bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burr to Bone Time for Joint Preparation in Minimally Invasive Foot and Ankle Fusion Surgeries: A Cadaver Study
Authors: Idris Maksat , Vulcano Ettore , Chien Bonnie Y. 
Published: December 2024

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Minimally invasive surgical (MIS) techniques have been implemented in various foot and ankle procedures, including joint arthrodesis. While these techniques can be effective in reducing complications and improving outcomes, there remains variability with surgeon learning curves, the type of instruments used, and approach to intraoperative imaging. This study seeks to aid surgeons through more reproducible guidelines by measuring the time needed for joint preparation with an MIS specific burr. Methods: A total of 8 cadaveric limbs (4 left and 4 right feet) were used for the preparation of the 1st metatarsophalangeal (MTP), 1st tarsometatarsal (TMT), talonavicular (TN), subtalar and ankle joints. The active burr use time to debride all cartilage from each joint was recorded. Each joint was prepared with an open approach to precisely determine the amount of time needed for cartilage removal. Descriptive statistics and a Kruskal-Wallis with post-hoc comparisons were used to analyze the data. Results: The 1st MTP was prepared with a mean (SD) time of 54.49 (34.65) seconds; the 1st TMT 51.82 (19.69) seconds; the TN joint 87.89 (43.77) seconds; the subtalar joint 59.46 (37.84) seconds; and the ankle joint 95.59 (54.99) seconds. Only the ankle joint preparation times compared with 1st MTP, 1st TMT and subtalar joints were significantly longer. Conclusion: This study provides burr time metrics for joint debridement in MIS foot and ankle arthrodesis procedures. Although there remains variability in types of burrs used, joint sizes and individual experience with the instruments, the timing of joint preparation can be an objective reference for surgeons to effectively and safely perform minimally invasive techniques. Figure 1. Comparison of joint preparation time across different joints The error bars depict one standard deviation of uncertainty. Asterisk (*) lines indicate a statistically significant difference (P < 0.05) based on unadjusted P values from the Dunn post hoc group comparisons. *Abbreviations: metatarsophalangeal (MTP), tarsometatarsal (TMT), talonavicular (TN).
Clinical and Radiological Outcomes of Flexible Flatfoot Correction with Calcaneal Osteotomy
Authors: Kim Sunghoo , Lee HoSeong 
Published: December 2024

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Various surgical procedures have been used to correct flexible flatfoot deformity; however, the most effective procedure for this deformity remains controversial. This study was performed to evaluate the radiographic and clinical effectiveness of double calcaneal osteotomy (medial displacement calcaneal osteotomy with lateral column lengthening) to correct flexible flatfoot deformities. Methods: Thirty-one patients who had 44 symptomatic flexible flatfeet and underwent double calcaneal osteotomy were examined retrospectively with a mean follow-up of 50 months. Visual analog scale, foot and ankle activity measure, and other clinical data were obtained from medical records. Various radiographic variables for assessing flatfoot and osteoarthritic change in tarsal joints were analyzed from weightbearing radiographs. Results: Results revealed that clinical scores and radiographic variables were significantly improved postoperatively. The mean values of medial sliding and lateral lengthening were 7.6 and 8.7 mm, respectively. No osteoarthritic changes were observed. Conclusion: Double calcaneal osteotomy could be used to correct flatfoot deformities effectively and sustainably and provide symptomatic relief and patient satisfaction.
Clinical Results of All-Inside Lateral Ankle Ligament Complex Repair were Comparable to Open Brostrom Procedure in High-Demand Patients with Chronic Ankle Instability: Randomized Controlled Study
Authors: Lee Sung Hyun , Lim Gyeong Hun 
Published: December 2024

