bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Evans Osteotomy without Fixation Does Not Increase the Nonunion Rate
Authors: Materon Solangel Rodriguez , Gallagher Brian P. , Miles Megan , Mathew Smitha E. , Mansur Nacime Salomao Barbachan , Dai Amos , Alkaramany Eslam , Guyton Gregory P. 
Published: December 2024

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used in the correction of flexible flatfoot deformities. Currently, there is no consensus on whether fixation is necessary when performing this osteotomy. The primary aim of this study was to determine the nonunion rate of an unfixed Evans osteotomy with use of an allograft wedge performed in patients undergoing flexible flatfoot reconstruction. The secondary aim was to report on the incidence and magnitude of calcaneocuboid (CC) joint subluxation. Methods: a retrospective chart review was done for a consecutive series of 145 feet in 137 patients who underwent Evans osteotomy as part of a flatfoot reconstruction with allogenic bone graft between January 2013 and October 2017, by a single fellowship-trained foot and ankle surgeon. Of those, 118 cases were available for analysis at a mean follow up of 62.5 weeks (SD 56.9). No fixation was used in any case. Time to union, estimated by clinical and plane radiographic evaluation was recorded, along with standard measures of deformity correction and CC joint subluxation. Results: There was only one nonunion 1/118 (0.84%) at final follow up. The mean time to union was 10.9 weeks (SD 1.56). Postoperative calcaneocuboid joint subluxation occurred in 50.8% of feet, with a mean of 1.51 mm, SD 2.3 mm and no correlation with wedge size (r=0.05, p=0.55). The mean wedge size was 7.1 mm , SD 1.4 mm (range, 5-12 mm). There was no correlation between wedge size and change in lateral column length (r=0.13, p=0.16). There was significant change between pre and postoperative calcaneal pitch, talonavicular uncoverage percentage, anteroposterior and lateral talo-first metatarsal angle, medial and lateral column height, and lateral column length (p < 0.05). Conclusion: Evans osteotomy without fixation for symptomatic flatfoot deformity resulted in an exceptionally low nonunion rate. CC joint subluxation occurred frequently but was small in magnitude, a finding that may be related to the relatively small size of the wedges used.
The Impact of Each Burr Pass on Gap Size and Hindfoot Alignment in Minimally Invasive Zadek Osteotomy
Authors: Karaismailoglu Bedri , Nassour Nour , Duggan Jessica L. , Peiffer Matthias , Ghandour Samir , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil , Miller Christopher P. 
Published: December 2024

Category: Hindfoot; Sports Introduction/Purpose: While MIS Zadek osteotomy offers numerous advantages, it does come with a significant drawback as it impedes the direct measurement of the planned resection, depending solely on the surgeon's perception. This reliance can result in either insufficient or excessive resection of the calcaneus. The aim of this study is to elucidate the impact of each burr pass on the extent of correction, gap size, and calcaneal morphology following MIS Zadek osteotomy. Methods: en cadaveric specimens devoid of apparent foot pathology underwent a minimally invasive Zadek osteotomy utilizing a 3.1 mm Shannon burr. The osteotomy initiation point was anterior to the attachment of the calcaneal plantar fascia, preserving the plantar cortex and extending dorsally to the anterior aspect of the posterosuperior tubercle of the calcaneus. Following each burr pass, the created defect was closed and maintained in a reduced state during subsequent burr passes. This sequence was reiterated five times, and neutral lateral x-rays were captured before and after each burr pass to quantify the impact of individual passes. Measurements were calibrated using markers placed during radiological examination. These measurements encompassed the defect size formed with each burr passage, determined by the change (shortening) in the overall length of the dorsal calcaneal cortex. Additionally, alterations in various foot alignment parameters were assessed, including Böhler angle, Calcaneal X/Y ratio, and Fowler Philip angle. Results: The dorsal calcaneal cortical length exhibited an average reduction with each burr pass as follows: 2.1 mm during the 1st pass, 1.9 mm during the 2nd pass, 1.6 mm during the 3rd pass, 1.2 mm during the 4th pass, and 0.9 mm during the 5th pass. The Böhler Angle (°), X/Y Ratio (%), and Fowler Philip Angle consistently decreased with each successive burr passage. Conclusion: Our research showcased that employing a percutaneous 3.1 mm burr in Zadek osteotomy sequentially can result in a 10 mm dorsal wedge size after 5 burr passes. The calcaneal geometry, assessed through the X/Y ratio, Fowler-Philip angle, and Böhler angle, exhibited gradual alterations with each burr pass. The insights gained from this study offer valuable information for foot surgeons, deepening their comprehension of the influence of each burr pass on gap size and foot alignment parameters in minimally invasive Zadek osteotomy.
The Impact of GLP-1 Agonist Therapy in Tibiotalar and Subtalar Fusion: A Propensity-Matched Analysis
Authors: Levidy Michael , Vatsia Sohrab , Tucker Scott , Rowe Nicholas , Aynardi Michael , MacDonald Ashlee 
Published: December 2024

