this group, using FiberTape (Arthrex, Inc.). After ligament lesion and fixation, the construct rigidity was measured with the help of a 3D Digitizer arm, comparing the distances between the marked bones over a stress condition (pronation and supination of the forefoot). Results: Distance C1-C2 increased 3 mm after ligament injury (23% increase) with supination motion. C1-M2 increased 4 mm after ligament injury (21% increase) with pronation motion. Distances between C1-M1 and C2-M2 only changed in Group 2, increasing 3 mm (14%) and 2 mm (16%) respectively. Rigidity between C1-C2, C1-M1 and C2-M2 did not differ between the fixation with screws and with tape. The fixation with screws presented more rigidity in C1-M2 distance (p=0,03), but only in pronation stress. Conclusion: Pronation and supination motion of the forefoot relative to the hindfoot produces measurable joint displacements. Tape and Screws can produce the same rigidity after repairing Lisfrac Ligament injuries, except for distance C1-M2 in pronation stress.
3D Printed Cage in Patients with Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail: Early Outcomes
Authors: Bejarano-Pineda Lorena , Adams Samuel B. , Parekh Selene G. 
Published: October 2019

Category: Diabetes, Hindfoot, Trauma, salvage procedure Introduction/Purpose: Segmental bone loss in the hindfoot hinders the chance of successful outcomes. Tibiotalocalcaneal arthrodesis is a reliable option; however, the risk of nonunion is high. Structural graft is needed to fill the gap, but the use of bone grafts are limited by the availability, risk of collapse, and disease transmission. Three-dimensional (3D) printed titanium implants offer a strong scaffold that can be customized and present similar healing rates. The purpose of the study was to describe the clinical outcomes and the radiologic union rate of a case series of patients with hindfoot arthrodesis, using a retrograde intramedullary nail associated to a 3D printed titanium cage. Methods: After obtaining approval from our institution review board, a retrospective chart review was performed on seven patients undergoing hindfoot arthrodesis, using a retrograde intramedullary nail associated to a custom 3D printed titanium cage from March 2015 to December 2017. Demographic and clinical data were collected. Functional outcomes were assessed using The American Orthopedic Foot and Ankle Score (AOFAS) and the Visual Analog Scale (VAS) for pain. Hindfoot alignment was evaluated using preoperative and postoperative weightbearing radiographs that included anteroposterior, lateral and Saltzman views. Radiographic union was assessed using computed tomography scan at 6 and 12 months postoperatively. Results: All patients had ankle arthritis and six of them (85%) had prior surgery in the compromised hindfoot. The average age at TTC fusion was 57 (range, 29 to 71) years. The mean follow-up time was 21 (range, 12 to 32) months. Six patients had a healed fusion and one patient underwent below knee amputation due to recurrence of chronic osteomyelitis in the ankle. Two additional patients had minor complications. The average AOFAS at pre-op was 35 (range, 20 to 42) points as compared to 68 (range, 53 to 78) points at final follow-up; P=0.004. Preoperative VAS pain was 80.4 (range, 70 to 85) points as compared to 26.8 (range, 6 to 60) points; P=0.002. Conclusion: Tibiotalocalcaneal arthrodesis using customized titanium cages for patients with large bone defects has shown a high rate of union in those at high risk of nonunion. Further research is needed to monitor the development of late complications.
Virtual Scribe Services Decrease Documentation Burden Without Affecting Patient Satisfaction: A Randomized Controlled Trial
Authors: Benko Savannah , Idarraga Alex , Bohl Daniel D. , Hamid Kamran S. 
Published: October 2019

