bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between number of medications and indicators of potentially inappropriate polypharmacy: a population-based cohort of older adults in Quebec, Canada
Authors: Campeau Calfat Alexandre , Turner Justin P. , Simard Marc , Boiteau Véronique , Sirois Caroline 
Published: December 2024

Background: As the number of medications increases, the appropriateness of polypharmacy may become questionable due to the heightened risk of medication-related harm. Objectives: (1) To investigate the relationship between the number of current medications used by older adults and three indicators of potentially inappropriate polypharmacy: (a) the mean number of potentially inappropriate medications (PIMs), (b) the average count of drug–drug interactions, and (c) the anticholinergic burden; (2) To characterize the population-based burden of potentially inappropriate polypharmacy by calculating the proportion of individuals with these indicators. Design: We conducted a population-based observational study using the Quebec Integrated Chronic Disease Surveillance System. Methods: We included all individuals over 65 years insured by the public drug plan on April 1st, 2022. For each individual, we calculated the number of current medications and the number of (a) PIMs (Beers 2019), (b) drug–drug interactions (Beers 2019), and (c) anticholinergic burden (Anticholinergic Cognitive Burden (ACB) scale). The association between the number of medications and these indicators was quantified using linear regression. Prevalence with 99% confidence intervals (CIs) was calculated. Results: A total of 1,437,558 individuals (mean age: 75; 55% female) were included, taking an average of 4.9 medications (±4.1). For each additional medication, the mean number of PIMs, drug–drug interactions, and anticholinergic burden increased by 0.11, 0.04, and 0.17, respectively ( p-trend <0.0001). Nearly half the population (45.5%; 99% CI: 45.5–45.5) had a regimen containing ⩾1 PIMs, ⩾1 drug–drug interaction, or an ACB ⩾3. Conclusion: The strong association between the increasing number of medications and reduced polypharmacy quality underscores the importance of medication count beyond therapeutic indications. With widespread medication use, many older adults face quality issues.
Finite Element Analyses of Three Minimally Invasive Fixation Techniques for Treating Sanders Type II Intra‑Articular Calcaneal Fractures
Authors: Shi Zhongmin , Gu Wenqi 
Published: December 2024

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods: A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results: After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was < 56 Mpa, and stress on the implants using the three techniques was less than the yield strength, with Technique C having the least stress. Conclusion: All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques.
Foot and Ankle Biomechanics During Gait of Patients with an Osteochondral Lesion of the Talus
Authors: Emanuel Kaj , Schallig Wouter , Piech Maciej , Dahmen Jari , van der Krogt Marjolein , M.M.J. Kerkhoffs Gino M , Stufkens Sjoerd 
Published: December 2024

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: An osteochondral lesion of the talus (OLT) is a defect of talar cartilage and subchondral bone, primarily linked to a history of ankle trauma. Mechanical overload is considered one of the reasons for the development of osteochondral lesions of the talus. However, no gait analysis of this patient group exists to date. We hypothesize that altered gait patterns lead to increased load at the side of the lesion compared to healthy controls. The primary aim of the study was to compare the foot and ankle biomechanics during gait between individuals with OLT and healthy controls. The secondary aim was to compare these parameters between individuals with a medial and lateral OLT. Methods: Ten patients diagnosed with symptomatic OLT (5 medial and 5 lateral lesions) underwent gait analysis. 3D kinematics according to the Amsterdam Foot Model, ground reaction force, and plantar pressure data were collected to quantify the motions and forces within the foot. OLT data were compared to a reference dataset of healthy controls (n=13) using statistical parametric mapping and one-way ANOVA. Results: The ankle joint was significantly rotated towards valgus in both the OLT groups compared to the control group during most of the gait cycle. Moreover, the medial OLT group showed decreased plantarflexion in the Lisfranc joint, and lateral OLT group showed higher peak pressures in the midfoot zone compared to the control group. Conclusion: The valgus rotation reduces medial loading, but was present in both OLT groups. Decreased Lisfranc plantarflexion and increased midfoot pressures indicate a tendency towards flat feet. The observed alterations in the OLT group could be adaptations to, or causes of, osteochondral damage in the ankle joint.