Category: Diabetes; Ankle Introduction/Purpose: The rising prevalence of obesity and diabetes mellitus have rendered the usage of GLP-1 agonists increasingly commonplace since their introduction in 2005. Foot and ankle surgeons consistently provide orthopedic care to diabetic patients through tibiotalar and subtalar fusion. There is, however, a dearth of evidence to suggest whether outcomes of ankle fusion differ in patients treated with GLP-1 agonists. This study retrospectively compares rates of infection and failed fusion in patients who underwent tibiotalar or subtalar fusion with and without concurrent GLP-1 agonist therapy. Methods: The TriNetX Diamond Network was queried using CPT and ICD codes for patients with diabetes mellitus undergoing tibiotalar or subtalar fusions from 2005 to 2024. Diagnosis codes occurring within 1 year of the index procedure for: infection following a procedure (T81.4) and pseudoarthrosis after attempted fusion (M96.0) were compared using chi-squared statistical testing. Cohort balancing was performed categorically according to age at procedure, race, sex, and nicotine dependence. Cohort balancing was performed continuously for index BMI, Hemoglobin A1C, estimated Glomerular Filtration Rate (eGFR). Significance was set at p< 0.05 with associated 95% confidence intervals. Results: Overall, two propensity-matched cohorts of 708 patients were included in our analysis. Cohorts were not significantly different across any of the balancing parameters (p>.05). The postoperative infection rate was found to be significantly higher in the GLP-1-treated group (9.0%) than the non-treated group (5.6%) (p=0.02). No statistical significance was observed in the rate of postoperative pseudoarthrosis amongst patients who underwent fusion with (9.0%) and without (12.0%) GLP-1 agonist usage (p=0.08). Conclusion: Although GLP-1 agonists have provided significant benefit in the treatment of obesity and diabetes mellitus, results of this study suggest a previously unreported risk of postoperative infection associated with GLP-1 agonist use following ankle arthrodesis. Further investigation is needed GLP-1 agonists' effects on foot and ankle surgery. It is our hypothesis that previously demonstrated anti-inflammatory properties attenuate immune response and predispose patients to postoperative infection. Past inquiries have also demonstrated reduced osteoclast activity with GLP-1 agonist administration. Therefore, we suspect that decreased osteoclast activity at fusion margins may disrupt resorption of heat-necrosed bone, leaving a nidus for infection.
The Use of AI For Hallux Valgus Assessment via Mobile Phone-Based 3D Camera Scan
Authors: Ghandour Samir , Lebedev Anton , Tung Wei Shao , Semianov Konstantin , Semyanov Artem , Guss Daniel , Waryasz Gregory R. , Kwon John Y. , Skolnik Jennifer , DiGiovanni Christopher W. , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil 
Published: December 2024