Category: Ankle; Arthroscopy Introduction/Purpose: The open modified Broström-Gould procedure is widely accepted as the reference standard for lateral ankle stabilization. However, there is a lack of research comparing the outcomes of arthroscopic repair and open repair procedures for chronic ankle instability (CAI), despite the increasing number of publications on arthroscopic repair of the anterior talofibular ligament (ATFL). This study aimed to compare the clinical and radiological outcomes of arthroscopic repair and open repair of the lateral ligament complex (LLC) in patients with CAI. Methods: We prospectively randomized 64 patients who underwent ligament repair surgery for CAI into two groups: arthroscopic LLC repair (group A, 33 patients) and open modified Broström-Gould procedure (group O, 31 patients). High-demand patients, as determined by a Tegner Activity level ≥ 6, with CAI were included. Subjective outcomes were measured using the pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score. Posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic evaluations were conducted preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). A subgroup analysis was also performed according to arthroscopic ligament quality (excellent to fair vs. poor). Results: Both groups showed significant improvements in all clinical scores, objective posturography results, and stress radiographs at 2 years postoperatively (all p < 0.05), with no significant differences between the groups in terms of preoperative and postoperative values (all p > 0.05). Additionally, we identified 5 cases of retear (7.8%) based on postoperative MRI evaluation (9.1% [3/33] in group A and 6.5% [2/31] in group O). One patient in group O experienced postoperative soft tissue infection. However, there were no significant differences between the two groups (p > 0.05). There was no difference in clinical results between each group in subgroup analysis according to ligament quality (p > 0.05). Conclusion: Arthroscopic LLC repair produced similarly favorable outcomes when compared with open lateral ankle ligament repair. In addition, arthroscopic LLC repair, as a minimally invasive technique, provide comparable outcomes to open procedure, even when the ligament tissue was poor.
Clinical Results of Os Subfibulare Resection with Ligament Repair in Chronic Lateral Ankle Instability
Authors: Suh Jae Wan , Park Youngchae , Kwon Joohan , Park Hyun-Woo 
Published: December 2024

Category: Sports; Ankle Introduction/Purpose: Previous studies still have conflicting views on the size of the ossicle during ligament repair after ossicle removal. However, there is no standard for measuring the size of the ossicle. Furthermore, ossicle has various sizes, shapes, and positions. This study aimed to investigate the subfibular ossicles' morphologic characteristics and correlations with variables and to determine the clinical outcomes of ossicle removal and ligament repair. Methods: From February 2012 to December 2022, we retrospectively studied patients who underwent ossicle removal and MBO for chronic lateral ankle instability. Patients with degenerative arthritis, a history of previous ankle ligament surgery, or bilateral subfibular ossicles were excluded. The ankle stress radiographs were taken, and anterior drawer distance and talar tilt angle were obtained. The size, location, and number of ossicles were evaluated on MRI and radiographs. The location of the ossicle was classified into three zones according to the insertion of the ankle ligaments. Ossicle size measurements in MRI were as follows: length: anterior-posterior distance, height: superior-inferior distance, width: medial-lateral distance. The greatest distance among the coronal and sagittal images was measured, respectively. Clinical results were assessed using the Karlsson-Peterson (KP) ankle score and Foot and ankle outcome score (FAOS). Results: Forty ankles out of 477 patients were included. As for the location of ossicles, the ATFL attachment site was the most common with 57.5% (23/40), the CFL attachment site was 17.5% (7/40), and the case that spanned both ATFL and CFL was 20% (8/40). Most showed one ossicle, but 5% (2/40) of ankles showed two. Ossicles with a length greater than 10 mm in the sagittal view were 30% (12/40). At the last follow-up, all clinical scores improved significantly. There were no significant differences in preoperative radiographic instability, ossicle size, and clinical outcomes according to ossicle location. Ossicle width showed a significant correlation with anterior drawer distance (Pearson coefficient=0.437, p=0.033). Ossicle size showed no significant correlation with clinical scores at the last follow-up. Conclusion: For chronic ankle lateral instability with ossicle, ossicle removal and Brostrom ligament repair can achieve good clinical results. The size and location of ossicles had no significant correlation with post-operative clinical outcomes. Depending on the width of the ossicles, instability is thought to be related to which anatomical ligaments are involved and how much.
Combined Anterior and Posterior vs Isolated Posterior Facet Fixation for Subtalar Arthrodesis: A Proportional Meta-Analysis and Systematic Review of the Literature
Authors: Izzo Antonio , Manzi Giovanni , D'Agostino Martina , Mariconda Massimo , Patel Shelain , Bernasconi Alessio 
Published: December 2024