From Jargon to Clarity. Improving the Readability of Foot and Ankle Radiology Reports with An Artificial Intelligence Large Language Model
Authors: Butler James J. , Harrington Michael , Tong Yixuan , Rosenbaum Andrew , Samsonov Alan P. , Walls Raymond J. , Kennedy John G. 
Published: December 2024

Category: Other; Ankle Introduction/Purpose: The purpose of this study was to evaluate the efficacy of an Artificial Intelligence Large Language Model (AI-LLM) at improving the readability foot and ankle orthopedic radiology reports. Methods: The radiology reports from 100 foot or ankle X-Rays, 100 computed tomography (CT) scans and 100 magnetic resonance imaging (MRI) scans were randomly sampled from the institution’s database. The following prompt command was inserted into the AI-LLM. “Explain this radiology report to a patient in layman's terms in the second person. [Report Text]”. The mean report length, Flesch reading ease score (FRES) and Flesch-Kincaid reading level (FKRL) were evaluated for both the original radiology report and the AI-LLM generated report. The accuracy of the information contained within the AI-LLM report was assessed via a 5-point Likert scale. Additionally, any “hallucinations” generated by the AI-LLM report were recorded. Results: There was a statistically significant improvement in mean FRES scores in the AI-LLM generated X-Ray report (33.8±6.8 to 72.7±5.4), CT report (27.8±4.6 to 67.5±4.9) and MRI report (20.3±7.2 to 66.9±3.9), p< 0.001. There was also a statistically significant improvement in mean FKRL scores in the AI-LLM generated X-Ray report (12.2±1.1 to 8.5±0.4), CT report (15.4±2.0 to 8.4±0.6) and MRI report (14.1±1.6 to 8.5±0.5), p< 0.001. Superior FRES scores were observed in the AI-LLM generated X-Ray report compared to the AI-LLM generated CT report and MRI report, p< 0.001. The mean Likert score for the AI-LLM generated X-Ray, CT and MRI report was 4.0±0.3, 3.9±0.4, and 3.9±0.4, respectively. The hallucination rate in the AI-LLM generated X-Ray report, CT report and MRI report was 4%, 7% and 6%, respectively. Conclusion: AI-LLM was an efficacious tool for improving the readability of foot and ankle radiological reports across multiple imaging modalities. Superior FRES scores together with superior Likert scores were observed in the X-Ray AI-LLM reports compared to the CT and MRI AI-LLM reports. This study demonstrates the potential use of AI-LLMs as a new patient-centric approach for enhancing patient understanding of their foot and ankle radiology reports.
Gait in Controlled Ankle Movement (CAM) Walker Boot Using a Contralateral Shoe Lift
Authors: Fanfan Dino , Orellana Sergio Lemus , Lopez Kyra E. , Travascio Francesco , Murray Daniel , Chapman Cary B. 