Category: Other Introduction/Purpose: Scribes are utilized as a means to reduce administrative burden on surgeons and enhance the physician- patient interaction. Virtual scribe services (VSS) are a contemporary take on the scribe that use a HIPAA-compliant smart device to record patient encounters for transmission, remote transcription, and insertion into the electronic medical record. The purpose of this study was to determine if the use of a VSS could decrease the total time an orthopaedic surgeon spends on documentation without diminishing the patient experience when compared to traditional post-encounter dictation (TD). Methods: Patients presenting for a first-time visit with an orthopaedic foot and ankle surgeon were consented and randomized to VSS or TD prior to the physician-patient encounter. Time spent with the patient in the exam room and time used to document away from the patient were recorded. A validated post-encounter survey assessed patient satisfaction, perception of physician empathy, understanding of the plan, and perception of the amount of time spent with the physician on scales of 0 to 10. An a priori sample size calculation with an alpha level set at 0.05 and power of 80% estimated that 50 patients were necessitated to demonstrate a 2-minute difference in time spent documenting away from the patient. Comparisons were made using a two-sample Student’s t-test. Results: Of the 50 patients enrolled, 25 were randomized to VSS. No differences in demographic characteristics were identified between cohorts (p>0.05 for each). Time spent documenting away from the patient differed between VSS and TD (1.19±0.65 minutes for VSS versus 5.80±1.70 minutes for TD, p<0.001) as did time elapsed between the end of the visit and the start of dictation (0±0 for VSS versus 123±70 minutes for TD, p<0.001). There was a trend towards more time spent with the patient in the VSS group than in the TD group (14.25±5.86 minutes versus 11.37±5.07 minutes, p=0.069). There were no differences between groups in survey responses regarding satisfaction, empathy, understanding, or perception of sufficient time spent with the physician (p>0.05 for each; Table 1). Conclusion: VSS in an orthopaedic foot and ankle practice decreases documentation time by approximately 4 minutes per new patient compared to TD, resulting in 2 hours of reclaimed physician time for every 30 new patients. With VSS, documentation is completed during the visit versus TD which is dictated on average 2 hours later. A validated survey identified no differences in patient satisfaction, perception of physician empathy and sufficient time spent with the physician, or understanding of the plan with VSS versus TD. Orthopaedic surgeons should consider VSS a HIPAA-compliant documentation option with time savings and no measurable difference in patient satisfaction.
Pes Cavovarus in Charcot-Marie-Tooth Compared to the Idiopathic Cavovarus Foot: A Preliminary Weightbearing CT Analysis
Authors: Bernasconi Alessio , Cooper Lucy , Lyle Shirley , Patel Shelain , Cullen Nicholas , Welck Matthew 
Published: October 2019

Category: Ankle, Hindfoot Introduction/Purpose: Charcot-Marie-Tooth disease (CMT) is an inherited sensory motor peripheral neuropathy progressively leading to cavovarus deformity of the foot. Conversely, the idiopathic cavovarus foot represents a non-neurological condition, with a spectrum from subtle to markedly deformed. Our aim was to investigate morphological differences between CMT pes cavovarus (CMT-PC), idiopathic pes cavovarus (I-PC) and normally aligned feet using three-dimensional (3D) cone beam weightbearing computed tomography (WBCT) measurements. We hypothesised that the hindfoot alignment was significantly different between the three groups. Methods: Retrospectively, we compared 17 CMT-PC (15 patients) with 24 I-PC and 24 clinically normally aligned feet. Patients were comparable by age, sex and body mass index. All WBCTs were performed during routine investigation. Exclusion criteria included previous ipsilateral foot/ankle surgery and inability to heel weightbear. Three measurements were made by one orthopaedic surgeon: foot and ankle offset (FAO), a three-dimensional calculation describing the relationship between the centre of gravity of the tripod of the foot and the centre of the ankle; calcaneal offset (CO), measuring the distance between a theoretically neutral position of the calcaneus and its true position; and hindfoot angle (HA), an estimative of coronal angular hindfoot alignment. These measurements were all repeated twice for intraobsever reliability calculation (Pearson correlation). The mean values were compared using one-way ANOVA (values normally distributed after Shapiro-Wilk test) with the Bonferroni test. Results: Intraobserver reliability was excellent for all the three measurements (r=0.98 for FAO, CO and HA). Mean FAO value ± standard deviation in CMT-PC group (-14.1% ± 7.2) and in I-PC group (-9.6% ± 5.2) both differed from normal feet (1.6% ± 3.3) (p< .001). Of note, a difference was found between mean FAO in CMT-PC and I-PC feet (p .025). Furthermore, the mean CO (- 23.6 mm ± 11.3 in CMT-PC, -16.7 mm ± 8.2 in I-PC and 3.1 mm ± 6 in normal feet) and the mean HA (-44.9° ± 21.7 in CMT-PC; - 30.3° ± 16.9 in I-PC; 5.1° ± 10.1 in normal feet) significantly differed in three groups (p< .001) and specifically between CMT-PC and I-PC feet (p .032 and p .02 for CO and HA, respectively). Conclusion: This study confirms our hypothesis. Hindfoot alignment in patients diagnosed with CMT cavovarus and idiopathic cavovarus feet significantly differed between them and from normal controls, with a more accentuated varus deformity in CMT patients. This probably reflects the presence of a known neuromuscular imbalance driving the deformity over time in CMT feet. We therefore propose using a reliable method of quantifying heel varus and seeking a potential neurological diagnosis in the more severe.
Medial and Lateral Malleoli Impose Anatomical Constraints on Total Ankle Arthroplasty Design
Authors: Bischoff Jeffrey E. , Snyder Sandra , Coetzee J. Chris , Miller Stuart , Philbin Terrence 
Published: October 2019