Category: Bunion; Other Introduction/Purpose: Hallux valgus (HV) is a prevalent forefoot deformity that leads to pain, stiffness, and difficulties with footwear. Conventional diagnosis of HV relies on clinical and radiographic examination, which can be cumbersome and expose patients to ionizing radiation. The emergence of 3D scanning technologies, such as structured light, integrated into smartphones, presents a novel approach to early detection and diagnosis of HV, potentially allowing for earlier intervention and subsequent reduction in the progression of the deformity. Methods: This prospective non-randomized clinical trial recruited patients from the foot and ankle clinic, identifying cases and controls based on the presence or lack of clinically diagnosed HV. Patients older than 18 years of age and able to consent were included. The 3D scanning of the foot utilized structured light technology integrated into smartphones, with an algorithm developing a surrogate angle for HV detection. This angle was correlated with conventional radiographic measurements, including hallux valgus angle (HVA) and intermetatarsal angle (IMA) from weightbearing radiographs. A cluster analysis assessed the algorithm’s capacity to identify deformity severity according to radiographic severity grading. The algorithm's accuracy and performance were assessed using the area under the receiver operating characteristic curve, precision-recall Curves, and the leave-one-out cross-validation method. Results: 120 patients were enrolled in this trial. Out of 240 feet examined, HV was present in 29.1% of cases. The algorithm's surrogate angle showed a robust correlation with the clinical hallux valgus angle (HVA), with a correlation coefficient of 0.91 and a specificity of 0.882. Notably, the surrogate angle's correlation with the intermetatarsal angle (IMA) was also significant, albeit lower (r = 0.65). The area under the ROC curve (AUC) was 0.947, and the precision-recall AUC scores for positive and negative classes were 0.89 and 0.92, respectively. These metrics confirmed the algorithm's potential as a reliable diagnostic tool for detecting HV and determining its severity through non-invasive, commonly available smartphone technology. Conclusion: This study validates the accuracy of a smartphone-based 3D scanning algorithm in detecting and grading HV deformity, providing a low-cost, accessible decision-support tool for physicians and patients. This approach could improve early detection, reduce the need for clinical visits, and potentially expand to remote monitoring of HV and other pathologies, aligning with the growing trend of telemedicine and personalized healthcare.
Trends in Management of Adult Tarsometatarsal Joint Injuries in a Contemporary Australian Context: A Nationwide Study of Claims Data Over 20 Years
Authors: Wines Andrew , Fung Mitchell , Sivakumar Brahman , Jiang Eric , Suthersan Mayuran , Mittal Rajat , Symes Michael 
Published: December 2024

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Traumatic tarsometatarsal joint (TMTJ) injuries are uncommon, but can cause significant morbidity due to delayed or missed diagnosis. Recent evidence highlights the importance of achieving anatomical reduction via operative management. This study aims to analyse trends in rates of open reduction internal fixation (ORIF) for Lisfranc inju- ries in Australia according to Nationwide claims data. Methods: Claims according to the Medicare Benefits Schedule (MBS) on ORIF of trau- matic TMTJ injuries were collated for the period from January 2000 to December 2020. Paediatric patients were excluded. Two negative binomial models were utilized to analyse the trends in TMTJ injuries over time after controlling for sex, age group and population changes. Results were absolute and per 100 000 population. Results: 7840 patients underwent TMTJ ORIF over the period studied. There was a mean yearly increase of 12% (P < 0.001). Age group (P < 0.001) and year (P < 0.001) were sig- nificant predictors for TMTJ fixation, whilst sex was not (P = 0.48). Patients older than 65 years were noted to have a 53% lower rate of TMTJ ORIF per person, when compared to the reference group of 25–34 year-olds (P < 0.001). Five-year block analysis revealed increases in rate of fixation for all age groups. Conclusion: Rates of operative fixation for TMTJ injuries are increasing in Australia. This is likely due to improved diagnostics, understanding of optimal treatment goals, and increased orthopaedic subspecialisation. Further studies with clinical and patient reported outcomes, as well as comparing rates of operative intervention to incidence, will be useful.
Utilization of Neural Network in the Diagnosis of Pes Planus and Pes Cavus with a Smartphone Camera
Authors: Ghandour Samir , Lebedev Anton , Tung Wei Shao , Semianov Konstantin , Semyanov Artem , Guss Daniel , Waryasz Gregory R. , Kwon John Y. , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil , Bejarano-Pineda Lorena 
Published: December 2024