Published: December 2024

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Walking mechanics play a fundamental role in daily mobility and are significantly influenced by footwear choices, particularly in individuals with lower limb conditions. Among the interventions commonly used in rehabilitation settings are controlled ankle movement (CAM) boots and shoe lifts, which aim to provide support and improve gait dynamics. The purpose of this outcome study was to test how different a person walks when wearing the controlled ankle movement (CAM) boot and the shoe lift compared to walking with your running shoes. Methods: We conducted a prospective cohort study comprised of 30 participants, 15 men and women, who underwent three-level walking trials under the following conditions: athletic shoes, tall CAM boot, and tall CAM boot with a balancer added to the contralateral foot. Sixteen anatomical markers were placed on participants according to Vicon’s Plug-in Gait Full Body (PIGFB) model. Kinematic data and ground reaction forces were collected at 500 Hz and processed with the PIGFB biomechanical model and Vicon’s gait cycle parameters. Data post-processing provided spatiotemporal gait parameters (contact times, stride length, speed, time spent in stance/swing phases, cadence) and lower limb kinematics and kinetics (knee and hip joint angles, movement, and forces). A Two-Way ANOVA, using walking condition and gender as factors, followed by a Tukey Pairwise comparison identified significant effects of walking conditions on various gait characteristics. Results: In both limbs, cadence (p = 0.002) and step width (p < 0.001) were significantly different in NB compared to CAM and CAMB. Specific to contralateral limb, stride time (p = 0.025), step time (p = 0.007), and limb index (p ≤ 0.001) were also affected. Regarding kinematics, the walking condition significantly affected contralateral hip abduction angle (p = 0.027). In addition, the walking condition had significant effect on the ipsilateral limb for both knee internal rotation (p = 0.024), and knee varus/adduction angle (p = 0.024). Regarding kinetics, the walking condition affected hip medial/lateral force (p =0.002), knee compression force (p =0.029), and knee varus/adduction moment (p = 0.024). The boot condition had the greatest hip force (5.7 N/kg) compared with the NB and CAMB conditions. Conclusion: Our study demonstrates significant changes in gait patterns and lower limb biomechanics when individuals wear a controlled ankle movement (CAM) boot and a shoe lift compared to athletic shoes. These results underscore the importance of considering footwear interventions in clinical and rehabilitation settings, as they can substantially influence gait patterns and biomechanical dynamics, highlighting the need for careful consideration in clinical and rehabilitation settings.
Impact of Body Mass Index on Complication Rates Following Primary Total Ankle Arthroplasty
Authors: McDonald Weston E. , Kulkarni Ronit , Morningstar Joshua L. , Friedman Richard J. , Scott Daniel J. , Gross Christopher E. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Recent literature has indicated higher body mass index (BMI) to be of concern for poorer outcomes following total ankle arthroplasty. The purpose of this study is to evaluate the impact of implementing BMI cutoff points on 6-month postoperative outcomes following total ankle arthroplasty (TAA). Methods: The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 5,865 patients undergoing primary elective TAA with a reported BMI range via ICD-10 diagnosis. Our cohort consisted of patients with BMI ≥30 kg/m2, stratified into groups by 5 BMI point intervals. Preoperative demographics, comorbidities, postoperative outcomes, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to control for predictors of adverse postoperative outcomes other than BMI. Results: When stratifying by preoperative BMI, higher BMI was associated with significantly lower age (p <.001) and rate of smoking (p <.001), and higher rate of female sex (p <.001), Medicaid insurance (p <.001), higher CCI score (p <.001), among other comorbidities. Multivariate regression analysis of 180-day postoperative outcomes, controlling for demographic and comorbidity differences, found that preoperative BMI 40-44.9 and ≥45 kg/m2 was significantly predictive of increased risk of any complication (44-44.9: OR=1.843; p<.001)(45+: OR=1.960; p<.001), adverse discharge (44-44.9: OR=1.217 p=.015)(45+: OR=2.030; p<.001), and extended stay greater than 4 days (44-44.9: OR=1.653; p<.001)(45+: OR=2.171; p<.001), with BMI ≥45 kg/m2 also being significantly predictive of 65% increased risk of readmission (OR=1.655; p=.004). Conclusion: Higher BMI in TAA is associated with an increased risk of any postoperative complication, adverse discharge, and extended LOS. Specifically, a BMI cutoff of 40kg/m2 would serve to prevent 38.6% of the 963 obese patients experiencing complications following TAA. While our results suggest that implementing a strict BMI cutoff would serve to reduce complications substantially, it will also prevent a large number of patients from undergoing a complication-free surgery that will ultimately serve to reduce pain and increase function. Instead, we suggest physicians consider a BMI cutoff in concert with other comorbidity factors that may affect surgical outcomes following TAA.