Category: Hindfoot; Other Introduction/Purpose: Subtalar arthrodesis (SA) is a common procedure to treat end-stage subtalar osteoarthritis. We set out in order to determine whether a combined direct fixation of both anterior and posterior facets during SA might influence union and complications compared to isolated fixation of the posterior facet. Our hypothesis was that a combined fixation increases the union rate and reduces the complication rate. Methods: In this PRISMA-compliant PROSPERO-registered systematic review, we included studies reporting data after SA stabilized with screws in adults. The characteristics of the cohort, study design, surgical details, nonunion and complication rate at the longest follow-up were recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were compared: an ANT/POST group (screws positioned both in the anterior and posterior facet) and an ONLY POST group (isolated posterior facet fixation). Results: Eighteen series (685 feet: ANT/POST=96, ONLY POST=589) were selected. The median follow-up was 28 months (IQR, 12-42). The pooled proportion showed a similar nonunion rate (6% vs 10%;p=0.46) and complication rate (14% vs 19%,p=0.47) in the ANT/POST group as compared to the ONLY POST group. The pooled proportion of reoperation was not different either (ANT/POST: 7% vs ONLY POST: 10%,p=0.37). Kernel regression suggested a correlation between the proportion of open/arthroscopic procedures and the nonunion rate (p=0.025) with a median nonunion rate at 10.9% and 5.9% for open and arthroscopic procedures, respectively. Mean CMS was 40.4 points (poor quality). Conclusion: This proportional meta-analysis suggested that a combined direct fixation of anterior and posterior facets during subtalar arthrodesis does not significantly influence the risk of nonunion nor affects the risk of complication and reoperation as compared to isolated posterior facet fixation.
Comparison of In-Shoe Plantar Pressure Between Korean Combat Boots and Running Shoes: A Prospective Comparative Study
Authors: Yoon Youngsik , Kyung Min Gyu , Lee Dong Yeon 
Published: December 2024

Category: Basic Sciences/Biologics Introduction/ Purpose: Combat boots are special shoes designed for soldiers to wear during activities in rough terrains, such as long marches or military training. Combat boots cause high plantar pressure and increase the injury rate of the lower extremities. Therefore, this study aimed to compare the difference of in-shoe plantar pressure between Korean combat boots and running shoes. We hypothesized that the newest Korean combat boots would have comparable plantar pressure distribution to running shoes. Methods: We prospectively recruited 30 asymptomatic male participants, who are considered as candidates for military services, from the local area. Two types of shoes (newly developed Korean combat boots and running shoes) were examined. Data of pedobarographic measurements were collected using the pedar®-X in-shoe pressure measurement system. Peak pressure (PP), pressure time integral (PTI), contact area, and contact time were analyzed. Results: Both PP and PTI at the region of central and lateral forefoot (FF) were significantly higher in combat boots. The contact area of combat boots was significantly lower at the region of the hallux, 2-5 toes, medial FF, central FF, and midfoot. Contact time at the region of central FF and medial heel was significantly higher in combat boots. Conclusion: Understanding plantar pressure distribution of combat boots can be helpful in the development of combat boots and prevention of injury. Based on the results of our study, the next generation Korean combat boots should be developed to increase contact area and distribute impulse under the head of the metatarsal bone
Comparison of Outcomes of the Third Generation Minimally Invasive Chevron-Akin Procedure Between Elderly and Younger Patients with Hallux Valgus
Authors: Choi Seung-myung , Cho Byung-Ki , Bae Seung-Hwan , Choi Seo-yool 
Published: December 2024