Category: Midfoot/Forefoot Introduction/Purpose: Pes Planus (flatfoot) and Pes Cavus (high arch) are common foot deformities requiring clinical assessment and radiographic imaging for diagnosis and subsequent management. While effective, traditional diagnostic methods pose limitations such as cost, radiation exposure, and accessibility, particularly in underserved areas. With the advent of artificial intelligence and its integration into mobile cameras, we aim to develop a tool that detects and classifies such deformities using photos taken with smartphone cameras. Methods: An algorithm that integrated a deep learning, convolutional neural network (CNN) into a smartphone camera was utilized to detect Pes planus and Pes cavus deformities. The study was conducted at a tertiary hospital with participants recruited from two orthopaedic foot and ankle clinics. The CNN model was trained and tested using photographs of the medial aspect of participants’ feet. Participants included subjects with standard foot alignment, pes planus, or pes cavus determined by an expert clinician using the Foot Posture Index (FPI). The model’s performance was compared to clinical assessment and radiographic measurements, including the lateral tarsal-first metatarsal angle (LTMA) and calcaneal inclination angle (CIA). Results: The CNN model demonstrated high accuracy in diagnosing Pes planus and Pes cavus, with an optimized area under the curve of 0.897 for Pes Planus and 0.898 for Pes cavus. It showed a specificity and sensitivity of 84% and 87% for Pes Planus detection, respectively; for Pes cavus, 97% and 70%, respectively. The model’s prediction correlated moderately and significantly with radiographic LTMA measurements (r=-0.65, P< 0.001), indicating the model’s excellent reliability in assessing food arch deformity. Conclusion: Our smartphone-based CNN model is highly accurate as a decision-support tool, and it is reliable and accessible for predicting Pes planus and Pes cavus deformities. This tool may be very useful in underserved healthcare settings and for patients with limited access to expert clinical assessment. Future efforts should enhance this technology for pediatric use and improve severity differentiation, paving the way for more personalized and inclusive healthcare solutions.
What Are These Cysts Doing in My Graft?! A Meta-Analysis on Cystic Occurrence after Autografting and Allografting for Osteochondral Lesions of the Talus
Authors: Dahmen Jari , Hollander Julian , Butler James J. , Emanuel Kaj , Rikken Quinten , Stufkens Sjoerd , Kennedy John G. , M.M.J. Kerkhoffs Gino M 
Published: December 2024

Category: Sports; Arthroscopy Introduction/Purpose: Graft transplantation is a widely used treatment for large osteochondral lesions of the talus. However, cyst formation surrounding the graft is of concern. The primary purpose was to assess and compare cystic occurrence after autografting, allografting and osteoperiosteal grafting for osteochondral lesions of the talus. Our secondary aim was to assess correlation of clinical outcomes with the presence of postoperative cysts. Methods: A literature search was performed up to October 2023 through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the postoperative cystic occurrence rate. A random effects model with moderator analysis was used to calculate differences in occurrence rates between treatment groups. The relationship between the presence of cysts and clinical outcomes was additionally described. Results: Thirteen studies were included with 382 ankles that were radiologically assessed at follow-up after osteochondral autograft, allograft, and osteoperiosteal transplantation. The rates of cystic occurrence for the osteochondral autograft transplantation group, the allograft transplantation group, and the osteoperiosteal transplantation group were 42% (95% CI 24-61), 58% (95% CI 40-74), and 34% (95% CI 12-67), respectively, without any significant differences noted between these treatment groups. Six studies studied the relationship between the presence of cysts and clinical outcomes: none of these studies found a significant relationship between these two variables. Conclusion: Postoperative cystic occurrence is common after osteochondral autograft transplantation (42%), allograft transplantation (58%), and osteoperiosteal transplantation (34%) in osteochondral lesions of the talus – without significant intertreatment differences. The postoperative presence of cysts was not correlated with clinical outcomes.
Role of tranexamic acid via intravenous and irrigation fluid route in controlling TURP-associated bleeding
Authors: Kundargi Vinay S. , Patil Santosh , Patil Siddanagouda B. , Vaidya Manoj K. , Patil Basavesh S. , Shariff A. Nawaz , Shukla Vikas 
Published: December 2024

Abstract
Background
This study aims to evaluate the efficacy and safety of tranexamic acid (TXA) administered via the I/V (Intravenous) route and irrigation fluid route during TURP to directly target the bleeding site.

Methods
A total of 105 cases undergoing bipolar–TURP with gland size 40–100 g were randomized into three groups—control/placebo group (n = 35), I/V group (n = 35) (received 1gm TXA 20 min before the procedure) and irrigation group (n = 35) (received 500 mg TXA in every 3000 ml irrigation fluid up to a maximum of 2 g). Blood loss was estimated by recording haemoglobin and hematocrit at 4 h after the procedure and on first postoperative day. Other parameters such as resection time, intraoperative endoscopic vision, irrigation fluid volume and complications were noted.

Results
When measured at 4 h postoperatively, the drop in haemoglobin and haematocrit, respectively, was maximum in the control group (ΔHb = 0.78 g/dl, ΔHCT = 1.23%) followed by the irrigation group (ΔHb = 0.51 g/dl, ΔHCT = 0.72%) and was least in the I/V group (0.27 g/dl, 0.62%). The intergroup analysis showed significant difference only between the control vs I/V group (ΔHb p = 0.0163, ΔHCT p = 0.0253).
On postoperative day 1, the drop in haemoglobin and haematocrit, respectively, was maximum in the control group (1.10 g/dl, 1.63%) followed by the irrigation group (0.828 g/dl, 0.911%) and was least in the I/V group (0.811 g/dl, 0.948%). The intergroup analysis showed significant difference between the control vs irrigation group (ΔHb p = 0.026, ΔHCT p = 0.0001) and control vs I/V group (ΔHb p = 0.016, ΔHCT p = 0.0003).
Total resection time, average volume of irrigation fluid and average postoperative stay were comparable. No significant complications were observed.