Impact of Socioeconomic Factors on Patient Reported Outcomes Following Operative Treatment for Ankle Fractures
Authors: Cantrell William A. , Teplensky Jason , Mueller James , Pasqualini Ignacio , Chawla Sagar 
Published: December 2024

Category: Ankle Introduction/Purpose: The impact of socioeconomic status on outcomes following operative treatment of ankle fractures is an emerging area of research. Recent studies have shown that lower socioeconomic status is associated with failure to return to work, increased risk of infection and amputation, and receiving care at higher cost locations. The Area Deprivation Index (ADI) is an effective measure of socioeconomic status that has been correlated with poorer outcomes in various orthopedic procedures, such as arthroscopic rotator cuff repair and total joint arthroplasty. However, the relationship between ADI and outcomes following operative treatment of ankle fractures has not been well-studied. Therefore, the purpose of this study was to evaluate the relationship between ADI and patient-reported outcomes following operative treatment of ankle fractures. Methods: This single-institution study utilized the OrthoMidas Episode of Care prospective database to identify 281 patients who underwent operative fixation for ankle fractures between January 1, 2021 and October 7, 2022. The primary outcomes were differences in FAAM, VR-12, PEG, and Patient Acceptable Symptom State (PASS) scores between patients from the least deprived (ADI tertile 1, range 1-33) and most deprived (ADI tertile 3, range 66-100) neighborhoods. Results: Of the available 281 patients, 12 did not have ADI information available. Of the remaining 270, 107 (40%) had completed 1-year patient-reported-outcomes. 130/270 (48%) of patients with ADI information available were in the most deprived neighborhoods (tertile 3, ADI range 66-100), whereas 45/270 (17%) were in the least deprived neighborhoods (tertile 1, ADI 1-33). Conclusion: This study demonstrates a clear association between neighborhood-based socioeconomic deprivation and patient reported outcomes following operative treatment for ankle fractures. The true etiology could be a function of geography or potentially modifiable patient factors. Further investigation is essential to identify areas to target interventions and improve outcomes for low socioeconomic status patients.
In-Office Needle Arthroscopy Is a Cost-Effective Alternative for Operating Room Diversion for Anterior Ankle Arthroscopy a Financial Analysis
Authors: Butler James J. , Gianakos Arianna , Savage-Elliott Ian , Kennedy John G. 
Published: December 2024

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to evaluate the impact on cost effectives with in-office needle arthroscopy (IONA) for the management of anterior ankle pathologies in comparison to anterior ankle arthroscopy performed in a traditional formal operating suite. Methods: Data regarding costs was obtained from the local institution in the following areas: . A Monte Carlo simulation combined with DuPont analysis running 10,000 simulations was conducted to calculate the revenue, expenses and profits between the 2 cohorts. Sensitivity analyses examined the influence of patient preference and revision rates on profit and throughput. Two-sample Student's t test was performed (p < .05). Results: There was a 91.4% reduction in costs in favor of anterior ankle IONA. Sensitivity analysis revealed 4.3% of patients need to select IONA over traditional arthroscopy in an operating suite with the revision rate remaining below 42% for the proposed state profit to be higher than the current state. Conclusion: IONA is a cost-effective alternative to traditional OR arthroscopy in patients undergoing anterior ankle arthroscopy. The next steps are to assess patients' perceptions of IONA as an alternative to traditional OR arthroscopy, and to carry out clinical trials to determine the efficacy, patient-reported outcome metrics, and complications of IONA.