Category: Ankle Introduction/Purpose: Contemporary total ankle arthroplasty (TAA) techniques reconstruct the tibiotalar articulation while preserving the medial and lateral malleoli. The malleoli place anatomic constraints on the design of the talar component of the TAA system. If these constraints are not respected, then proper placement of the talar component may be compromised intra- operatively, or unintended contact between the prosthesis and bone may occur post-operatively. The goal of this study was therefore to quantify the medial and lateral malleolar boundaries. Methods: The orientation of the talus from a frontal view was quantified based on CT scans of left leg, non-arthritic specimens (n=89; 52M/37F) (Figure 1a). The talar dome was identified as the portion of the talus superior to the talar neck. The frontal profile of the dome defined by a plane positioned through the medial and lateral high points was extracted for each specimen. Statistical shape analysis was performed to identify the modes of variation of the frontal profile. Medial and lateral lines were fit to each profile, and resulting angles relative to the superior-inferior axis were measured. A paired student t-test (P<.05) was used to assess differences between the medial and lateral malleolus. Results: Figure 1b shows the average frontal profile of the talar dome, as well as ±1 and ±2 standard deviations. The average medial and lateral taper angles of the talus were 15.5° ± 5.9° and 7.6° ± 2.9°, respectively, with the lateral taper angle being significantly smaller than the medial taper angle (P<.001). The medial taper increased with talus size (as measured by the medial- lateral width of the dome) whereas the lateral taper decreased with talus size (Figure 1c), though both regressions were weak (R2 < 0.1). No statistically significant difference in taper angles was found between genders. Conclusion: Restoration of the bicondylar articulation geometry of the tibiotalar joint is an important design goal for TAA. One aspect of this geometry is the anatomic constraints imposed by the medial and lateral malleoli, to minimize unexpected impingement of the TAA prostheses with surrounding anatomic structures. Here, we have quantified those constraints through analysis of the medial and lateral taper of the talus, showing an increased taper angle on the medial side of the talus as compared to the lateral side.
Second Metatarsophalangeal Joint Interpositional Arthroplasty Using Decellularized Human Dermal Allograft
Authors: Bohl Daniel D. , Idarraga Alex J. , Hur Edward S. , Lee Simon , Hamid Kamran S. , Lin Johnny 
Published: October 2019

Category: Lesser Toes Introduction/Purpose: Success has been reported in treating first metatarsophalangeal joint osteoarthritis with allograft interpositional arthroplasty, but little has been published regarding the use of similar techniques for the second metatarsophalangeal joint. We hypothesized that second metatarsophalangeal joint allograft interpositional arthroplasty would result in improvement in patient-reported outcomes, a low rate of postoperative complications, and a low rate of reoperation at minimum follow-up of one year. Methods: A retrospective review of medical records was conducted for patients having undergone allograft interpositional arthroplasty of the second metatarsophalangeal joint with at least one year of postoperative follow-up. Our technique included a dorsal incision and joint exposure, removal of the cartilage from the metatarsal head using a conical reamer, suture of a human decellularized dermal allograft to the metatarsal head though drill holes, and capsular repair (Figure 1). Preoperative and postoperative findings were compared, including Foot Function Index (FFI) and radiographic joint space measured on the AP view. Postoperative range of motion and satisfaction with the procedure were quantified. Results: In total, 5 patients met inclusion criteria. Mean follow-up was 3.2+/-2.1 years. Three of 5 patients (60.0%) reported that they would have the procedure again, and mean satisfaction with the procedure was 6.0+/-5.1 out of 10. One patient had conversion to fusion at 2 postoperative years. Among the 4 unfused patients, Foot Function Index decreased from 75.7+/-29.8 preoperatively to 52.0+/-46.5 at final follow-up (p=0.526). Mean final arc of motion was 35.0+/-7.1 degrees. Radiographic joint space was 0.4+/-0.3 mm preoperatively, increased to 2.2+/-0.5 mm immediately postoperatively, and decreased to 1.5+/-0.8 mm at final follow-up. The final follow-up joint space trended towards a larger number among the patients who stated they would have the procedure again compared to the patients who stated they would not (2.6+/-1.0 mm versus 0.4+/-0.4 mm, p=0.178). Conclusion: Second metatarsophalangeal joint allograft interpositional arthroplasty is a reasonable alternative to arthrodesis for management of isolated late-stage second metatarsophalangeal joint osteoarthritis. Arthrodesis of the second metatarsophalangeal joint is suboptimal due to altered gait mechanics; hence, novel joint preserving procedures are of value. Despite the modest results of interpositional arthroplasty in this limited series, the procedure can result in pain relief while allowing for motion in a subset of patients. The major determinant of success among our cohort was the maintenance of radiographic joint space at final follow-up.