Conclusions
TXA, given either via I/V or irrigation fluid route, reduces postoperative blood loss associated with TURP. Both routes are superior to placebo, but neither is superior to the other. TXA via the intravenous route also reduces intraoperative blood loss, but the same advantage is not observed with administration through irrigation fluid. TXA via either route has no impact on endoscopic vision. Both routes of administration are safe with no reported side effects.
GPs’ perspectives on care models integrating medical and non-medical services in primary care—a representative survey in Germany
Authors: Herrmann Wolfram J. , Napierala Hendrik 
Published: December 2024

Abstract
Background
Health-related social problems are common in primary care. Different care models integrating medical and non-medical services in primary care have been tested and established nationally and internationally, such as social prescribing, social work in primary care, health kiosks and integrated primary care centres. The aim of our study was to explore the perspective of general practitioners (GPs) working in Germany on these four care models regarding their meaningfulness and if they would like to use them. Secondary objective was to explore factors influencing this assessment.

Methods
We conducted a survey of a representative sample of GPs working in Germany. The questionnaire included questions on the assessment of the care models’ meaningfulness and whether the GPs would like to use them. The analysis was carried out descriptively and using linear regression.

Results
One thousand four hundred thirty-nine GPs took part in the survey. Social prescribing and social work in primary care were rated as the most meaningful concepts. Over 65% of the GPs believed that using at least one of the care models would be beneficial. One in four GPs would even welcome the idea of integrating their practice into an integrated primary care center. Older age and male gender were associated with a more negative assessment of the care models.

Conclusions
German GPs consider integrating medical and non-medical services in primary care to be meaningful, yet they are somewhat skeptical about its practical implementation in daily practice. However, younger GPs in Germany are significantly more receptive to these models.

Trial registration
German Register of Clinical Studies (DRKS-ID: DRKS00032585; Registration Date: September 1, 2023).
Mismatch repair, p53, and L1 cell adhesion molecule status influence the response to chemotherapy in advanced and recurrent endometrial cancer
Authors: Kim Jung Chul , Ahn Byungsoo , Lee Yong Jae , Nam Eun Ji , Kim Sang Wun , Kim Sunghoon , Kim Young Tae , Park Eunhyang , Lee Jung-Yun 
Published: December 2024

Abstract
Objective
This study aimed to identify the recurrence and survival rates according to the mismatch repair (MMR), p53, and L1 cell adhesion molecule (L1CAM) status in patients with advanced and recurrent endometrial cancer (EC) receiving systemic chemotherapy.

Methods
This single-center retrospective cohort study included chemotherapy-naïve patients with advanced-stage (III/IV) or recurrent EC between January 2015 and June 2022 (n = 156), who were administered chemotherapy as adjuvant therapy or first-line palliative treatment. MMR and p53 status were assessed, and L1CAM was tested using immunohistochemistry in the p53-wild and MMR-proficient (p53wt/pMMR) group. The primary outcomes were progression-free survival (PFS) and overall survival (OS).

Results
Of the 156 patients, 62 (39.7%), 53 (34.0%), and 41 (26.3%) had p53wt/pMMR, abnormal p53 (p53abn), and MMR-deficient (dMMR) tumors, respectively. PFS and OS were longest in dMMR, followed by p53wt/pMMR, and were the least in p53abn tumors (PFS: p = 0.0006, OS: p = 0.0013). After p53wt/pMMR was classified according to positive or negative L1CAM status, the L1CAM negative group exhibited significantly shorter survival rates than the L1CAM positive group (PFS: p = 0.0001, OS: p = 0.0027). p53abn tumors were independent prognostic factors for poor PFS (PFS: p = 0.039 on multivariable analysis).

Conclusion
In chemotherapy-naïve patients with advanced and recurrent EC, there was a better prognosis in the order of MMR-D, p53wt/pMMR, and p53abn tumors after chemotherapy. L1CAM status is useful as a new marker to stratify p53wt/pMMR in advanced and recurrent groups.