Inter-Rater Reliability & Value of the Hawkins Sign
Authors: Lake Logan , Kurkowski Sarah , Roca Augusto , Kuechly Henry Albert , Huertas Andres Mor , Thimmesch Michael , Spencer Peter , McMillan Paul , Laughlin Richard T. 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Hawkins III talus neck fractures are associated with elevated rates of complications, notably avascular necrosis, which range between 40% to 70%. The Hawkins sign, characterized by subchondral lucency of the talar dome observed on post-injury ankle x-rays at 6-8 weeks post-injury, has traditionally served as a predictive factor for avascular necrosis development within a year. Nevertheless, we propose that the presence of the Hawkins sign exhibits considerable inter-observer variability and may not predict clinically relevant avascular necrosis development as reliably as previously assumed. Methods: A retrospective study was conducted on patients who experienced Hawkins III fractures between 2018 and 2022 at a Level 1 trauma center. Electronic medical records were thoroughly reviewed to ascertain the occurrence of avascular necrosis. An assessment of six-week postoperative ankle x-rays was conducted by a fellowship-trained foot and ankle orthopaedic surgeon to ascertain the presence or absence of the Hawkins sign. Subsequently, five orthopaedic surgeons independently assessed the x-rays to determine the presence of the Hawkins sign. Statistical analysis was then employed to assess the inter-rater reliability of the Hawkins sign and its association with the future development of avascular necrosis over a one-year follow-up period. Results: Seventeen patients with Hawkins III talus neck fractures were identified. Fleiss' kappa was run to determine if there was agreement between five orthopaedic trauma surgeons’ judgement on whether 17 individuals with Hawkins III talar neck fractures had a Hawkins sign present or not on 6-week postoperative x-rays. There was poor agreement between the surgeons’ judgements, κ = .040 (95% CI, -.035 to .115), but was not statistically significant, p = .294. There was complete agreement between surgeons on only 5/17 (29.4%) cases. Of the 6 patients that went on to develop avascular necrosis at 1 year, only 1 had a Hawkins sign (determined by fellowship-trained foot and ankle surgeon) present on their 6-week postoperative x-ray (Table 1). Conclusion: The reliability of the Hawkins sign among orthopaedic surgeons is notably low due to significant inter-observer variability. This variability introduces subjectivity to the interpretation of the Hawkins sign, rendering it an unreliable objective measure. Furthermore, its inability to correlate with the presence of avascular necrosis at the one-year mark raises doubts about its validity as a predictive marker for talar neck fracture outcomes.
Median Age of Patients Undergoing Total Ankle Replacement Has Not Significantly Changed Between 1999 and 2023: A Systematic Review of Prospective Studies
Authors: Bernasconi Alessio , Izzo Antonio , D'Agostino Martina , Sgadari Arianna , Mariconda Massimo , Goldberg Andrew J. J. 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is an effective treatment for end-stage osteoarthritis. The aim of this systematic review was to assess the age of patients undergoing TAR in prospective comparative studies. Our hypothesis is that the age reported in most recent papers might be lower than those reported in older papers. Methods: This systematic review was performed using Pubmed, Scopus, EMBASE and Cochrane databases. Only Level I and II studies dealing with TAR were included. Data regarding demographics, study design, year of publication and year/years in which surgery was performed were extracted. A two-fold analysis was conducted building groups of patients based on the year of publication and creating 1) two groups (before and after the median year) and 2) three groups (using tertiles) in order to compare age of patients operated in different period of times. A comparison was also performed considering the median year of surgery for patients undergoing TAR. Results: Overall 59 cohorts (42 studies, published between 1999 and 2023; median year of publication: 2017) were included (6364 ankles, 6284 patients, median age 63 years). The difference between the median age for 27 cohorts published until 2016 (weighted median 63 years; IQR, 62.5-64) and the median age for 33 cohorts published after 2017 (weighted median 63.2 years; IQR, 63-67.8) was not statistically significant (p=0.09). The division in tertiles did not reveal any significant change in the weighted median age at surgery (T1 (1999-2014; 63.2 years; IQR, 62.8-64.1), T2 (2015-2018; 63 years; IQR,63-63.5) and T3 (2019-2023; 63.2 years; IQR, 62.6-67.8)) over time (p=0.65). The median age of patients operated between 1999 and 2008 vs 2009 and 2023 (data from 48 cohorts) was not different either (p=0.12). Conclusion: According to this review of prospective studies published between 1999 and 2023, the median age for patients undergoing TAR over the last two decades has been 63 years, remaining steady with no significant changes over time.