Category: Bunion; Other Introduction/Purpose: Hallux valgus is known to be more prevalent and present with greater severity in the elderly population compared to the younger age group. However, surgical treatment of hallux valgus in the elderly carries a risk of suboptimal results owing to porotic bone quality and multiple comorbidities typical of this age group. Although the third-generation minimally invasive Chevron and Akin osteotomy (MICA) technique, which features minimal soft tissue disruption and rigid internal fixation, may be an attractive option for surgical treatment of hallux valgus in the elderly, its outcomes have not been thoroughly investigated. This study sought to compare the outcomes of third-generation MICA procedures in patients aged 65 and older with those in the cohort under 65 years of age. Methods: In this retrospective cohort study, 76 patients (79 feet) who underwent the third generation MICA procedure for hallux valgus and were followed up for at least 1 year were stratified into 2 groups: ≥65 years old (Group 1: 36 feet) and < 65 years old (Group 2: 40 feet). Radiographic assessments included HV angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Postoperative complications, including recurrence of the deformity, reduction loss and reoperation, were assessed. Results: The average age at the time of surgery in group 1 was 70.9 ± 5.8 (range 65~90) years, and in group 2, 50.2 ± 2.8 (range 21~ 63), respectively. In the elderly group, Bone Mineral Density (BMD) was measured -2.9. The mean HVA, IMA and DMAA significantly improved at the final follow-up in both groups, respectively (all P < .001). Both preoperative and postoperative HVA were significantly greater in group 1 (both, P < .001), and the change of this parameter after surgery was also lower in group 1 than in group 2 (P < .001). There were significantly higher rates of reduction loss (16% vs 2.5%) and recurrence (11.1% vs 0.5%). However, clinical scores and patient satisfaction rates did not differ significantly. Conclusion: The present study demonstrates that chronological age, specifically categorized as 65 years or older, exhibits no substantial influence on the clinical outcomes following third-generation MICA surgery. Nevertheless, it is imperative to adequately apprise patients of the potential for reduction loss and recurrence, possibly due to age-associated bone fragility.
Comparison of Surgical Outcomes Between Bioabsorbable and Metal Screw Fixation for Distal Tibial Physeal Fracture in Children and Adolescents
Authors: Kim Woo Sub , Sung Ki Hyuk , Choi Yoon Hyo 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Metal screws for fixation often necessitate a second surgery for removal, posing challenges in orthopedic care, which adds to treatment costs, introduces potential complications, and increases the psychological burden on patients. In pediatric cases, the need for repetitive general anesthesia during the second operation heightens the risk of neurotoxicity, creating an unsatisfactory experience for both the patients and their parents. We aimed to compare the surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescents, in the radiographic and clinical aspects. Additionally, we sought to compare the length of hospital study and medical cost between the two groups. Methods: Consecutive 67 children and adolescents who underwent open reduction and internal fixation using metal or bioabsorbable screws for the distal tibia physeal fracture were included. All patients underwent preoperative radiographs, three-dimensional computed tomography scans, and postoperative follow-up teleradiogram. Patients were divided into metal (N =40) and bioabsorbable groups (N =27). We compared the surgical outcomes between the two groups in terms of clinical and radiographic outcomes, length of hospital stays, and medical cost. Results: Age at surgery and follow-up duration were significantly older and longer in the metal group than those in the bioabsorbable group. There was no significant difference in the incidence of growth arrest after surgery between the two groups. There were no significant differences in the scores of the Oxford Ankle and Foot Questionnaire between the two groups. However, the total hospital stay was significantly longer in the metal group (5.2 ± 4.8 days) compared to the absorbable group (2.6 ± 0.5 days). Medical costs were significantly higher in the absorbable group than in the metal group with a difference of 397 US dollars. Conclusion: The use of bioabsorbable screws exhibited therapeutic effects equivalent to that of metal screws for pediatric distal tibia physeal fractures regarding clinical and radiological outcomes. Moreover, it had the advantage of avoiding the need for repeated general anesthesia and secondary operation for implant removal. Therefore, the use of bioabsorbable screws may be a favorable surgical option for treating pediatric fractures.
Contact Pressures of the Posterior Heel in Lower Extremity Splints: A Biomechanical Study
Authors: Nakken Erik R. , Walley Kempland C. , Talusan Paul , Walton David , Holmes James 
Published: December 2024

Category: Basic Sciences/Biologics; Trauma Introduction/Purpose: Immobilization using lower extremity splints is a ubiquitous tool in orthopaedic care in the emergency department, operating room, and outpatient clinic settings. Prolonged use of these splints may result in skin changes or ulceration of the heel if not padded or positioned correctly. There is currently no biomechanical study in the literature measuring posterior heel contact pressure in lower extremity splints. The purpose of our study is to measure the contact pressure differences in the posterior heel with increasing layers of cotton padding, with and without the heel floating. We hypothesize that increased layers of padding will decrease contact pressure, but improvement will plateau. We predict that floating the heel will also considerably offload contact pressure. Methods: Short leg splints were applied to six limbs in three healthy subjects with an underlying pressure transducer (Tekscan I-Scan system) on the skin surface of the posterior heel. Peak contact pressures were measured after 0, 2, 4, and 6 layers of cotton padding were applied behind the heel in positions both with and without the heel freely floating. Each limb served as their own control, as pressure changes were compared to each limb’s baseline measurement (splint applied with all padding removed). Results: Over a 3-fold decrease in peak contact pressure was observed after the application of 4 or 6 layers of cotton padding. This escalated to over a 6-fold decrease with 2, 4, or 6 layers of padding while the splint was positioned with the heel freely floating. Splints with 4 and 6 layers of padding decreased heel contact pressure similarly (reduced to 29% and 28% from baseline, respectively), improved from 2 layers of padding (51% decrease from baseline). The mean contact pressure with 6 layers of padding (28% from baseline) remained higher than the mean contact pressure with 0 layers of padding with the heel floating (21% from baseline). Conclusion: Lower extremity splints with 4 or 6 layers of cotton padding provided a meaningful decrease in peak posterior heel contact pressure. The greatest decrease in heel contact pressure was observed in splints with the heel floating, even with all layers of cotton padding removed. This was more optimal than all layers of cotton padding tested. This study emphasizes the critical nature of patient counseling regarding the importance of proper splint positioning with the heel floating when at rest. Neglecting to do so may put the patient at increased risk for posterior heel skin complications.